To realize the development goal of "primary health care for all" requires the goal of medical and health undertakings to move towards universal health protection. At present, the medical security system only for some people not only violates the principle of fairness, but also costs a lot. Strengthening public investment in health care for low-income people in underdeveloped rural areas is not only fair, but also the most efficient. Therefore, it is necessary to increase the proportion and scale of rural public health expenditure.

According to the principle of public finance, the basic public health expenditure should be mainly borne by the finance at the same level and higher level, but the decision-making expenditure of the central government will make the social welfare level higher. Because the central government considers the impact of every decision on the whole country, not just the impact of a certain region, and internalizes all externalities, and it is difficult for local governments to pay for the construction of public health system due to the restrictions of tax power and fiscal revenue, so the central government can provide the best public health expenditure. In addition, for local governments, rural health investment should be included in the overall government budget to prevent local governments from arbitrarily changing and compressing rural health investment and ensure the normal funding of basic medical and health care.

(two) the establishment of rural medical and health special transfer payment system.

One of the reasons for the insufficient public investment in rural health care is the local financial difficulties, which is largely caused by the incomplete tax-sharing reform, especially the tax-sharing reform below the provincial level. Therefore, under the framework of tax-sharing system, it is necessary to clarify the powers, financial rights and financial resources of governments at all levels and realize their rational allocation, especially to push the financial system below the provincial level into the real tax-sharing track as soon as possible. However, in the design of local tax-sharing system, after the reasonable distribution of financial power, it is necessary to support a reasonable and powerful top-down transfer payment system to ensure that the financial resources of regions with different economic development conditions are generally consistent with their affairs. This is because in China, the grass-roots government is responsible for providing most public services directly to 70% of the residents. However, due to the financial difficulties of grass-roots governments, especially the huge financial gap in counties and townships in poverty-stricken areas, it is impossible to guarantee the provision of the most basic public services to local residents. In this case, it is unrealistic to build rural public health only by relying on the strength of county and township governments. Therefore, in order to realize the equalization of rural public health services, it is necessary to strengthen the central government's transfer payment to rural grass-roots governments, especially to establish a special transfer payment system for rural health care, control the total amount of general transfer payment by increasing special funds for rural health care, improve the efficiency of fund use, and prevent grass-roots governments from abusing and compressing the funds for medical care transfer payment. However, because the central special funds generally need local matching funds, it just provides convenience for developed areas, while for poor areas, the more special funds, the greater the local financial pressure. In this regard, according to the policy objectives and some special factors, the central government can give some areas asymmetric special funds. For example, for the construction of rural public health undertakings in ethnic minority areas, difficult areas and central and western regions, a certain proportion of funds can be allocated from the central government every year to support them through asymmetric special funds, so that rural residents there can enjoy universal and standardized medical and health services as soon as possible to meet the most basic survival needs.

(3) The transformation of public financial subsidies to rural medical and health care.

For a long time, the government's health investment in rural areas is mainly concentrated in service providers (medical and health institutions), and the demand side (farmers) of health services is rarely subsidized. This subsidy mechanism was established to adapt to the reality that there was a general shortage of doctors in rural areas in the traditional period. At present, the problem of lack of medical care and medicine in most rural areas has been solved. The main problems are lack of money to see a doctor, poverty caused by illness, and returning to poverty due to illness. The original government subsidy model has lost its meaning. Therefore, except in remote areas where few medical institutions are lacking, the government will increase financial support for medical service institutions, and medical institutions in other areas will try their best to be regulated by the market, so as to improve service quality and reduce the prices of www.bfblw.com and paper nets through market competition. Instead, the government subsidizes the service demand side, supports the construction of the medical and health security system, and enhances farmers' ability to purchase medical care and resist disease risks.

(D) improve the rural health service public * * * financial input mode, improve the output efficiency.

Public health is a typical public product, and the government is responsible for rural public health, but it is not necessary for the government to directly organize production and operation. For a long time, China has been directly producing and organizing rural public health services in the form of rural health institutions arranged by the government. Practice has proved that this way of providing rural public health directly by the government has become increasingly unsuitable for the development requirements of market economy reform, and its disadvantages are increasingly apparent. Mainly manifested in the lack of regulatory agencies, leading to the loss of state-owned assets; The autonomy of operators can not be truly implemented; Overworked personnel; Inefficiency caused by lack of competition consciousness, etc.