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The on-going transition to a market economy in China is having a profound effect on health services. As a result, the government has made health one of the key policy areas, and there is now a general recognition of the need to reform urban health services. Multidisciplinary in scope, this exceptional volume draws on a prestigious report to explore how changes in health finance have affected the performance of urban health services in terms of equity and efficiency. Based on empirical evidence from the cities of Nantong, Jiangsu Province and Zibo, Shandong Province (selected for their innovative approach to health system development), the book offers an in-depth understanding of the relationship between transition, health reform and health system performance in urban settings. It features collaboration between European and Chinese academics and Chinese practitioners and officials, providing valuable background and contextual information on a complex system of healthcare, and presenting an analysis of policy impact and likely future direction.
The on-going transition to a market economy in China is having a profound effect on health services. Based on empirical evidence, this exceptional multidisciplinary volume offers an in-depth understanding of the relationship between transition, health re
This book provides an overview of the ongoing transition in China’s health system, especially focusing on the new healthcare reform initiated in 2009. First, it reviews the changes in China’s healthcare system from the 1950s to 2008, establishing the situation when the reform was introduced. The book subsequently analyzes the social and economic context in which the health system is embedded. Since the primary focus is on the new healthcare reform, the book introduces the blueprint and the year-for-year development of the new healthcare reform, as well as the specific reforms in health financing, public hospitals, and primary care. Given its central importance in the health system, the book also described major trends in long-term care in the past several years. In addition, it examines the health policy-making process with a case study of the New Cooperative Medical Scheme of China. Lastly, the book assesses the performance of China’s health system and predicts future developmental trends.
With its transition to a market-oriented economy, China has gone through significant changes in health care delivery and financing systems in the last three decades. Since 1998, a new public health insurance program for urban employees, called Basic Medical Insurance Program (BMI), has been established. One theme of this reform was to control medical service over-consumption with new cost containment methods. This dissertation attempts to evaluate the effects of the reformed public health insurance on health care utilization, with in-depth studies. In the analytical investigation, I formulate a health care demand model based on the structure of health care delivery and health insurance systems in China. It is assumed in the model that physicians have pure monopoly power in determining patients' health care utilization. The major inference is that the insurance co-payment mechanism can not reduce medical service over-utilization effectively without any efforts to control physicians' behavior. Meanwhile, I use the calibrated simulation to demonstrate my hypothesis in the theoretical model. The main implication is that physicians' incentive to over utilize medical services for their own benefits is significant and severe in China. In the empirical studies, I explore the extent to which the public health insurance status affects individual's medical service utilization and medical expenditure over the period when the new urban public health insurance has been in effect. This study uses the 1997 and 2004 waves of China Health and Nutrition Surveys (CHNS) data with relevant econometric models such as the two-part model and difference-in-difference model. The empirical results provide evidences that (1) public health insurance in China has increasing effect on individual's medical service utilization and medical expenditure, i.e., there exists patients' ex post moral hazard; (2) China's public health insurance reform reduced the increasing effect of public insurance on the probability of utilizing medical services, i.e., reduced patients' ex post moral hazard; (3) China's public health insurance reform enlarged the increasing effect of public insurance on medical service expenditure, implying there exists physicians' severe incentive to over utilize medical services for their own benefits in China, which is consistent with the conclusions in my theoretical analysis.
This book investigates public medical insurance reform in China and studies its effects from both institutional and empirical study perspectives. It provides the reader with academic evidence for understanding the transformation of public medical insurance and its effect on the utilization of healthcare services, expenditure for medical care, individuals’ financial portfolio allocation, and well-being. The main content of the book comprises two parts. First, institutional transformations of public medical insurance are considered: medical insurance reform in rural and urban China, and problems of medical insurance reform in the country. Second, it looks at the impact of public medical insurance reforms in China: evidence-based on empirical studies, including determinants of participation in medical insurance, the New Rural Cooperative Medical Scheme and its effects on the utilization of healthcare services, medical insurance and its effects on out-of-pocket expenditure, risky financial market participation, and well-being in China. This study provides academic evidence about these issues based on economic theories and econometric methods using many kinds of nationwide Chinese representative survey data. The book is highly recommended to readers who are interested in up-to-date and in-depth empirical studies on the mechanisms of participation in medical insurance and the impact of public medical insurance reforms on individuals and household behaviors in China. This volume will be of interest to those who are interested in the Chinese economy, social security policymakers, and scholars with an econometric analysis background.
At a meeting in July 2014 in Beijing, we committed to working together on a flagship report that would help set the direction for health sector reform in China. This report, Deepening Health Reform in China, is the result. Using the successful model offered by previous flagship reports like China 2030 and Urban China, this report primarily offers a blueprint for a new direction for China's health sector. The report's main theme is the need for China to transition its healthcare delivery system toward people-centered, quality, integrated care built on the foundation of a strong primary healthcare system.
This book explores the changing landscapes of the commercialisation of medical care in China. It is the first work of its kind, and discusses how the rise of market socialism, coupled with decollectivisation of agriculture and autonomisation of hospitals in rural and urban China, have fragmented the health service system. The book examines public hospital reforms; the rise of the medical–industrial complex; the emerging public–private partnerships in the health sector; the challenges of financing; and the growing inequalities in access to health services, to present a comprehensive view of the Chinese health care system over the last four decades. This topical book will be useful to scholars and researchers of Chinese studies, Chinese economy, public health, health management, social health and medicine, medical sociology, sociology, political economy, public policy and public administration as well as policymakers and practitioners.
This thesis is a study of health policy, as well as a study on social inequality. It studies who gets what in China's market transition, and how the state policy legitimised and institutionalised certain social inequalities. The thesis' findings parallel what the literature suggests for other transitional societies. Analysis of the new health care policy clearly shows the discontinuity in the state's commitment to equity, which is a common phenomenon in transitional Asia as well as in Eastern Europe. Through analyzing a specific state redistributive policy and its implementation in one Chinese city, this thesis explores the state's important role in shaping social stratification and inequality. This study examines the state policy's direct impact on inequality with respect to health care access in China. It is one of the first analyses of the social impact of the most recent health care financing system reform in urban China.