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This book empirically examines health care financing reforms and popular responses in three major cities in East Asia: Shanghai, Singapore, and Hong Kong. It adopts a new revised version of the theory of historical institutionalism to compare and explain the divergent reform paths in these three places over the past three decades. It also examines forces that propel institutional change. The book provides three detailed case studies on the development of health care financing reforms and the politics of implementing them. It shows that health care systems in Shanghai, Singapore, and Hong Kong were the products of Western presence in the nineteenth century. It illustrates how greater attention is paid to the roles played by ideas, actors, and environmental triggers without abandoning the core assumptions that political institutions and policy feedback remain central to impact health care financing reforms. It shows that health care financing reform is shaped by a complex interplay of forces over time. It also provides the most updated material about health care financing reforms in Shanghai, Singapore, and Hong Kong. The central argument of this book is that health care financing reform is both an evolving process responding to changing circumstances and a political process revealing an intricate interplay of power relationships and diverse interests. It shows that institutional changes in health care financing system can be incremental but transformative in nature. It argues that social policies will continue to develop and welfare states will continue to adapt and evolve in order to cope with new risks and needs. This book sheds new lights on understanding the politics of health care financing reform and sources and modes of institutional change.
The authors find that economic growth does not automatically improve health care, and that prioritizing health care as China has done does not necessarily lead to cost efficiency and equity in health care for the whole nation.
This volume provides a comprehensive review of China's healthcare system and policy reforms in the context of the global economy. Following a value-chain framework, the 16 chapters cover the payers, the providers, and the producers (manufacturers) in China's system. It also provides a detailed analysis of the historical development of China's healthcare system, the current state of its broad reforms, and the uneasy balance between China's market-driven approach and governmental regulation. Most importantly, it devotes considerable attention to the major problems confronting China, including chronic illness, public health, and long-term care and economic security for the elderly. Burns and Liu have assembled the latest research from leading health economists and political scientists, as well as senior public health officials and corporate executives, making this book an essential read for industry professionals, policymakers, researchers, and students studying comparative health systems across the world.
How efficient is the Chinese healthcare system? Milcent examines the medication market in China against the global picture of healthcare organization, and how public healthcare insurance plans have been implemented in recent years, as well as reforms to tackle hospital inefficiency. Healthcare reforms, demographic changes and an increase in wealth inequity have altered healthcare preferences, which need to be addressed. Significantly, the patient–medical staff relationship is analysed, with new proposals for different lines of communication. Milcent puts forward digital healthcare in China as a tool to solve inefficiency and rising tensions, and generate profit. Where China is leading in the digitalization of healthcare, other countries can learn important lessons. Chinese social models are also put into context with respect to current reforms and experimentation.
Most of the existing literature on health system reform in China deals with only one part of the reform process (for example, financing reform in rural areas, or the new system of purchasing pharmaceuticals), or consists of empirical case studies from particular cities or regions. This book gives a broad overview of the process of health system reform in China. It draws extensively both on the Western literature in health economics and on the experience of health care reform in a number of other countries, including the US, UK, Holland, and Japan, and compares China's approach to health care reform with other countries. It also places the process of health system reform in the context of re-orienting China's economic policy to place greater emphasis on equity and income distribution, and analyzes the interaction of the central and local governments in designing and implementing the reforms. This book will be of interest to policymakers, academics, students of health economics, health policy and health administration, and people who are interested in Chinese social policy.
This dissertation, "Reform of Health Care System in Urban China: a Case Study in Shanghai" by Mengyu, Xie, 謝孟渝, was obtained from The University of Hong Kong (Pokfulam, Hong Kong) and is being sold pursuant to Creative Commons: Attribution 3.0 Hong Kong License. The content of this dissertation has not been altered in any way. We have altered the formatting in order to facilitate the ease of printing and reading of the dissertation. All rights not granted by the above license are retained by the author. Abstract: Abstract Abstract of thesis entitled Reform of Health Care System in Urban China: A Case Study in Shanghai Submitted by Xie Mengyu for the degree of Master of Philosophy at the University of Hong Kong in February, 2005 Since early 1980s, the Chinese health care system has encountered great challenges. The challenges come with the economic reform and the health care expenditure keeps rising. Because of the demographic changes, the increase of the elderly population in particular, the demand of health care has greatly increased as well. In addition, the decentralization and privatization of the health care system have led to inequity of the accessibility to health care among different groups of people and different regions, and also to the competition among different health care providers. This study aims to explore the current problems in Chinese health care system through ia case study in Shanghai. The case study constitutes of document analysis, review of research literature, and in-depth interviews with medical insurance bureau officials and medical practitioners. It aims at scrutinizing how the health care policy in China is designed and implemented, and how the government departments liaison with concerned organizations in the implementation process. After identifying the strengths and weaknesses of current Chinese health care system, this study also reviews the health care reforms in Australia and Canada. For similar problems had been encountered and resolved in Australia and Canada before and, as two developed countries, their experiences can suggest some lessons that China can learn from . The research findings indicate that the current Chinese health care system has three major problems. Firstly, the government has excessively decentralized the responsibility of health care but invested too little in the system. Secondly, the public sectors have taken up the lion's share of health care provision in urban area and there is little competition in the Chinese health care market. Thirdly, there exists a great gap between the rich and poor in terms of the accessibility to health care. Finally, based on the analysis of different health care systems investigated above, this study concludes by making recommendations for the future reform of Chinese health care system. Implications for research, policy and practice are also presented. (327 words) ii DOI: 10.5353/th_b3136525 Subjects: Medical care - China - Shanghai
First published in 1999, this book constitutes a unique account of the development and reform of health care in Hong Kong. Its main focus is on policy developments since 1945. Victor Wong demonstrates the development of a two-tier health system in both a capitalist and Chinese context. His work is one of both health policy and political economy. Wong utilises the latter perspective to show the state’s role in the interests of capital, the public demand for health care and the power of the medical profession. Alongside this, Wong brings in the role of Chinese and family medicine and the role of the family in cost containment and minimising the hospitalisation of elderly, frail and chronically ill patients. The volume is the most comprehensive analysis available for health policy in Hong Kong.
Especially since the 2003 SARS crisis, China’s healthcare system has become a growing source of concern, both for citizens and the Chinese government. China’s once praised public health services have deteriorated into a system driven by economic constraints, in which poor people often fail to get access, and middle-income households risk to be dragged into poverty by the rising costs of care. The New Rural Co-operative Medical System (NRCMS) was introduced to counter these tendencies and constitutes the main system of public health insurance in China today. This book outlines the nature of the system, traces the processes of its enactment and implementation, and discusses its strengths and weaknesses. It argues that the contested nature of the fields of health policy and social security has long been overlooked, and reinterprets the NRCMS as a compromise between opposing political interests. Furthermore, it argues that structural institutional misfits facilitate fiscal imbalances and a culture of non-compliance in local health policy, which distort the outcomes of the implementation and limit the effectiveness of insurance. These dynamics also raise fundamental questions regarding the effectiveness of other areas of the comprehensive New Health Reform, which China has initiated to overhaul its healthcare system.