Confucian Trust, Market and Health Care Reform

Abstract

Health care systems in the world are beset by a common problem. The problem to frame a moral basis for health care policy that provides all citizens with basic coverage, encourages innovation, contains costs, and supports commitment to trust and responsibility which can guarantee the reliable function of the market and the ethical behaviour of health care professionals. This paper begins with the background recognition that, first, while medical advances offer the prospect of lowering morbidity and morality risks through the development of ever more effective health care interventions, they at the same time generate more costs, particularly in societies with an increasing proportion of the population advancing beyond retirement age. Second, there are evidences that an egalitarian health care system which provides all citizens with all health care services can create moral hazards by removing incentives for the prudent choice and use of health care resources. Third, market forces can contribute to the efficient distribution of medical goods and services, and to spur medical innovation in a medical market, if an appropriate balance is achieved between the roles of the government, private investment, and the market. Fourth, the paper points out that creating a market in China would need to proceed with extreme care and caution since in our study, there are also serious problems with the move towards the marketization of health care which threatening to erode trust and to undermine care in the Chinese health system. While liberalizing the health market can be useful for creating dynamism and diversity in the system, strengthening public health care to protect equity and accessibility in the face of huge economic inequality in China under transition to the market economy will be essential. The intention of this paper is to examine the possible contribution of Confucian cultural and moral resources to guide the development of a responsible market context for the private provision of health care which can sustain commitments of trust and reliability. It begins by examining the concept of trust and identifies three levels of trust: first-order trust, second-order trust, and third-order trust, which are pertinent as the basis of freedom, autonomy and responsibility in modern