Reforming China’s Rural Health System

Reforming China’s Rural Health System examines the performance and workings of China’s rural health system leading up to the reforms of the 2000s, outlines the reforms, and presents some early evidence on their impacts.

The authors outline ideas for building on these reforms to further strengthen China’s rural health system, covering health financing and health insurance, service delivery, and public health.

The authors conclude by using the experiences of the Organisation for Economic Co-operation and Development countries to gaze into China’s future, asking not only what China’s health system might look like, but also how China might get there from where it is today.

Reforming China’s Rural Health System will be of interest to health care policy makers, public health officials, university researchers, and others working to improve rural health and health service delivery in China and in other countries especially those in East and South Asia.

Table of Contents

1. Introduction
China's Shift from Economic Growth to "Balanced Development" • The World Bank's Analytic and Advisory Activities on China's Rural Health Sector • Overview of the Book

2. China's Health Challenges at the Start of the New Millennium
Trends in Health Outcomes • Trends in Health Inequalities • Out-of-Pocket Costs—A Barrier to Care and a Cause of Poverty • Accounting for the Household Burden • Provider Incentives, Costs, and the Quality of Care • Health Insurance Contraction • Inequality in Government Spending • Challenges and Reforms—Creating a Path Forward

3. The Rural Health Reforms of the 2000s
The New Cooperative Medical Scheme • Medical Assistance • Public Health • Provider Payment Reform • Other Reforms in Service Delivery • Sizing-Up the Recent Reforms

4. Looking toward a New Decade: The Big Picture
Health Systems—Goals, Functions, and Actors • Evolving Ideas and International Best Practice • Reform over the Medium Term • Reform over the Longer Term

5. Financing Rural Insurance Coverage
More Resources for NRCMS • Converting NRCMS into a "Purchaser" • What Should Be Covered? • Strengthening Management and Governance • Priorities and Sequencing

6. Improving Service Delivery—A Question of Incentives
Changing Provider Incentives • Enabling Providers to Respond to New Incentives • Reform Priorities, Sequencing, and Capacity

7. Enhancing Accountability and Incentives in Public Health
The Misalignment of Incentives and Accountability • Geographic Disparities in Spending • Roles and Responsibilities across Levels of Government • Clarifying Responsibilities and Financial Incentives at the County Level • Priorities, Sequencing, Political Economy, and Skills

8. The Longer-Term Reform Agenda
Limitations of the Emerging Health Insurance Model • A Dual Agenda for Financing Long-Term Reform • Getting from Here to There

9. Conclusions