The establishment of a new rural cooperative medical system and its sustainable development mechanism is of great significance to the construction of a new socialist countryside and the coordinated development of urban and rural society in China.

1 chapter mainly analyzes the basic theoretical problems of the new rural cooperative medical system. Firstly, the characteristics, economic impact and management methods of rural disease risk are analyzed from the perspective of disease risk, and then the nature, characteristics and basic operating principles of the new rural cooperative medical system are emphatically discussed. Finally, the theoretical perspective of studying the new rural cooperative medical system is discussed. The author believes that for the majority of farmers, to effectively deal with disease risks, we must not only solve the supply and convenience of rural health services, but also solve the ability to pay medical expenses; As a means of medical expenses compensation, the new rural cooperative medical system essentially belongs to a major form of social medical insurance. It has both connections and differences with the traditional cooperative medical system and the basic medical insurance for urban workers. The new rural cooperative medical system should follow the basic principles of voluntary participation, self-risk, fixed expenditure based on income, fairness and efficiency. In-depth study of the new rural cooperative medical system should have a multidisciplinary theoretical vision, such as insurance and risk management, social security and welfare economics, sociology and health economics.

The second chapter mainly analyzes the social and historical background of the development of the new rural cooperative medical system, aiming at exploring the institutional roots of the development of the new rural cooperative medical system. Firstly, the formation process of the unequal urban-rural dual social security system in China is investigated, and the root of the division of the security system is analyzed. Then, it discusses the influence of industrialization and urbanization on the traditional rural family security and land security after the reform and opening up. The author thinks that the social policy arrangement that discriminates against farmers' employment system and household registration system solidified the dual social security system in China. Industrialization and urbanization have rapidly weakened the role of traditional family security and land security system in rural areas, and rural areas in China urgently need formal institutional arrangements for rural medical security. The new rural cooperative medical system evolved from the traditional cooperative medical system. Traditional cooperative medical care has gone through five stages in the history of our country. The author analyzes the institutional roots of the tortuous development of traditional cooperative medical care, and holds that the main reasons for the failure of cooperative medical care reconstruction are the loss of economic and organizational support, the conflict of central government policies and the defects of management technology.

The third chapter mainly analyzes the operation effect and existing problems of the new rural cooperative medical system pilot through the field investigation in Dujiangyan, Sichuan and Dali, Yunnan, using a large number of actual data. The author believes that the new rural cooperative medical system has achieved initial results in reducing the medical burden of farmers, enhancing farmers' health awareness and promoting the development of rural primary health care, but there are also unstable factors that affect the development of the system, such as high financing cost, low degree of protection, unscientific determination of compensation standards, and excessive growth of medical expenses. Then, the author makes a further comparative study on the two popular operation modes (whether to establish family account) in the pilot project, and holds that the establishment of family account mode has advantages in the financing, fund management and spontaneous control of medical needs of the new rural cooperative medical system, while the complete overall planning mode has advantages in resisting the risk of serious diseases, stimulating farmers to seek medical treatment in time for minor illnesses and expanding the scope of benefits. At the end of this chapter, aiming at the short-term problems existing in the new rural cooperative medical system, this paper discusses the defects in its system design and their roots from the theoretical point of view, and holds that the new rural cooperative medical system is obviously dependent on the traditional path, urban path and commercial insurance path, and the realistic rural social structure and traditional cultural environment make this system unable to adapt to and achieve sustainable development in most parts of China.

The fourth chapter makes a comparative study of the main rural medical security modes at home and abroad, aiming at providing reference for the mode selection of the new rural cooperative medical system reform in the next chapter. Firstly, this chapter summarizes the main pilot models of rural medical security formed in China for many years, and divides them into five categories: improved cooperative medical care, cooperative medical insurance for serious illness hospitalization, combination of individual account and township (or county) overall planning, combination of family account and social overall planning, and commercial insurance companies participating in rural medical insurance in various forms, and analyzes the characteristics and applicability of these five models; Then it makes a comparative study on the development characteristics and lessons of four rural medical security modes abroad, including free medical security, social medical insurance, community cooperative medical care and market-led commercial medical insurance, and holds that the enlightenment we can get from them is: emphasizing government responsibility, choosing appropriate medical security methods according to different regions, adhering to the medical system dominated by public hospitals, and reducing the cost of medical security.

The fifth chapter mainly studies the reform direction of the sustainable development of the new rural cooperative medical system, that is, establishing a regional multi-level rural medical security system under the leadership of the government. This chapter is the focus of the whole book, which holds that to realize the sustainable development of the new rural cooperative medical system, we must rebuild the regional multi-level rural medical security system under the leadership of our government. The author thinks that the high natural cost of rural medical insurance, the nature of public goods and excellent products, the existence of external effects, and the government's ability to bear comprehensive and universal risks are stronger than the market and the government's redistribution function beyond market efficiency, which are the theoretical basis for the government to lead the development of rural medical insurance. Regional multi-level rural medical security system refers to: the first level of basic medical security, by arranging a formal security system for each region, to ensure that farmers can enjoy basic medical rights and interests. Due to regional differences, developed areas, moderately developed areas and poor areas should choose different ways to establish rural basic medical security system. The second level is supplementary medical security, which provides basic security for farmers to see a doctor through the advocacy and role of informal systems such as family assistance, community mutual assistance and commercial medical insurance. The third level is to establish a rural medical assistance system as the last line of defense for farmers' serious illness medical treatment. This chapter discusses the content and system design of each security level in detail in three parts.

The sixth chapter mainly studies the principles of determining the level of new rural cooperative medical insurance and the ways to improve the financing system.

Financing and compensation are the "entrance" and "exit" of medical insurance fund. If the import and export management is not good, it will directly shake the foundation of the development of the new rural cooperative medical system. This chapter first analyzes the meaning of the new rural cooperative medical insurance system and the influence of the improper determination of the security level, and then constructs the actuarial model of the new rural cooperative medical insurance system in China. Taking Midu and Binchuan County as examples, it analyzes and demonstrates the application procedure of the actuarial model and the calculation method of the compensation ratio of medical expenses under the principle of "fixed income and fixed expenditure". Then the principle of determining the compensation ratio of medical expenses is discussed theoretically, and it is considered that the current policy direction of the new rural cooperative medical system, which focuses on ensuring serious illness, needs to be reflected. The determination of the compensation target of "big insurance and small insurance" will affect the compensation level through different fund division mechanisms. Finally, this chapter studies the financing system of the new rural cooperative medical system, mainly analyzes the rationality and sustainability of the current financing system, and holds that the central government should assume more responsibilities in the financing of the cooperative medical system, the provincial finance should clearly assume the main responsibilities in the local financing, the areas with conditions should take the community as a separate financing subject, and the financing level of the cooperative medical system should be coordinated with the social and economic development level and the medical and health needs of farmers and gradually improved.

The seventh chapter mainly studies the moral hazard, adverse selection and its avoidance in the new rural cooperative medical system. Due to the principle of voluntary participation in the new rural cooperative medical system and the particularity of medical insurance participants' behavior, moral hazard and adverse selection in the new rural cooperative medical system are quite serious. By studying the manifestations and formation mechanism of adverse selection and moral hazard in the new rural cooperative medical system, the author thinks that the market information asymmetry and opportunism tendency are the fundamental reasons, and their influence may lead to price distortion, market shrinkage and efficiency loss of the new rural cooperative medical system. Adverse selection and moral hazard avoidance in the new rural cooperative medical system should start from two aspects: health demand side control and supply side control, of which supply side control is the main one. Demand-side control mainly enhances patients' cost consciousness through the adjustment of economic interests, and the key to supply-side control lies in the reform of rural health management system.

The eighth chapter mainly discusses the government responsibility orientation and policy suggestions for the sustainable development of the new rural cooperative medical system. As the foothold of the book, this chapter holds that the government should play the role of public welfare person, supervisor, supervisor and night watchman in the development of the new rural cooperative medical system. Specific policy suggestions to promote development include: strengthening rural medical security legislation, clarifying the responsibilities of all parties, and ensuring the stability of system development; To provide rural medical security system and act as the organizer and supervisor of the system; Establish a multi-party financing system based on financial assistance, and explore a stable growth mechanism for raising funds and an innovative mechanism for individual contributions; At the same time, it is necessary to create an external environment suitable for the construction of rural medical security system. In view of the fact that the current rural health market is out of control to a certain extent, and the problems in the pilot project of new rural cooperative medical care, it is necessary to reform the rural health management system: establish a rural medical system with non-profit public hospitals as the main body, rationally allocate and distribute rural health resources, strengthen the supervision of health service behavior, and form an all-round control mechanism for the growth of medical expenses.

The main innovations of this book are as follows: First, based on sustainable development and a large number of field surveys, the development background, institutional roots, organizational model, management technology and reform and development direction of China's new rural cooperative medical system have been comprehensively and systematically studied, and innovations have been made in topic selection, conception and research methods. The establishment of a new rural cooperative medical system is an important "three rural" policy promoted by the central government in recent years. However, establishing and popularizing this system in rural areas involves many problems and great difficulties, not only because the rural problems in China are extremely complicated, but also because the development of medical insurance is very professional and technical, involving many stakeholders and requiring the coordination of multiple interests. Drawing lessons from sociological research methods, this book has conducted more than two months of on-the-spot investigation in rural areas of Sichuan, Yunnan and Fujian, and made a comprehensive and in-depth analysis of the initial results, existing problems, their roots and operation modes of various experiments by using a large number of first-hand materials. It is believed that the lack of sustainability is the key to the pilot problem of the new rural cooperative medical system, and then the reform direction, perfect ways and systematic policy suggestions to promote the sustainable development of the new rural cooperative medical system in China are put forward.

Secondly, it puts forward the idea of establishing a regional multi-level rural medical security system under the leadership of the government, and deeply demonstrates the theoretical basis of government-led and the content and system design of various levels of security, which has a certain promotion effect on the construction of new socialist countryside and the coordinated development of urban and rural areas in China. According to the characteristics of regional differences in rural development in China, this book puts forward the framework of three-level rural medical security system: rural basic medical security, supplementary medical security and last aid, and holds that developed areas, moderately developed areas and poor areas should choose different basic medical security system arrangements according to the actual situation. This book also fully discusses the development model of supplementary medical security and medical assistance, which has certain reference value for the decision-making of relevant government departments in China.

Thirdly, under the management principle of "support by income", the actuarial model of the security level and compensation ratio of the new rural cooperative medical system in China is studied and constructed, and the application method of actuarial principle and the determination process of compensation ratio are systematically discussed. Under the background that the determination of the new rural cooperative medical insurance level is generally unscientific, this concise and practical actuarial model can provide scientific basis and effective quantitative methods for the formulation of compensation schemes for new rural cooperative medical insurance in various places in practical work.

Fourthly, creatively investigated the performance, influence and formation mechanism of moral hazard and adverse selection in the new rural cooperative medical system. There are many analyses on adverse selection and moral hazard in commercial insurance, and there are also many studies on the control of medical expenses in urban social medical insurance, but few people pay attention to moral hazard and adverse selection in the new rural cooperative medical system. Based on the risk utility theory, this book comprehensively and deeply analyzes the formation mechanism and influence of moral hazard and adverse selection in the new rural cooperative medical system, and puts forward risk control methods according to the actual situation of farmers and rural areas, which has an important role in promoting the risk management of the new rural cooperative medical system and the improvement of the pilot scheme in China.