Health Care Reform In Urban China

This volume provides a comprehensive review of China's healthcare system and policy reforms in the context of the global economy. Following a value-chain framework, the 16 chapters cover the payers, the providers, and the producers (manufacturers) in China's system. It also provides a detailed analysis of the historical development of China's healthcare system, the current state of its broad reforms, and the uneasy balance between China's market-driven approach and governmental regulation. Most importantly, it devotes considerable attention to the major problems confronting China, including chronic illness, public health, and long-term care and economic security for the elderly. Burns and Liu have assembled the latest research from leading health economists and political scientists, as well as senior public health officials and corporate executives, making this book an essential read for industry professionals, policymakers, researchers, and students studying comparative health systems across the world.

The authors find that economic growth does not automatically improve health care, and that prioritizing health care as China has done does not necessarily lead to cost efficiency and equity in health care for the whole nation.

The on-going transition to a market economy in China is having a profound effect on health services. As a result, the government has made health one of the key policy areas, and there is now a general recognition of the need to reform urban health services. Multidisciplinary in scope, this exceptional volume draws on a prestigious report to explore how changes in health finance have affected the performance of urban health services in terms of equity and efficiency. Based on empirical evidence from the cities of Nantong, Jiangsu Province and Zibo, Shandong Province (selected for their innovative approach to health system development), the book offers an in-depth understanding of the relationship between transition, health reform and health system performance in urban settings. It features collaboration between European and Chinese academics and Chinese practitioners and officials, providing valuable background and contextual information on a complex system of healthcare, and presenting an analysis of policy impact and likely future direction.

This paper is intended to 1) present an overview of the Chinese urban health care system and its reforms in the past two decades; 2) discuss the pros and cons of the Chinese employment based health care insurance system, and 3) analyze the cost sharing health care insurance schemes, which has been introduced to the urban Chinese recently, and its impact to different social groups in urban areas, S. [...] Such pre-payments also shifted the financial risk to the provider's side by making the hospitals bear the financial burden if there is any shortage between the prepaid amount and the actual costs of the health care they provided. [...] Reform of the employee health protection system (1996 -) In early 1996, the State Commission for Economic Restructuring, the Ministry of Finance, the Ministry of Labor, and the Ministry of Health jointly drafted a document entitled "Opinions on Expanding the Number of Pilot Cities for Reform of the Employee Health Protection System". [...] Recent reform in the Chinese health care system The most recent health care system reform in China started with the issuing of the Decision on Health Care Reform and Development by the Chinese Central Committee and the State Council in 1997. [...] The main goals of the recent health care system changes in China are: 1) To establish a cost-sharing system, in order to control the growth of health care expenditure and ensure urban workers' basic health care; 2) To promote competition in the health care sectors, allowing patients to choose hospitals and doctors, and to improve service quality and efficiency; and 3) To break a regional and indus.

The report recommends that China maintain the goal and direction of its healthcare reform, and continue the shift from its current hospital-centric model that rewards volume and sales, to one that is centered on primary care, focused on improving the quality of basic health services, and delivers high-quality, cost-effective health services. With 20 commissioned background studies, more than 30 case studies, visits to 21 provinces in China, the report proposes practical, concrete steps toward a value-based integrated service model of healthcare financing and delivery, including: 1) Creating a new model of people-centered quality integrated health care that strengthens primary care as the core of the health system. This new care model is organized around the health needs of individuals and families and is integrated with higher level care and social services. 2) Continuously improve health care quality, establish an effective coordination mechanism, and actively engage all stakeholders and professional bodies to oversee improvements in quality and performance. 3) Empowering patients with knowledge and understanding of health services, so that there is more trust in the system and patients are actively engaged in their healthcare decisions. 4) Reforming public hospitals, so that they focus on complicated cases and delegate routine care to primary-care providers. 5) Changing incentives for providers, so they are rewarded for good patient health outcomes instead of the number of medical procedures used or drugs sold. 6) Boosting the status of the health workforce, especially primary-care providers, so they are better paid and supported to ensure a competent health workforce aligned with the new delivery system. 7) Allowing qualified private health providers to deliver cost-effective services and compete on a level playing field with the public sector, with the right regulatory oversight, and 8) Prioritizing public investments according to the burden of disease, where people live, and the kind of care people need on a daily basis.

This book provides an overview of the ongoing transition in China’s health system, especially focusing on the new healthcare reform initiated in 2009. First, it reviews the changes in China’s healthcare system from the 1950s to 2008, establishing the situation when the reform was introduced. The book subsequently analyzes the social and economic context in which the health system is embedded. Since the primary focus is on the new healthcare reform, the book introduces the blueprint and the year-for-year development of the new healthcare reform, as well as the specific reforms in health financing, public hospitals, and primary care. Given its central importance in the health system, the book also described major trends in long-term care in the past several years. In addition, it examines the health policy-making process with a case study of the New Cooperative Medical Scheme of China. Lastly, the book assesses the performance of China’s health system and predicts future developmental trends.

Most of the existing literature on health system reform in China deals with only one part of the reform process (for example, financing reform in rural areas, or the new system of purchasing pharmaceuticals), or consists of empirical case studies from particular cities or regions. This book gives a broad overview of the process of health system reform in China. It draws extensively both on the Western literature in health economics and on the experience of health care reform in a number of other countries, including the US, UK, Holland, and Japan, and compares China''s approach to health care reform with other countries. It also places the process of health system reform in the context of re-orienting China''s economic policy to place greater emphasis on equity and income distribution, and analyzes the interaction of the central and local governments in designing and implementing the reforms. This book will be of interest to policymakers, academics, students of health economics, health policy and health administration, and people who are interested in Chinese social policy. Sample Chapter(s). Chapter 1: Health Policy in China: Introduction and Background (189 KB). Contents: Introduction: Health Policy in China: Introduction and Background; Health Systems and Health Reform: International Models; Main Components of Health Reform: Strengthening China''s Social Insurance System; Providing Primary Care; The Hospital Sector and Hospital Reform; China''s National Drug Policy: A Work in Progress; Health Care and Harmonious Development in China: Health Policy and Inequality; Decentralized Government, Central-Local Fiscal Relations, and Health Reform; China''s Health System in the Future: Health Services in the Future: Social Insurance and Purchasing; China''s Future Health Care System: A Mixed Public-Private Model?. Readership: Policy makers, academics, students of health economics, health policy, and health administration, and people who are interested in Chinese social policy.

This dissertation, "Shifting Health Care Regimes in Urban China and the Impact on the Urban Poor" by Hui, Yang, 杨慧, was obtained from The University of Hong Kong (Pokfulam, Hong Kong) and is being sold pursuant to Creative Commons: Attribution 3.0 Hong Kong License. The content of this dissertation has not been altered in any way. We have altered the formatting in order to facilitate the ease of printing and reading of the dissertation. All rights not granted by the above license are retained by the author. DOI: 10.5353/th_b4514200 Subjects: Medical care - China Health care reform - China Urban health - China Health services accessibility - China Urban poor - China

In the last 30 years, China’s record economic growth lifted half a billion people out of poverty, with rapid urbanization providing abundant labor, cheap land, and good infrastructure. While China has avoided some of the common ills of urbanization, strains are showing as inefficient land development leads to urban sprawl and ghost towns, pollution threatens people’s health, and farmland and water resources are becoming scarce. With China’s urban population projected to rise to about one billion – or close to 70 percent of the country’s population – by 2030, China’s leaders are seeking a more coordinated urbanization process. Urban China is a joint research report by a team from the World Bank and the Development Research Center of China’s State Council which was established to address the challenges and opportunities of urbanization in China and to help China forge a new model of urbanization. The report takes as its point of departure the conviction that China's urbanization can become more efficient, inclusive, and sustainable. However, it stresses that achieving this vision will require strong support from both government and the markets for policy reforms in a number of area. The report proposes six main areas for reform: first, amending land management institutions to foster more efficient land use, denser cities, modernized agriculture, and more equitable wealth distribution; second, adjusting the hukou household registration system to increase labor mobility and provide urban migrant workers equal access to a common standard of public services; third, placing urban finances on a more sustainable footing while fostering financial discipline among local governments; fourth, improving urban planning to enhance connectivity and encourage scale and agglomeration economies; fifth, reducing environmental pressures through more efficient resource management; and sixth, improving governance at the local level.