Chinese-Style Decentralization and Health System Reform

Hipgrave, David; Sufang, Guo; Yan, M.; Guo, Yan; Yan, Fei; Scherpbier, Robert; Brixi, Hana

doi:10.1371/journal.pmed.1001337

Cited by 46 publications

(44 citation statements)

References 12 publications

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“…5 Major reform of China's decentralized health system relies fundamentally on the willingness and capacity of the relevant authorities at relatively low levels of government to formulate policy details, implementation mechanisms and financing arrangements. 31,32 The responsibilities of low-level health-care providers and the importance of their support will only increase as village doctors are encouraged to play an ever-increasing role in China's health system. 33 Our research confirms the conclusion drawn by a Ministry of Finance researcher 34 and the Xinhua News Agency 35 that the longterm success of the NEMS will depend largely on local subsidies.…”

Section: Researchmentioning

confidence: 99%

“…More guidance is needed, from the national level, on options for provider compensation and on whether the basic public-health funds provided as part of recent healthsector reform may be used to supplement the salaries of village doctors. The sustainability of the NEMS and, in particular, the zero-mark-up policy, like that of most of China's recent reforms, 31 will largely depend on financial inputs from local governments. However, local governments should perhaps not be given too much responsibility for the detailed design and funding of the NEMS, as this could also threaten the NEMS' viability.…”

Section: Limitationsmentioning

confidence: 99%

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Evaluation, in three provinces, of the introduction and impact of China’s National Essential Medicines Scheme

Yang

Cui²,

Sufang³

et al. 2013

Bull. World Health Organ.

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Section: Researchmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

Evaluation, in three provinces, of the introduction and impact of China’s National Essential Medicines Scheme

Yang

Cui²,

Sufang³

et al. 2013

Bull. World Health Organ.

Self Cite

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“…The majority of the village doctors in China are underqualified [21], having only received limited training [17], whereas there are strict qualification requirements for primary care physicians in developed counties. It is true that the developed countries are facing serious workforce shortages, while China is facing an over-supply of medical graduates recently [19,20].…”

Section: Discussionmentioning

confidence: 99%

Aging village doctors in five counties in rural China: situation and implications

Zhang

et al. 2014

Hum Resour Health

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BackgroundThe aging population, rapid urbanization, and epidemiology transition in China call for the improvement and adaptation of the health workforce, especially in underserved rural areas. The aging of village doctors (the former “barefoot doctors”) who have served the rural residents for many decades has become a warning signal for the human resources for health in China. This study aims to investigate the village doctors’ aging situation and its implications in rural China.MethodsThe data reviewed were obtained from the baseline survey of a longitudinal study of rural health workforce in five counties in rural China in 2011. Using a stratified multi-stage cluster sampling process, the baseline data was collected through the self-administered structured Village Doctor Questionnaire. Descriptive analyses, correlation analyses, and multivariate linear regression with interaction terms were conducted with the statistics software Stata 12.0.ResultsThe average age of the 1,927 village doctors was 49.3 years (95% CI 48.8 to 49.9), 870 (45.2%) of whom were aging (50 years or older). Both the age and the recruitment time of the village doctors were demonstrated to have a bimodal distribution. A greater proportion of the male village doctors were aging. Furthermore, aging of the village doctors was significantly correlated to their education level, type of qualification, practicing methods, and their status as village clinic directors (P <0.05, respectively). As shown in the regression models, aging village doctors provided significantly more outpatient services to rural residents (P <0.01) but without an increase in income, and their expected pension was lower (P <0.01), compared with their non-aging counterparts.ConclusionsAging of village doctors is a serious and imperative issue in China, which has a complex and profound impact on the rural health system. Greater attention should be paid to the construction of the pension system and the replenishment of the village doctors with qualified medical graduates.

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“…Nevertheless, aiming to minimize them, authors like Hipgrave et al (2012) highlight that, in July 2011, the State Council of the People's Republic of China demanded the standardization of primary care, the implementation of public health programs, community education, participation in health financing systems, and the maintenance of individual medical records as new functions to be incorporated by medical institutions at the local level. This new system contributed to the accessibility of the Chinese population, even of users/participants from the country's poorer regions.…”

Section: Healthcare Policy In China After the Reforms Initiated By Dementioning

confidence: 99%

Política de saúde na China: a influência ocidental europeia em suas reformas a partir de 1978

Silva

2015

Saude soc.

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This paper intends to study the health policy in China. It starts from the hypothesis that the changes brought by the political and opening-up reform after 1978 are not configured by an "Americanization" process (implementation of the neoliberal project), but by an European occidentalization process based on the social services of the Welfare State of the "thirty glorious years". This process has a contributory character, through the introduction of social insurance in the constitution of China's social security system and, consequently, in its health systems. This results in a throwback in the health policy's collective and universal character, with problems to face regarding access and the financing of the health systems existing today, if we compare the Maoist period with the period after the political and opening-up reform launched by Deng Xiaoping. This situation brings to China the big challenge of creating strategies and reforms to ensure coverage of access to health services and equipment to its large population.

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Chinese-Style Decentralization and Health System Reform

Abstract: David Hipgrave and colleagues discuss health system reform in China and argue that parallel reforms in governance, financing, and accountability are also needed to ensure health equity.

Cited by 46 publications

References 12 publications

Evaluation, in three provinces, of the introduction and impact of China’s National Essential Medicines Scheme

Evaluation, in three provinces, of the introduction and impact of China’s National Essential Medicines Scheme

Aging village doctors in five counties in rural China: situation and implications

Política de saúde na China: a influência ocidental europeia em suas reformas a partir de 1978

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