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Li Y, Malik V, Hu FB. Health Insurance In China: After Declining In The 1990s, Coverage Rates Rebounded To Near-Universal Levels By 2011. Health Aff (Millwood) 2017; 36:1452-1460. [DOI: 10.1377/hlthaff.2016.1658] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Yanping Li
- Yanping Li is a research scientist in the Department of Nutrition, Harvard T. H. Chan School of Public Health, in Boston, Massachusetts
| | - Vasanti Malik
- Vasanti Malik is a research scientist in the Department of Nutrition, Harvard T. H. Chan School of Public Health
| | - Frank B. Hu
- Frank B. Hu (
) is a professor in the Departments of Nutrition and Epidemiology, Harvard T. H. Chan School of Public Health
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Dai B. The old age health security in rural China: where to go? Int J Equity Health 2015; 14:119. [PMID: 26530528 PMCID: PMC4632370 DOI: 10.1186/s12939-015-0224-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 09/25/2015] [Indexed: 11/24/2022] Open
Abstract
Introduction The huge number of rural elders and the deepening health problems (e.g. growing threats of infectious diseases and chronic diseases etc.) place enormous pressure on old age health security in rural China. This study aims to provide information for policy-makers to develop effective measures for promoting rural elders’ health care service access by examining the current developments and challenges confronted by the old age health security in rural China. Methods Search resources are electronic databases, web pages of the National Bureau of Statistics of China and the National Health and Family Planning Commission of China on the internet, China Population and Employment Statistics Yearbook, China Civil Affairs’ Statistical Yearbook and China Health Statistics Yearbooks etc. Articles were identified from Elsevier, Wiley, EBSCO, EMBASE, PubMed, SCI Expanded, ProQuest, and National Knowledge Infrastructure of China (CNKI) which is the most informative database in Chinese. Search terms were “rural”, “China”, “health security”, “cooperative medical scheme”, “social medical assistance”, “medical insurance” or “community based medical insurance”, “old”, or “elder”, “elderly”, or “aged”, “aging”. Google scholar was searched with the same combination of keywords. Results The results showed that old age health security in rural China had expanded to all rural elders and substantially improved health care service utilization among rural elders. Increasing chronic disease prevalence rates, pressing public health issues, inefficient rural health care service provision system and lack of sufficient financing challenged the old age health security in rural China. Conclusions Increasing funds from the central and regional governments for old age health security in rural China will contribute to reducing urban–rural disparities in provision of old age health security and increasing health equity among rural elders between different regions. Meanwhile, initiating provider payment reform may contribute to improving the efficiency of rural health care service provision system and promoting health care service access among rural elders.
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Affiliation(s)
- Baozhen Dai
- Department of Health Policy and Management, School of Management, Jiangsu University, 301 Xuefu Road, Zhenjiang, 212013, China. .,Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, 624 North Broadway, Baltimore, 21205, USA.
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Dai B. Does China's new cooperative medical scheme promote rural elders' access to healthcare services in relation to chronic conditions? Int Health 2014; 7:32-41. [PMID: 25091022 DOI: 10.1093/inthealth/ihu050] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This study examined use of healthcare services by elderly people with a long-term condition living in rural China and participating in that country's New Cooperative Medical Scheme (NCMS). METHODS Data were taken from the 2009 China Health and Nutrition Survey. RESULTS The study results showed that education level and annual income were low among rural elders (aged ≥65 years); the illiteracy rate was 58.0% (200/345) and 67.6% (92/136) had an annual income of less than 5000 Chinese yuan renminbi. The elders had low rates of treatment and use of preventive healthcare services while the prevalence of chronic disease was highest among them when compared to other age groups. Among the few elders who received preventive healthcare, most received it at village clinics. CONCLUSIONS Preventive healthcare services and chronic disease management are urgently needed by rural elders in China. NCMS should initiate payments to township health centers to enable them to undertake community outreach and education campaigns among rural residents, and train village doctors in standard chronic condition management and prevention, with prioritization of the provision of prevention and management of chronic conditions by village clinics.
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Affiliation(s)
- Baozhen Dai
- Department of Health Policy and Management, School of Management, Jiangsu University, 301 Xuefu Road, Zhenjiang 212013, China
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Sipsma H, Liu Y, Wang H, Zhu Y, Xue L, Alpern R, Dale M, Bradley E. Patient experiences with inpatient care in rural China. Int J Qual Health Care 2013; 25:452-8. [DOI: 10.1093/intqhc/mzt046] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Chen D, Tang KK, Zhao L, Zhang Y. Will China's Cooperative Medical System fail again? Insight from farmer satisfaction survey. Health Promot Int 2013; 30:251-61. [PMID: 23669160 DOI: 10.1093/heapro/dat032] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This paper studied the sustainability of China's New Rural Cooperative Medical System (NCMS) by evaluating the satisfaction rate of its participants-the farmers. The study related the overall satisfaction of the farmers to their satisfaction with the four different aspects of the program. It also identified which personal and program attributes affect the farmers' satisfaction rate. Survey data of 1278 households from 66 counties in Shandong Province of China were collected in 2011 using a multi-stage stratified cluster-sampling method. To overcome the nepotistic barriers in rural China, field surveys in each township were conducted by university students from the same place. Data were analyzed using multiple regressions and structural equation modeling method. The results showed that 86% of the farmers were either satisfied or very satisfied with the NCMS and 82% indicated their intention to continue participating in the program. Aside from its financial benefits, both the publicity and reimbursement procedure of the program were found to be significant factors in influencing the satisfaction of the farmers. Majority of the participants held positive opinions toward the NCMS, contradicting the negative assessments made by many previous studies. Given the high proportion of farmers willing to continue with the program, it is likely to be sustainable in the near future. Greater publicity and education efforts should be made to make the farmers better informed about the program, and measures should be taken to improve its reimbursement procedure and the setting of the premium level.
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Affiliation(s)
- Dong Chen
- School of Economics, Shandong University, Shandong Province, Jinan, China
| | - Kam Ki Tang
- School of Economics, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Lifeng Zhao
- School of Economics, Shandong University, Shandong Province, Jinan, China
| | - Yuhong Zhang
- School of Economics, Shandong University, Shandong Province, Jinan, China
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McCollum R, Chen L, ChenXiang T, Liu X, Starfield B, Jinhuan Z, Tolhurst R. Experiences with primary healthcare in Fuzhou, urban China, in the context of health sector reform: a mixed methods study. Int J Health Plann Manage 2013; 29:e107-26. [PMID: 23576191 DOI: 10.1002/hpm.2165] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2011] [Accepted: 01/04/2013] [Indexed: 11/09/2022] Open
Abstract
China has recently placed increased emphasis on the provision of primary healthcare services through health sector reform, in response to inequitably distributed health services. With increasing funding for community level facilities, now is an opportune time to assess the quality of primary care delivery and identify areas in need of further improvement. A mixed methodology approach was adopted for this study. Quantitative data were collected using the Primary Care Assessment Tool-Chinese version (C-PCAT), a questionnaire previously adapted for use in China to assess the quality of care at each health facility, based on clients' experiences. In addition, qualitative data were gathered through eight semi-structured interviews exploring perceptions of primary care with health directors and a policy maker to place this issue in the context of health sector reform. The study found that patients attending community health and sub-community health centres are more likely to report better experiences with primary care attributes than patients attending hospital facilities. Generally low scores for community orientation, family centredness and coordination in all types of health facility indicate an urgent need for improvement in these areas. Healthcare directors and policy makers perceived the need for greater coordination between levels of health providers, better financial reimbursement, more formal government contracts and recognition/higher status for staff at the community level and more appropriate undergraduate and postgraduate training.
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Affiliation(s)
- Rosalind McCollum
- Liverpool School of Tropical Medicine, International Public Health, Liverpool, UK
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Dai B, Zhou L, Mei YJ, Zhan C. Regional inequity in financing New Cooperative Medical Scheme in Jiangsu, China. Int J Health Plann Manage 2013; 29:e97-e106. [PMID: 23296711 DOI: 10.1002/hpm.2162] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Revised: 10/25/2012] [Accepted: 12/09/2012] [Indexed: 11/11/2022] Open
Abstract
This study examined the regional inequity in the New Cooperative Medical Scheme (NCMS) financing in Jiangsu, China. Counties were classified into three categories according to socio-economic development level: South Jiangsu, Middle Jiangsu and North Jiangsu. Five counties (Changshu, Danyang, Gaoyou, Jiangyan and Ganyu) were selected on the basis of the following criteria: (i) NCMS had been implemented before 2005; (ii) county governments were willing and able to collaborate with the research team; and (iii) counties had different socio-economic development status representing the low, medium and high level of socio-economic development in Jiangsu. As shown in this study, local governments in Jiangsu took the major NCMS financing responsibilities (75.2% in 2009), and local governments (county and lower) subsidies ranged from 220 RMB per capita in South Jiangsu to 18 RMB per capita in North Jiangsu in 2009, with a larger contribution (73.3%) in South than that in Middle (40.0%) and North Jiangsu (18.0%). For achieving more equity in NCMS financing and carrying NCMS forward, we propose that provincial and municipal governments should increase their contribution to NCMS for balancing the regional inequity in subsidies from county and lower-level governments, and the risk pool of NCMS should be promoted to a higher level (e.g., provincial).
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Affiliation(s)
- Baozhen Dai
- School of Management, Jiangsu University, Zhenjiang, China
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Public vs private administration of rural health insurance schemes: a comparative study in Zhejiang of China. HEALTH ECONOMICS POLICY AND LAW 2012; 8:269-88. [PMID: 23036504 DOI: 10.1017/s1744133112000163] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Since 2003, China has experimented in some of the country's counties with the private administration of the New Cooperative Medical Scheme (NCMS), a publicly subsidized health insurance scheme for rural populations. Our study compared the effectiveness and efficiency of private vs public administration in four counties in one of China's most affluent provinces in the initial stage of the NCMS's implementation. The study was undertaken in Ningbo city of Zhejiang province. Out of 10 counties in Ningbo, two counties with private administration for the NCMS (Beilun and Ninghai) were compared with two others counties with public administration (Zhenhai and Fenghua), using the following indicators: (1) proportion of enrollees who were compensated for inpatient care; (2) average reimbursement-expense ratio per episode of inpatient care; (3) overall administration cost; (4) enrollee satisfaction. Data from 2004 to 2006 were collected from the local health authorities, hospitals and the contracted insurance companies, supplemented by a randomized household questionnaire survey covering 176 households and 479 household members. In our sample counties, private administration of the NCMS neither reduced transaction costs, nor improved the benefits of enrollees. Enrollees covered by the publicly administered NCMS were more likely to be satisfied with the insurance scheme than those covered by the privately administered NCMS. Experience in the selected counties suggests that private administration of the NCMS did not deliver the hoped-for results. We conclude that caution needs to be exercised in extending private administration of the NCMS.
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Ma Y, Zhang L, Chen Q. China's new cooperative medical scheme for rural residents: popularity of broad coverage poses challenges for costs. Health Aff (Millwood) 2012; 31:1058-64. [PMID: 22566447 DOI: 10.1377/hlthaff.2009.0808] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
One of the components in China's massive health reform effort is the New Cooperative Medical Scheme, which is intended to provide affordable health insurance, especially to the rural poor. This program offers three options with different benefits and costs to county health officials, who select one of the options to make available to local residents. Data were obtained from the New Cooperative Medical Scheme survey conducted by the Chinese Ministry of Health and the World Bank in 2005, which covered more than 47,000 people living in twenty-seven counties, to determine participation levels, identify which option was most attractive, and characterize the impact that each option had on care and costs. Our study found that those participants with the most limited coverage might have delayed seeking care, while the broadest coverage--the "Cadillac option"--was the most popular. Yet if this generous package were to be broadly offered, health costs would become unsustainable. Therefore, the Chinese government must consider which costs to cover for people in economically depressed rural areas.
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Affiliation(s)
- Yuqin Ma
- Institute of Military Health Management, Second Military Medical University, Shanghai, China.
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Liu J, Shi L, Meng Q, Khan MM. Income-related inequality in health insurance coverage: analysis of China Health and Nutrition Survey of 2006 and 2009. Int J Equity Health 2012; 11:42. [PMID: 22891984 PMCID: PMC3544615 DOI: 10.1186/1475-9276-11-42] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Accepted: 07/29/2012] [Indexed: 11/15/2022] Open
Abstract
Introduction China introduced the urban resident basic medical insurance (URBMI) in 2007 to cover children and urban unemployed adults, in addition to the new cooperative medical scheme (NCMS) for rural residents in 2003 and the basic health insurance scheme (BHIS) for urban employees in 1998. This study examined whether the overall income-related inequality in health insurance coverage improved during 2006 and 2009 in China. Methods The China Health and Nutrition Survey (CHNS) data of 2006 and 2009 were used to create the concentration curve and the concentration index. GEE logistic regression was used to model the health insurance coverage as dependent variable and household income per capita as independent variable, controlling for individuals' age, gender, marital status, educational attainment, employment status, year 2009 (Y2009), household size, retirement status, and geographic variations. The change in the income-related inequality in 2009 was estimated using the interaction term of income*Y2009. Results In 2006, 49.7% (4,712/9,476) respondents had health insurance: 13.4% with BHIS and 28.4% with NCMS. In 2009, 90.8% (8,964/9,863) had health insurance: 10.1% with URBMI, 18.3% with BHIS, and 57.6% with NCMS. The BHIS, URBMI, and NCMS programs had different patterns of population coverage over 10 income deciles. The concentration index was 0.15 in 2006 and 0.04 in 2009. The dominance test showed that the concentration curves were significantly different between 2006 and 2009 (p < 0.05). An income increase per capita by 10,000 RMB was associated with 25.5% more likely to have health insurance coverage (odds ratio = 1.255, 95% confidence interval: [1.130-1.393]). In 2009, there was significant improvement in the income-related inequality (p < 0.001). Discussions Comparing 2009 to 2006, the income inequality in health insurance coverage was largely corrected in China through rapid expansion of CHNS in rural areas and initiation of URBMI in urban areas.
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Affiliation(s)
- Jinan Liu
- HealthCore, Inc, Wilmington, DE 19801, USA
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Dai B, Zhou J, Mei YJ, Wu B, Mao Z. Can the New Cooperative Medical Scheme promote rural elders' access to health-care services? Geriatr Gerontol Int 2011; 11:239-45. [PMID: 21545383 DOI: 10.1111/j.1447-0594.2011.00702.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The aim of the present study was to examine the impact of the New Cooperative Medical Scheme (NCMS) on rural elders' access to health-care services. Articles were identified from PubMed, Elsevier, Wiley, EBSCO, EMBASE, SCI Expanded, ProQuest, Google, and CNKI which is the most informative database in Chinese, with the search terms "rural", "China", "old", "older", or "elder", "elderly", or "aged", "aging", "medical insurance", or "community-based medical insurance", or "cooperative medical scheme". Related websites and yearbooks were searched as well. The NCMS has improved the health-care utilization of rural elders, and they have the highest satisfaction with it among all age groups. However, affordability difficulty remained the common barrier for the rural elderly to access quality health care, in spite of the special considerations given to the rural elderly, such as premium remission and free check-ups. Faced with ever-growing health challenges, some impoverished rural elders with poor physical health and functional limitations may lack sufficient access to basic health-care services. Followed by the provider payment reform initiated by the NCMS, a stricter regulation for doctors' prescriptions, clinical practice and disease management is needed to promote rural elders' access to health-care services. Health management for rural elders can be expected for the NCMS to promote rural elders' health-care access once a better coordination between the NCMS and health-care system can be achieved.
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Affiliation(s)
- Baozhen Dai
- Department of Social Medicine, School of Public Health Economics and Management School, Wuhan University, Wuhan, China
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Trends of out-of-pocket expenditure for influenza in China Health and Nutrition Survey during 1989-2006. Int J Public Health 2011; 57:193-8. [PMID: 21503770 DOI: 10.1007/s00038-011-0251-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2010] [Revised: 03/05/2011] [Accepted: 03/24/2011] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVES To examine the trends of out-of-pocket expenditure for influenza during 1989-2006 in China. METHODS Data were extracted from the China Health and Nutrition Survey (CHNS) during 1989-2006 (in seven waves). A fixed effect model with robust standard errors was employed to examine trends of out-of-pocket expenditure (adjusted to 2006 Chinese RMB). RESULTS The out-of-pocket expenditure increased from 11.92 RMB in 1989 to 50.75 RMB in 2006. The final sample for fixed effect model was 23,050 households. Income elasticity of out-of-pocket expenditure was 1.6%. Using 1989 as reference, the predicted increase was 242.23% [95% confidence interval (CI): 225.79-259.50%] in 2006; it was 143.54% in city hospitals [95% CI: 130.43-157.40%] compared to village clinics. CONCLUSIONS Adjusted for inflation and income elasticity, Chinese households experienced an increase of more than double the out-of-pocket expenditure during 1989-2006. The expenditure was higher in higher-level facilities. Policy implications include the government fixed-budget financing to health providers could contribute to the rapidly increased financial burden; a referral system should be rebuilt; private health providers may play an important role in containing healthcare price in China.
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Jiang Q, Jiang Z, Zhao M, Tao J, Ling C, Cherry N. Evaluation of a pilot cooperative medical scheme in rural China: impact on gender patterns of health care utilization and prescription practices. BMC Public Health 2011; 11:50. [PMID: 21261968 PMCID: PMC3037865 DOI: 10.1186/1471-2458-11-50] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2010] [Accepted: 01/24/2011] [Indexed: 11/16/2022] Open
Abstract
Background In 2003 the Chinese government introduced voluntary cooperative medical schemes (CMS), soon to be in place throughout rural China. Families who chose to enroll do so as a single unit and nothing is known about any differential effect of these new schemes on family members. This study evaluates the impact of one pilot CMS in Anhui Province on health care use by girls aged less than 5 years and women 65 years or older, and on the pattern and cost of prescriptions. Methods Health care records were extracted covering a 10 year period, before, during and after the pilot CMS in 4 townships, one with the intervention and 3 comparison townships without. The impact of the intervention on the age and gender distribution of patients presenting for health care and on the prescription of certain drugs was assessed by logistic regression. The cost of prescriptions before, during and after the intervention period was also assessed. Results 203,058 registration and 643,588 prescription records were identified. During the intervention there was a reduced likelihood overall that a patient was female (OR = 0.92: 95%CI 0.87 - 0.97) at the intervention site. Girls aged < 5 years had an increased likelihood of health care (OR = 1.41: 95%CI 1.23 - 1.59) during the CMS, but women ≥ 65 years were relatively disadvantaged (OR = 0.84: 95%CI 0.75 - 0.95). The use of antibiotics and systemic steroids increased disproportionately at the intervention site for patients ≥ 5 years. Prescription costs at the township hospital also increased at the intervention site, particularly for older men. Conclusions This evaluation suggests that all family members did not benefit equally from the pilot CMS and that women ≥ 65 years may be disadvantaged by the newly available reimbursements of health care costs through the CMS. It points to the need, in future evaluations, to use individuals rather than families as the unit of analysis, in order to determine whether such health care inequalities are wide-spread and persistent or are reduced in the longer term. The results also support earlier concerns about the influence of new funding resources on prescription practices and the need for regulation of for-profit prescribing.
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Affiliation(s)
- Qicheng Jiang
- School of Health Administration, Anhui Medical University, Meishanlu 81, Hefei, Anhui, China
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Hougaard JL, Osterdal LP, Yu Y. The Chinese healthcare system: structure, problems and challenges. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2011; 9:1-13. [PMID: 21174479 DOI: 10.2165/11531800-000000000-00000] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
We describe the structure and present situation of the Chinese healthcare system and discuss its primary problems and challenges. We discuss problems with inefficient burden sharing, adverse provider incentives and huge inequities, and seek explanations in the structural features of the Chinese healthcare system. The current situation will be further challenged in the future by an aging population, an increasing need for privatization and growing expectations about quality of healthcare.
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Affiliation(s)
- Jens Leth Hougaard
- Institute of Food and Resource Economics, University of Copenhagen, Copenhagen, Denmark.
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Pan X, Zhang Y, Xu L, Huang J, Zhao Q. An analysis of farmers' perception of the new cooperative medical system in Liaoning Province, China. BMC Health Serv Res 2009; 9:230. [PMID: 20003369 PMCID: PMC2799398 DOI: 10.1186/1472-6963-9-230] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2008] [Accepted: 12/12/2009] [Indexed: 11/29/2022] Open
Abstract
Background Since 2003, the number of pilot areas of the New Rural Cooperative Medical System (NRCMS) has increased in rural China. And the major efforts have been concentrated on the enrollment of prospective members. In this study, we examined the satisfaction of the rural residents with the NRCMS as well as factors affecting their attitudes towards the NRCMS. Methods The data for this study were collected from a survey involving twenty counties in Liaoning Province. Interviews and focus groups were conducted between 10th January and 20th August 2008. A total of 2,780 people aged 18-72 were randomly selected and interviewed. Data were evaluated by nonparametric tests and ordinal regression models. Results 71.6% of the study subjects were satisfied with the NRCMS. Single factor analysis showed that attitudes towards the NRCMS were influenced by gender, age, marital status, and self-rated health status. In the ordinal regression analysis, gender, age, and self-rated health status affect satisfaction (P < 0.05). Conclusions We found that a considerable proportion of farmers were satisfied with the NRCMS. Gender, age, and self-rated health status had significant effects on farmers' attitudes towards the NRCMS. The Chinese Central Government attempted to adopt active measures in the future to continuously improve the NRCMS, including initiating educational programs, building new medical facilities and increasing financial investment.
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Affiliation(s)
- Xilong Pan
- Peking University Health Science Center, School of Public Health, Health Policy and Management Department, Haidian District, Beijing 100191, PR China.
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Wagstaff A, Yip W, Lindelow M, Hsiao WC. China's health system and its reform: a review of recent studies. HEALTH ECONOMICS 2009; 18 Suppl 2:S7-S23. [PMID: 19551753 DOI: 10.1002/hec.1518] [Citation(s) in RCA: 138] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
This paper provides a survey of the recent empirical research on China's 'old' health system (i.e. prior to the spate of reforms beginning in 2003). It argues that this research has enhanced our understanding of the system prior to 2003, in some cases reinforcing conclusions (e.g. the demand-inducement associated with perverse incentives) while in other cases suggesting a slightly less clear storyline (e.g. the link between insurance and out-of-pocket spending). It also concludes that the research to date points to the importance of careful evaluation of the current reforms, and its potential to modify policies as the rollout proceeds. Finally, it argues that the research on the pre-2003 system suggests that while the recently announced further reforms are a step in the right direction, the hoped-for improvements in China's health system will far more likely occur if the reforms become less timid in certain key areas, namely provider payments and intergovernmental fiscal relations.
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Affiliation(s)
- Adam Wagstaff
- Development Research Group, The World Bank, Washington, DC 20433, USA.
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You X, Kobayashi Y. The new cooperative medical scheme in China. Health Policy 2009; 91:1-9. [PMID: 19121873 DOI: 10.1016/j.healthpol.2008.11.012] [Citation(s) in RCA: 126] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2008] [Revised: 11/18/2008] [Accepted: 11/27/2008] [Indexed: 11/16/2022]
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