2.1Traditional Culture: Formation of Value Medical Concept
Under the influence of traditional culture, the traditional notion of "taboo disease but not cure it" has deep-rooted influence. Due to the existence of medical risks, there were “medicine donation” activities in ancient China, such as “Kangzi feeding medicine”. During the period of the Republic of China, the ideological thread and medical practice of the medical elite have a far-reaching influence on the formation of current medical concepts. With the replacement and reform of medical concept and medical culture, as well as the introduction of Western medicine, there are complex contradictions between the traditional patients who have "acquired the illness for a long time" and "modern patients." Due to the lack of medical common sense, patients are often treated improperly. With the development of medical science, individuals or families have gradually formed the concept that "all diseases have medicine, and no ghosts don’t die", placing more responsibility on doctors or the hospital. At the same time, after the entry of western medicine, two sets of medical systems coexisted with the local medical concepts, but the two were completely different in terms of goals, values, knowledge and technology.The process of "looking, hearing, asking and cutting" in traditional medicine is a process of understanding and communicating with patients, listening to them and comforting them. In contrast, modern medicine focuses on the pursuit of the value of scientific medicine itself, separating and analyzing individuals. The changes of modern medical culture still has far-reaching impact on Chinese people's value medical concept.
2.1.1. The Emergence of Medical Values in Traditional Culture
Before and after the emergence of scientific medicine and becoming mainstream medicine in modern society, folk prescriptions were not uncommon among ordinary people, especially the lower class with low socioeconomic status and difficult access to formal medical services. In the traditional Chinese family structure, the five basic situations of "home", "raising", "illness", "mourning", and "sacrifice" cover the main content of each stage of parent-child relationship. Among them, "illness" has an important status. "Twenty-four filial piety" describes the behaviour of patients, families and doctors, and discusses behaviors related to diseases. In the pre-industrial society, due to the lack of good education and the lack of access to modern orthodox medical knowledge, Chinese people were more affected by non-professional knowledge in their disease-related behaviors.Secondly, the authority of doctors has been challenged by various factors such as medical standards, religious beliefs, popular medical concepts, and folk therapies".The types of medical diagnosis and treatment that people choose are closely related to their economic living standards and modern medical and health systems, and is also affected by their own understanding of the causes of the diseases . For example, there still exist local gods and religious beliefs in traditional Chinese society or in some folk areas. For example, under the concept of folk medicine of Baima Tibetan folklore in China, there is a medical practice of "two solutions of magic medicine", that is, taking medicine after getting sick, and believing in God. The gods play two roles, which can cause and cure diseases .Under the influence of supernatural forces, that is the cause of the disease and the method to eliminate the disease. Whenever a mass catastrophe endangers the entire society, it is resolved by the means of "Nana Sadu Pearl". In the practice of folk medicine , due to the mutual relationship among economy, religious beliefs, and inter-ethnic interactions, herbal therapies such as "blood gas", "activity", "eucommiaulmoides", propolis and gastrodia also play an important cultural role.
2.1.2. The Formation of a Value Medical Concept Based on the Development of "Health" and "Disease"
Reasonable definition of "health" and "disease" is an important basis for establishing the scientific values of medicine. The World Health Organization (1978) defines health as health including physical, mental, and social health. From the perspective of dialectical medicine, health is the acquisition and control of the basic material and non-material resources to maintain and promote life with high satisfaction. Among them, unequal social status, class, and social diseases are the important factors that hinder health. Diseases correspond to health, in general, and people still suffer from disease even in the best environmental conditions . As a medical disease, it mainly refers to the direct result of pathogens or physiological disorders. But just like the definition of health, ignoring the social background of environment, occupation, and residence will weaken the social connection of healthy .The social nature of the disease is that it is affected by social factors such as malnutrition, lack of economic security, housing security, and political rights, and it is highly susceptible to disease [15,16]. For example, existing studies have found that productive activities, differences in organizational forms of resources and production, implementation methods, and resource allocation have led to different disease phenomena in different societies. Therefore, diseases have both biological and social characteristics. Based on the reasonable definition of health and disease, a healthy lifestyle can also be defined as a comprehensive standard of life including health care, medical care and health undertakings. The medical concept formed on this basis is a scientific medical value.
2.2 Policy Protection: the Development and Change of Value Medical Concept
Not only is the concept of value medical care affected by traditional culture, but also the policy protection will play an important role with the development of society and economy. Studies have found that medical needs which are based on self-assessed health, chronic disease , and restricted mobility are the core indicators affecting individual medical behavior. The health insurance coverage and the soundness of public infrastructure services can help improve individual medical treatment. Characteristic variables such as gender, age, waiting time, distance to medical treatment, and disease severity are also significant influencing factors[22,23,24,25] ,but the supplier-induced demand factor has a significant impact on the choice of medical treatment for patients who haven’t received treatment for the first time[26,27].
2.2.1 Research on the Development of Medical Behavior under the Policy Protection Income
The transmission path of policy protection to the value medical concept is dominated by the economic income guarantee. The family income level has two effects. The first one is the direct effect, that is, the income level increases the health demand, and then increases the level of medical expenditure. For example, if the level of income has a direct impact on the behavior of the doctors, "self-treatment" and "treating diseases as secondary" account for a large proportion among the non-patients. The second is the indirect effect, also known as the health effect. Because of the poor health condition of low-income people, they are more likely to get sick. Therefore, a larger amount of medical expenditure is needed to avoid health risks. From the perspective of social psychology, the widening income gap will increase the frustration and pressure of low-income people, and cause depression, or some bad behaviors such as smoking and alcohol abuse, which will worsen the individual's health and bring in higher medical cost to avoid health risks. Research by Wagstaff (2008) shows that the policy protection of medical insurance encourages more people to choose higher medical institutions for medical treatment. As the most important external constraint that affects the individual's use of medical and health resources, the role of medical insurance is still controversial. Among them, there are two views on the impact of medical insurance on individual medical decision-making[31,32,33,34]. The core of the expansion is that the reduction of the relative price of medical services has improved the accessibility of medical services. From the perspective of the process, based on the research of the New Rural Cooperative Medical Service in rural China, the new rural cooperative medical service is facing the shrinking of “death”. The core of shrinking is that the medical expenses actually borne by families are rising because of the increasing consumption of medical resources [35,36,37].
2.2.2 Research on the Change of Medical Decision under the Change of Income Gap
The ability to pay is the direct carrier of economic income to individual medical treatment decisions. However, some studies have found that group differences of the ability to pay also affect the medical concept of different groups, that is, the income gap has a greater impact. Studies based on micro data have found that there is a strong negative correlation between income gap and health in the United States, which has led to differences in medical perceptions among different groups[38,39]. Other studies have shown that there is no relationship between the two. The income gap will affect public investment and expenditure in health care. The deep manifestation is the differentiation of the interests between the poor and the rich. The rich relatively prefer non-local medical services making the supply of local public medical services underestimated and reducing fiscal expenditures [41,42]. This trend will also reduce the effectiveness of the implementation of medical policies,and these policies will be passed health status on to individuals through community basic medical facilities [39,43,44]. However, some studies have shown that constraints such as lower income, lack of medical insurance, and a poor living environment are the core of the gap in wealth between rich and poor, rather than preferences [35,45]. The income gap can improve the level of people’s health and promote the value of higher medical consumption. For example, the wealthiest group promotes the technology and equipment upgrading of medical institutions in accordance with their own medical needs. Through spillover effects, the overall level of social medical consumption has been improved and people’s health has also been improved.Secondly, the income gap drives the growth of fiscal revenue, and the fiscal revenue is converted into fiscal investment in public health and basic medical care, which improves the overall health level of the society and promotes the formation of a more scientific value of medical concept[46,47],as well as comprehensively improves the health level of social development[48,49].
2.3 Summary of Existing Research
On the basis of the existing research, in response to the main defects of the existing research, this article attempts to make breakthroughs and innovations in the following aspects : 1) From the perspective of research, this paper try to explore the formation and change of Chinese people's value medical concept from the perspective of the combination of cultural tradition and policy protection. 2) In terms of research methods, through the combination of qualitative and quantitative research, this paper not only analyzes the core concepts of value medical concepts, such as disease and health positioning, but also empirically tests the formation and change of the influence path of traditional culture and policy protection on Chinese people’s concepts of value medicine over the decades. 3) In terms of research content, this paper focuses on the occurrence of diseases and the laws of life processes, and highlights the analysis of the formation and changes of the value medical concept, in order to enrich the research content of the value medical concept. 4) On the conclusion of the study, the reform and optimization of the payment system of medical expenses are put forward by carding and empirical testing of the development and changes of medical value concept in China.