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Health shocks have been shown to have important economic consequences in industrial countries. Less is known about how health shocks affect income, consumption, labor market outcomes, and medical expenditures in middle- and low-income countries. The authors explore these issues in China. In addition to providing new evidence on the general impact of health shocks, they also extend previous work by assessing the extent of risk protection afforded by formal health insurance, and by examining differences in the impact of health shocks between the rich and poor. The authors find that health shocks are associated with a substantial and significant reduction in income and labor supply. There are indications that the impact on income is less important for the insured, possibly because health insurance coverage is also associated with limited sickness insurance, but the effect is not significant. They also find evidence that negative health shocks are associated with an increase in unearned income for the poor but not the non-poor. This effect is however not strong enough to offset the impact on overall income. The loss in income is a consequence of a reduction in labor supply for the head of household, and the authors do not find evidence that other household members compensate by increasing their labor supply. Finally, negative health shocks are associated with a significant increase in out-of-pocket health care expenditures. More surprisingly, there is some evidence that the increase is greater for the insured than the uninsured. The findings suggest that households are exposed to considerable health-related shocks to disposable income, both through loss of income and health expenditures, and that health insurance offers very limited protection.
Abstract: "Health shocks have been shown to have important economic consequences in industrial countries. Less is known about how health shocks affect income, consumption, labor market outcomes, and medical expenditures in middle- and low-income countries. The authors explore these issues in China. In addition to providing new evidence on the general impact of health shocks, they also extend previous work by assessing the extent of risk protection afforded by formal health insurance, and by examining differences in the impact of health shocks between the rich and poor. The authors find that health shocks are associated with a substantial and significant reduction in income and labor supply. There are indications that the impact on income is less important for the insured, possibly because health insurance coverage is also associated with limited sickness insurance, but the effect is not significant. They also find evidence that negative health shocks are associated with an increase in unearned income for the poor but not the non-poor. This effect is however not strong enough to offset the impact on overall income. The loss in income is a consequence of a reduction in labor supply for the head of household, and the authors do not find evidence that other household members compensate by increasing their labor supply. Finally, negative health shocks are associated with a significant increase in out-of-pocket health care expenditures. More surprisingly, there is some evidence that the increase is greater for the insured than the uninsured. The findings suggest that households are exposed to considerable health-related shocks to disposable income, both through loss of income and health expenditures, and that health insurance offers very limited protection."--World Bank web site.
Health shocks have been shown to have important economic consequences in industrial countries. Less is known about how health shocks affect income, consumption, labor market outcomes, and medical expenditures in middle- and low-income countries. The authors explore these issues in China. In addition to providing new evidence on the general impact of health shocks, they also extend previous work by assessing the extent of risk protection afforded by formal health insurance, and by examining differences in the impact of health shocks between the rich and poor. The authors find that health shocks are associated with a substantial and significant reduction in income and labor supply. There are indications that the impact on income is less important for the insured, possibly because health insurance coverage is also associated with limited sickness insurance, but the effect is not significant. They also find evidence that negative health shocks are associated with an increase in unearned income for the poor but not the non-poor. This effect is however not strong enough to offset the impact on overall income. The loss in income is a consequence of a reduction in labor supply for the head of household, and the authors do not find evidence that other household members compensate by increasing their labor supply. Finally, negative health shocks are associated with a significant increase in out-of-pocket health care expenditures. More surprisingly, there is some evidence that the increase is greater for the insured than the uninsured. The findings suggest that households are exposed to considerable health-related shocks to disposable income, both through loss of income and health expenditures, and that health insurance offers very limited protection.
Over the past twenty years, many low- and middle-income countries have experimented with health insurance options. While their plans have varied widely in scale and ambition, their goals are the same: to make health services more affordable through the use of public subsidies while also moving care providers partially or fully into competitive markets. Colombia embarked in 1993 on a fifteen-year effort to cover its entire population with insurance, in combination with greater freedom to choose among providers. A decade later Mexico followed suit with a program tailored to its federal system. Several African nations have introduced new programs in the past decade, and many are testing options for reform. For the past twenty years, Eastern Europe has been shifting from government-run care to insurance-based competitive systems, and both China and India have experimental programs to expand coverage. These nations are betting that insurance-based health care financing can increase the accessibility of services, increase providers' productivity, and change the population's health care use patterns, mirroring the development of health systems in most OECD countries. Until now, however, we have known little about the actual effects of these dramatic policy changes. Understanding the impact of health insurance–based care is key to the public policy debate of whether to extend insurance to low-income populations—and if so, how to do it—or to serve them through other means. Using recent household data, this book presents evidence of the impact of insurance programs in China, Colombia, Costa Rica, Ghana, Indonesia, Namibia, and Peru. The contributors also discuss potential design improvements that could increase impact. They provide innovative insights on improving the evaluation of health insurance reforms and on building a robust knowledge base to guide policy as other countries tackle the health insurance challenge.
Since 1978 when it embarked on sweeping agricultural and industrial reforms, China's economic growth has been remarkable. Its success in transforming itself within just three decades from a very poor low-income country to a successful middle-income country is unparalleled. During this period, however, and in contrast to the first 30 years of the People's Republic, progress in the health sector has been disappointing. For example, during the period 1980-2007, China increased its income per head as a percentage of the OECD average from 3 percent to 15 per cent, but infant mortality fell no faste.
This book draws attention to two neglected areas in the growing body of research on welfare in China: subnational variation and the changing mix of state and non-state provision. The contributors to this volume demonstrate the diversity of local welfare provision that lies behind broad national policies and programmes. Their focus on local diversity is particularly relevant to understanding the welfare system in China because national state programmes are so often organized by local governments in line with the specifics of their economic and social development. At the same time that social and economic development is itself independently creating an array of different conditions that shape non-state (family, business and third sector) welfare roles . Through chapters that draw on original research in eight provinces, the book adopts a ‘local’ perspective to illustrate and explain some of the transformations that are under way and discuss not only local government initiatives and programmes, but also the services and support provided by families, informal social networks and community or third sector organizations, as well as those delivered by private businesses on a commercial, for-profit basis. This book will be of interest to students and scholars of Chinese society, social policy, and Chinese studies more widely. Beatriz Carrillo is Lecturer in Asian Studies at the University of Technology, Sydney, Australia Jane Duckett is Professor of Chinese and Comparative Politics at the University of Glasgow, UK
China’s War against the Many Faces of Poverty measures multidimensional poverty in China and deprivation related to income, education, health issues, living standards and social security. The book adopts a well-developed methodology using three different empirical datasets to analyse aspects of regional diversity across rural and urban and migrant populations of China. The book also analyses the links between development policies considered by the government and the various facets of poverty in light of rapid economic growth and addresses important policy implications. In the existing literature, in-depth research on multidimensional poverty in China is almost non-existent. This book is a pioneer study in this important field of research. With its innovative approach in concepts and methodologies and in its analysis of policy implications make this book a definitive and valuable addition to the literature.
Since 1980, China's economy has been the envy of the world. Is annual growth rate of more than 9 percent during this period makes China today the world's fourth-largest economy. And this sustained growth has reduced the poverty rate from 60 percent of the population to less than 10 percent. However, such rapid growth has also increased inequalities in income and access to basic services and stressed natural resources. The government seeks to resolve these and other issues by creating a 'harmonious society' -- shifting priorities from the overriding pursuit of growth to more balanced economic and social development. This volume compiles analyses and insights from high-level Chinese policy makers and prominent international scholars that address the changes needed in public finance for success in the government's new endeavor. It examines such key policy issues as public finance and the changing role of the state; fiscal reform and revenue and expenditure assignments; intergovernmental relations and fiscal transfers; and financing and delivery of basic public goods such as compulsory education, innovation, public health, and social protection. And it offers concrete recommendations for immediate policy changes and for China's future reform agenda. Public Finance in China' is a must-read for specialists in public finance and for those seeking an understanding of the complex and daunting challenges China is facing.
“Stability preservation” (weiwen) has long been an imperative of China’s one-party state. At the same time, China has recently embedded a commitment to the protection of human rights in its constitution. This book examines the multiple and shifting ways in which weiwen impinges on the implementation of human rights. Using case studies, Sarah Biddulph methodically examines the state’s response to labour unrest, medical disputes, and forced housing evictions. As she demonstrates, the state’s reaction can vary from taking steps to ameliorate the underlying causes of the citizens’ grievances to the repression of rights-related protests and the punishment of protestors. The Stability Imperative: Human Rights and Law in China reveals how the systematic failure of the legal system to protect rights coupled with an overemphasis on coercive forms of stability preservation is undermining the authority of law in China and could, ultimately, damage the Communist Party’s leadership.