Table of Contents
Foreword xi
Acknowledgments xv
Abbreviations xix
Chapter 1 Introduction 1
China's Shift from Economic Growth to "Balanced Development" 1
The World Bank's Analytic and Advisory Activities on China's Rural Health Sector 5
Overview of the Book 7
Chapter 2 China's Health Challenges at the Start of the New Millennium 13
Trends in Health Outcomes 14
Trends in Health Inequalities 18
Out-of-Pocket Costs-A Barrier to Care and a Cause of Poverty 19
Accounting for the Household Burden 22
Provider Incentives, Costs, and the Quality of Care 25
Health Insurance Contraction 28
Inequality in Government Spending 29
Challenges and Reforms-Creating a Path Forward 30
Chapter 3 The Rural Health Reforms of the 2000s 33
The New Rural Cooperative Medical Scheme 34
Medical Assistance 38
Public Health 42
Provider Payment Reform 49
Other Reforms in Service Delivery 52
Sizing Up the Recent Reforms 56
Annex: Impact Evaluation of NRCMS 57
Chapter 4 Looking Toward a New Decade: The Big Picture 61
Health Systems-Goals, Functions, and Actors 62
Evolving Ideas and International Best Practice 64
Reform over the Medium Term 72
Reform over the Longer Term 78
Chapter 5 Financing Rural Insurance Coverage 81
More Resources for NRCMS 82
Converting NRCMS into a "Purchaser" 96
What Should Be Covered? 98
Strengthening Management and Governance 107
Priorities and Sequencing 111
Chapter 6 Improving Service Delivery: A Question of Incentives 115
Changing Provider Incentives 116
Enabling Providers to Respond to New Incentives 133
Reform Priorities, Sequencing, and Capacity 143
Chapter 7 Enhancing Accountability and Incentives in Public Health147
The Misalignment of Incentives and Accountability 151
Geographic Disparities in Spending 153
Roles and Responsibilities across Levels of Government 160
Clarifying Responsibilities and Financial Incentives at the County Level 171
Priorities, Sequencing, Political Economy, and Skills 182
Annex: Case Study of Public Health Financing and Organization in Two Counties 185
Chapter 8 The Longer-Term Reform Agenda 187
Limitations of the Emerging Health Insurance Model 187
A Dual Agenda for Financing Long-Term Reform 192
Getting from Here to There 198
Chapter 9 Conclusions 201
Notes 205
References 219
Index 239
Boxes
3.1 NRCMS circa 2005 36
3.2 Medical Assistance circa 2005 39
3.3 Challenges in Estimating Public Health Spending and Comparing across Countries 46
3.4 Provider Payment Reforms in Urban China 50
3.5 Prospective Payments and Purchasing in NRCMS 52
3.6 Impacts of Treatment Protocols, Drug Lists, and Other Innovations in the Health VIII Project in Gansu Province 55
5.1 Trends in Financing Health in Rural China 83
5.2 The Benefit Package in Mexico's Popular Health Insurance Program 103
5.3 Medical Savings Accounts in China and Singapore 105
5.4 Merging of NRCMS and BMI 108
5.5 Health Insurance Governance in Estonia and Costa Rica 109
6.1 Price Regulation in China 116
6.2 International Experience with Provider Payment Reforms 120
6.3 The Importance of Inpatient Care for NRCMS 123
6.4 Setting Health Sector Prices in Japan 129
6.5 Approaches to Extra Billing 130
