Reforming China's Rural Health System

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'Reforming China’s Rural Health System' examines the performance and workings of China’s rural health system leading up to the reforms of the 2000s, outlines the reforms, and presents some early evidence on their impacts. The authors outline ideas for building on these reforms to further strengthen China’s rural health system, covering health financing and health insurance, service delivery, and public health. The authors conclude by using the experiences of the Organisation for Economic Co-operation and Development countries to gaze into China’s future, asking not only what China’s health system might look like, but also how China might get there from where it is today.

'Reforming China’s Rural Health System' will be of interest to health care policy makers, public health officials, university researchers, and others working to improve rural health and health service delivery in China and in other countries especially those in East and South Asia.

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Product Details

  • ISBN-13: 9780821379820
  • Publisher: World Bank Publications
  • Publication date: 6/16/2009
  • Series: Directions in Development
  • Pages: 272
  • Sales rank: 546,072
  • Product dimensions: 6.00 (w) x 8.90 (h) x 0.60 (d)

Table of Contents

Foreword xi

Acknowledgments xv

Abbreviations xix

Chapter 1 Introduction 1

China's Shift from Economic Growth to "Balanced Development" 1

The World Bank's Analytic and Advisory Activities on China's Rural Health Sector 5

Overview of the Book 7

Chapter 2 China's Health Challenges at the Start of the New Millennium 13

Trends in Health Outcomes 14

Trends in Health Inequalities 18

Out-of-Pocket Costs-A Barrier to Care and a Cause of Poverty 19

Accounting for the Household Burden 22

Provider Incentives, Costs, and the Quality of Care 25

Health Insurance Contraction 28

Inequality in Government Spending 29

Challenges and Reforms-Creating a Path Forward 30

Chapter 3 The Rural Health Reforms of the 2000s 33

The New Rural Cooperative Medical Scheme 34

Medical Assistance 38

Public Health 42

Provider Payment Reform 49

Other Reforms in Service Delivery 52

Sizing Up the Recent Reforms 56

Annex: Impact Evaluation of NRCMS 57

Chapter 4 Looking Toward a New Decade: The Big Picture 61

Health Systems-Goals, Functions, and Actors 62

Evolving Ideas and International Best Practice 64

Reform over the Medium Term 72

Reform over the Longer Term 78

Chapter 5 Financing Rural Insurance Coverage 81

More Resources for NRCMS 82

Converting NRCMS into a "Purchaser" 96

What Should Be Covered? 98

Strengthening Management and Governance 107

Priorities and Sequencing 111

Chapter 6 Improving Service Delivery: A Question of Incentives 115

Changing Provider Incentives 116

Enabling Providers to Respond to New Incentives 133

Reform Priorities, Sequencing, and Capacity 143

Chapter 7 Enhancing Accountability and Incentives in Public Health147

The Misalignment of Incentives and Accountability 151

Geographic Disparities in Spending 153

Roles and Responsibilities across Levels of Government 160

Clarifying Responsibilities and Financial Incentives at the County Level 171

Priorities, Sequencing, Political Economy, and Skills 182

Annex: Case Study of Public Health Financing and Organization in Two Counties 185

Chapter 8 The Longer-Term Reform Agenda 187

Limitations of the Emerging Health Insurance Model 187

A Dual Agenda for Financing Long-Term Reform 192

Getting from Here to There 198

Chapter 9 Conclusions 201

Notes 205

References 219

Index 239


3.1 NRCMS circa 2005 36

3.2 Medical Assistance circa 2005 39

3.3 Challenges in Estimating Public Health Spending and Comparing across Countries 46

3.4 Provider Payment Reforms in Urban China 50

3.5 Prospective Payments and Purchasing in NRCMS 52

3.6 Impacts of Treatment Protocols, Drug Lists, and Other Innovations in the Health VIII Project in Gansu Province 55

5.1 Trends in Financing Health in Rural China 83

5.2 The Benefit Package in Mexico's Popular Health Insurance Program 103

5.3 Medical Savings Accounts in China and Singapore 105

5.4 Merging of NRCMS and BMI 108

5.5 Health Insurance Governance in Estonia and Costa Rica 109

6.1 Price Regulation in China 116

6.2 International Experience with Provider Payment Reforms 120

6.3 The Importance of Inpatient Care for NRCMS 123

6.4 Setting Health Sector Prices in Japan 129

6.5 Approaches to Extra Billing 130

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