Transformation of China's rural health care financing

Liu, Yuanli; Hsiao, William C.; Li, Qing; Liu, Xingzhu; Ren, Mingchun

doi:10.1016/0277-9536(95)00428-a

Cited by 94 publications

(66 citation statements)

References 5 publications

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“…In most places, especially the poorer areas, however, local governments have not been able to cover fixed hospital costs, and hospitals have had to charge patients to make up the difference. 18 In 1985, central government decentralized hospital management, giving hospital directors more autonomy over personnel and finance issues. 19 To increase income, to compensate for the inadequate investment by local government and to survive, local incentives were put in place to encourage staff to work more effectively and raise revenue.…”

mentioning

confidence: 99%

“…These not only made the staff work harder, but also encouraged them to over-treat and over-prescribe both high technology examinations and medications. 18 Areas such as public health and maternal and child health (MCH) care services were neglected because they did not generate a profit. 20 The study reported here was part of a larger study on Improving birth outcomes in China: consequences and potentials of policy, state and professional interactions, conducted between 2004 and 2007 in Sichuan and Shanxi provinces.…”

mentioning

confidence: 99%

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Barriers to increasing hospital birth rates in rural Shanxi Province, China

Gao

Barclay

Kildea

et al. 2010

Reproductive Health Matters

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mentioning

confidence: 99%

mentioning

confidence: 99%

Barriers to increasing hospital birth rates in rural Shanxi Province, China

Gao

Barclay

Kildea

et al. 2010

Reproductive Health Matters

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“…In this study, the schistosomiasis control facilities generated 70% of the revenues each year by not only treating schistosomiasis but also general diseases such as respiratory and gastrointestinal aliments. They must compete with village doctors, township hospitals, and other health care sectors to attract more patients (Liu et al 1995). But because of their long history of specialty in schistosomiasis researches and treatments, they are facing problems: they lack modern medical technologies, skilled staff, even reputations.…”

Section: Discussionmentioning

confidence: 99%

“…Ironically, while the trend between 1950s and the 1980s in many western countries has been towards an increasing role for government because of known market failures in health sectors, the market forces are being introduced in China to remedy the systemic failures of excessive rather than insufficient government involvement (Liu et al 1995). But whether it sticks to its 'vertical' management system for schistosomiasis control (Zhou et al 1994;Yuan 1995) in this new socioeconomic context or integrates schistosomiasis control programmes into the primary health care, China still faces the dilemma of how to finance the schistosomiasis control programmes.…”

Section: Discussionmentioning

confidence: 99%

Financing changes of schistosomiasis control programmes in China 1980–1995: a case study in Songzi county

Xiang

et al. 1998

Tropical Med Int Health

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SummaryTo assess the financing changes of schistosomiasis control programmes in China and estimate the impact of these changes on patients' treatment-seeking behaviour and control of schistosomiasis, a survey was conducted in five schistosomiasis-endemic areas of the lake regions, Hubei province, in 1996. This paper reports financing changes and their impact on the incidence and prevalence of schistosomiasis from one of the five areas as a case study. By examining the surveillance and financial data from 1980 to 1995, and through focus group discussions we found that the schistosomiasis control programmes in People's Republic of China have gone through dramatic financing changes from 1980 to 1995, when the transitions of China's social, economic, and political systems happened. The proportions of funding to schistosomiasis control programmes from high level governmental agencies, county budgets, and services revenue changed from 60%, 23%, and 17%, respectively, in 1980-1987 to 0.7%, 22.3%, and 72% in 1995. The percentageages of expenditure of schistosomiasis control activities, salaries and bonuses, and other activities unrelated to schistosomiasis control, were 53.5%, 14.4, and 17.2% in 1980. These percentageages changed to 7.7%, 33.3%, and 53.3%, respectively, in 1995. The preponderant role of the state in organizing, financing, and delivery of the services was replaced with the new system which is more influenced by the market economy. The incidence and the prevalence of schistosomiasis in the study area have increased year by year from 1980 to 1990, although there has been a tendency to decrease after 1991 but not to the low pre1980 levels. The collapse of the community-based medical system in rural areas and the dramatic financing changes of schistosomiasis control programmes have created major difficulties for schistosomiasis control in China.

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“…During the peak period of the RCMS's tenure (1970s), 90% of the rural populations were covered under this prepayment schemes. However, after the agricultural reform in the early 1980's, this community financing system collapsed in most of the rural areas (Gu et al, 1997;Liu et al 1995). There have been efforts to revitalize RCMS since then.…”

Section: China's Poor and Poor Policies: The Case Of Rural Health Insmentioning

confidence: 99%

Financial Sector Reform in China

Thorpe

2005

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(abstract)Thanks to continued economic growth and increasing income, the overall poverty rate has been on decline in China. However, due to medical cost escalation and lack of insurance coverage, catastrophic medical spending constitutes an increasingly important cause for poverty in rural areas. In 1993, the insurance coverage for the rural residents was already low (12.8%).By 1998, only 9.5% of the rural populations were insured. Ever since collapse of the once successful Cooperative Medical System (CMS) in the early 1980s when China transformed its system of collective agricultural production to private production, many rural communities, especially the poor, faced several major problems. User charges and high direct costs effectively block access for many rural residents who lack adequate income to purchase basic healthcare when it is needed. Using the 1998 National Health Services Survey data, we estimated impact of medical expenditure on the poverty headcount for different rural regions. Based on the reported income statistics alone, the headcount for the whole rural sample is 7.22%. Out-of-pocket spending on healthcare has raised the headcount by more than 3 percentage points. In other words, medical spending raised the number of rural households living below poverty line by 44.3%. Why has there been no vigorous development of a rural health insurance system in China? This paper provides a systematic review of the underlying factors affecting the initiation and sustainability of China's rural health insurance system, and discusses inadequacies of current policies.2

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Transformation of China's rural health care financing

Cited by 94 publications

References 5 publications

Barriers to increasing hospital birth rates in rural Shanxi Province, China

Barriers to increasing hospital birth rates in rural Shanxi Province, China

Financing changes of schistosomiasis control programmes in China 1980–1995: a case study in Songzi county

Financial Sector Reform in China

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