Work on this book began in 2003 during the initial formulations of China's 11th five-year plan, which covers the period 2006-10. The government of China had requested the World Bank's analytic partnership in assessing the rural health sector. With a generous grant from the United Kingdom's Department for International Development (DFID), the work became part of the Bank's Analytic and Advisory Activities (AAA) program in China, a program that includes technical assistance and policy advice. The rural health AAA work continued through 2007. This book was just one of the activities and outputs of this process. During the entire period, the rural health AAA team analyzed the sector and debated reform options with government officials and scholars. It is hoped that this work helped the government in its extensive reform efforts over the past few years. A lot has happened since the rural health AAA began, and since the first draft of this book was completed in June 2006. The health sector, along with other social sectors, such as education and social protection, become priorities in the 11th five-year plan. The plan called for comprehensive reform of the health system, noting that the current system does not meet the needs of the Chinese population. The 11th five-year plan proposed a wide range of reforms in the areas of health protection, public health Foreword 1 The NCMS was first proposed in 2002 in "Decision of the Central Committee of the Communist Party, State Council on Further Strengthening Rural Health." In early 2003, the State Council document "Suggestions on Establishing the New Rural Cooperative Medical System" formally launched the piloting. produce a master plan for health involving some 16 different ministries. This was a massive effort and, unsurprisingly, differences of view were apparent. Some favored a demand-driven reform approach; others favored a supply-driven approach. An explicit request was made to the Bank and a number of other agencies to formulate a formal contribution to these deliberations. The ongoing AAA work left the Bank well positioned to respond. The Bank's inputs-lessons from international experience, innovative ways to collect and analyze data and other information, and so onrepresented a significant investment by our technical experts team. A consultation draft of the book was discussed with the government and others toward the end of 2006 and early 2007. Based on these discussions, a revised draft was produced and delivered to the Ministry of Finance in late 2007. Reactions to the revised version varied within the government. Some agencies asked for changes beyond those requested during the consultation. These requests were understandable given that rural reform was moving quickly; there was a concern that the rapid progress was not adequately reflected in the draft. The manuscript was revised accordingly. We are indebted to the Ministries of Finance and Health, in particular, for their careful reviews and useful comments back to the authors. In the end, this is a joint effort,...
The Policy Research Working Paper Series disseminates the findings of work in progress to encourage the exchange of ideas about development issues. An objective of the series is to get the findings out quickly, even if the presentations are less than fully polished. The papers carry the names of the authors and should be cited accordingly. The findings, interpretations, and conclusions expressed in this paper are entirely those of the authors. They do not necessarily represent the view of the World Bank, its Executive Directors, or the countries they represent. Policy Research Working Papers are available online at http://econ.worldbank.org.
We report the results of a review of the Chinese-language and English-language literatures on service delivery in China, asking how well China's health care providers perform, what determines their performance, and how the government can improve it. We find current performance leaves room for improvement, in terms of quality, responsiveness to patients, efficiency, cost escalation, and equity. The literature suggests that these problems will not be solved by simply shifting ownership to the private sector, or by simply encouraging providers-public and private-to compete with one another for individual patients. By contrast, substantial improvements could be (and in some places have already been) made by changing the way providers are paid-shifting away from fee-for-service and the distorted price schedule toward prospective payments. Active purchasing by insurers could further improve outcomes.
This paper provides an overview of research on out-of-pocket health expenditures by reviewing the various summary measures and the results of multi-country studies using these measures. The paper presents estimates for 146 countries from all World Bank income groups for all summary measures, along with correlations between the summary measures and macroeconomic and health system indicators. Large differences emerge across countries in per capita out-of-pocket expenditures in 2011 international dollars, driven in large part by differences in per capita income and the share of GDP spent on health. The two measures of dispersion or risk—the coefficient of variation and Q90/Q50—are only weakly correlated across countries and not explained by our macroeconomic and health system indicators. Considerable variation emerges in the out-of-pocket health expenditure budget share, which is highly correlated with the incidence of “catastrophic expenditures”. Out-of-pocket expenditures tend to be regressive and catastrophic expenditures tend to be concentrated among the poor when expenditures are assessed relative to income, while expenditures tend to be progressive and catastrophic expenditures tend to be concentrated among the rich when expenditures are assessed relative to consumption. At the extreme poverty line of $1.90-a-day, most impoverishment due to out-of-pocket expenditures occurs among low-income countries.
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