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Restructuring the Basic Health Protection System in Rural China
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... It met the health demands of most peasants before the economic reforms. Such a system helped the Chinese to greatly improve their health with low resource input [56]. The barefoot doctor model became internationally renowned in public health and health development circles, and served as an inspiration for the World Health Organization's Primary Health Care initiative [57][58][59][60]. ...
... Most of the rural population was then left with no or very limited access to health services. Poverty caused by catastrophic diseases happened frequently especially in poor rural areas, and bad health services became an obvious obstacle to socioeconomic development [56,61]. In 1997, the Chinese government decided to establish a new CMS for the rural population [62], but implementation has been slow. ...
... It met the health demands of most peasants before the economic reforms. Such a system helped the Chinese to greatly improve their health with low resource input (Zhu 2004). The barefoot doctor model became internationally renowned in public health and health development circles, and served as an inspiration for the World Health Organization's Primary Health Care initiative (White 1998;Carpenter 2000;Zakus 2002;Cueto 16 2004). ...
... Most of the rural population was then left with no or very limited access to health services. Poverty caused by catastrophic diseases happened frequently especially in poor rural areas, and bad health services became an obvious obstacle to socioeconomic development (Zhu 2004;Huang et al. 2004). In 1997, the Chinese government decided to establish a new CMS for the rural population (Central Committee of Communist Party and State Council 1997), but implementation has been slow. ...
Since the socioeconomic reforms in China in the late 1970s the improvement of maternal and child health (MCH), which was once considered one of the great achievements of China after 1949, has slowed and some indicators show that the situation in some regions, especially in rural areas, is getting worse instead of better. This article will focus on policy and policy-related issues in the delivery of MCH services. It will cover historical changes in policy and their effects, especially in the financing of MCH. In addition, it will also touch upon new practices of MCH in the new cooperative medical scheme (NCMS) in present-day rural China.
... In addition, this increased inequality as well as reduced the ability of the poor to access health care services in China. This situation creates greater health vulnerability for those who are initially at greater risk of disease but not under the cover of social protection (Zhu, 2004). This had negative ramification for health care provisions in terms of vulnerability as health stricken households resort to out-of-pocket expenditure with which most of China's people pay for basic level of care at clinics or outpatient departments of hospitals (Henderson et al., 1994). ...
La thèse traite les questions abordées par la vulnérabilité, la décentralisation fiscale et les services publics en Chine. Le processus de développement était remarquable avec une croissance phénoménale et avec une réduction de la pauvreté massive. En même temps, il y avait de grandes réformes dans les secteurs publics notamment dans les domaines de l’éducation et de la santé. Le thème de la thèse est contemporain puisque la perspective de la vulnérabilité est considérée un défi important pour résoudre le problème de la pauvreté. Celle-ci est liée étroitement aux politiques menées dans le secteur public en général, plus précisément dans la décentralisation fiscale. La thèse présente une méthodologie pour estimer l’évolution de la vulnérabilité par région en Chine. Cela est fait à travers des actifs liquides, la capitale humaine et la santé publique. La vulnérabilité est estimée par un indice de la décomposition de Theil et celle- ci est introduite dans une régression logistique. La conclusion est la suivante : Premièrement, les actifs liquides contribuent à une réduction de la vulnérabilité. En revanche, la santé publique ne réduit pas la vulnérabilité. Deuxièmement, la région Ouest et la région Intérieur ont une vulnérabilité plus élevée par rapport à la région Est. Troisième, l’inégalité dans une région contribue 20-30% à la vulnérabilité, cependant, celle-là entre les régions contribue 80-70% à la vulnérabilité. La recherche dans la thèse montre également que les services publics ont un effet déterminant à la décentralisation fiscale en utilisant le MCO, les effets fixés, la DMC et la DMC avec les effets fixés. Ceux-ci sont appliques aux différentes variables de la décentralisation fiscale, respectivement, les dépenses publiques, les revenus publics, les dépenses publiques extrabudgetaires et les revenus publics extrabudgetaires. La conclusion est que la qualité dans le secteur d’éducatif au niveau secondaire et supérieure ont des impacts négatifs sur la décentralisation fiscale probablement à cause des effets de « spill-over » qui sont liées aux migrations, au coût fixe (au niveau supérieure) et à l’économie d’échelle. En revanche, le secteur de la santé n’a presque aucun effet. En plus, les revenus extrabudgétaires ainsi que les dépenses extrabudgétaires ont une corrélation très forte. La thèse aborde également une analyse de l ’ impact sur la vulnérabilité, mesurée avec la variable de la consommation alimentaire, par les qualités des services publics dans les secteurs de l’éducation et dans la santé publique. Celle-ci est faite à travers le MCO, les effets fixés, la DMC et la DMC avec les effets fixés. En plus, un test de robustesse est introduit avec un retard de 1 et 2 ans. La conclusion est les suivants : Premièrement, la qualité des services publics dans l’éducation aux niveaux secondaire et supérieur a des impacts négatifs sur la vulnérabilité. Deuxièmement, l’éducation au niveau primaire augmente la vulnérabilité, probablement à cause de l ’inégalité. Troisièmement, la qualité des services publics dans le secteur de la santé a peu des effets sur la vulnérabilité.
La recherche dans la thèse est fondée sur la base des données suivants : (i) China Datacenter de Université de Michigan sur le service public; (ii) Annuaire statistique de la Chine; (iii) Prof. Yiu Por Chen, Université de DePaul à Chicago sur la décentralisation politique ; (iv) Prof. Belton M. Fleicher et Prof Min Qiang, Université d’Ohio sur le capital humain ; et (v) Prof. Jing Jin de John Hopkins Université et Prof. Heng-fu Zou, Banque Mondiale sur la décentralisation fiscale. La recommandation politique de la thèse est que la vulnérabilité peut être réduire substantiellement par une politique du service social bien ciblé. Cependant, la décentralisation fiscale en Chine a suscité l ’introduction de frais d ’ usage qui est devenu une barrière pour accéder aux services essentiels, notamment dans la région rurale. C’est la raison pour laquelle la décentralisation fiscale devrait être accompagnée d ’ une enveloppe fiscale pour la région pauvre afin d ’assurer les services publics pour tous les citoyens de la Chine
... In India this was primarily due to the fiscal discipline imposed by the macroeconomic crisis, while in China market-oriented reforms introduced the logic of profit in the management of social services. This implied progressive privatization of supply agencies, a decline in government subsidies, and an increase in education and health costs, leading to an increase in school dropouts and in the health vulnerability of the population (Zhu 2004). In devising mechanisms to address the risks involved in the increased privatization of social services, China could learn from India's long experience with a vast array of government safety nets and welfare programs targeting the rural population. ...
"China's and India's rapid rise in the global arena has not only captured the attention of the world but has also set into motion a rethinking of the very paradigm of economic development....Today, China and India together account for 40 percent of the world's population. Both have implemented a series of economic reforms in the past two and half decades: China initiated this process at the end of the 1970s, while India began in the early 1990s. These reforms have led to rapid economic growth, with a growth rate of 8–9 percent per annum in China and 6–7 percent per annum in India. Despite similar trends in the reforms, the two countries have taken different reform paths; China started off with reforms in the agriculture sector and in rural areas, while India started by liberalizing and reforming the manufacturing sector. These differences have led to different growth rates and, more importantly, different rates of poverty reduction. They also have fundamentally different implications for growth and poverty reduction in the future. What can we learn from the process of economic reform in these two countries?... A number of studies looking into key aspects of reform and their relationship to outcomes, presented at two international workshops held in New Delhi and Beijing, try to offer some answers to these questions. These papers are currently being prepared by IFPRI for publication, and this discussion paper is a synopsis presented as a forerunner to the book. " from Authors' Abstract
The research of this thesis focuses on the nexus of vulnerability (or the risk to become poor), fiscal decentralization and public service delivery in the perspective of the development of China during the last 50 years. This development has been remarkable: a consistent high level of economic growth, a massive reduction of poverty and at the same time wide and fundamental reform of the public sector. The subject is a contemporary issue in particularly as vulnerability is considered a key for addressing the poverty challenges in the world and is strongly related to public services and decentralisation. The thesis presents a methodology to estimate the evolution of vulnerability by region through analysis of household assets consisting of liquid resources, human capital and health care. This is done on the basis of provincial level panel data in China from 1985 to 2001. Asset composition is estimated through an one-stage Theil decomposition index which is introduced into a logistic regression. The conclusion is threefold: Firstly, liquid assets and human capital contribute to the reduction of vulnerability, while health care does not reduce vulnerability. Secondly, Interior and Western regions have higher degree of vulnerability, while the Eastern region has lower vulnerability. Thirdly, inequalities within regions contribute about 20-30% to vulnerability, while inequality between regions contributes about 70-80% to vulnerability. The research provides also empirical evidence on the extend that public service delivery is a determinant of fiscal decentralization by using OLS regression, OLS regression with Fixed Effect, Two-Stage Least Square (TSLS) and TSLS with FE to analyze the effects of various education and health variables on fiscal decentralization. This is undertaken on the revenue and the expenditure side, as well as on the growth of extra-budget revenues and extra-budget expenditures. The conclusion is that the quality of secondary and higher education has overall a negative impact on the fiscal decentralization, probably due to lack of internationalization of spill-over effect caused by huge migration in China. Also part of the research is an analysis of the impact on vulnerability, as measured by the dependent variable food consumption, by the quality of public services delivery in the education and health sector. This is undertaken through an OLS, OLS with Fixed effect, Two Stage Least Square (TSLS) and TSLS with Fixed Effect regressions as well as robustness tests through lags of respective one and two years. The conclusion is fourfold: (i) the quality of primary education has a negative impact on vulnerability, probable due to high inequality and to the selection bias of children from poor families being taken out of school (Connelly and Zheng, 2003); (ii) the quality of the secondary education service has a negative impact on vulnerability in all time lags with TSLS with Fixed Effect. Therefore, these results are strongly robust; (iii) the quality of higher education service has a negative impact on vulnerability. However, these results are less robust than the one with secondary education; and (iv) the health care has also a partially positive impact under the fixed effect. The research in this thesis is based on datasets from five sources: (i) China Datacenter of Michigan University; (ii) China Statistical yearbook; (iii) Prof. Belton M. Fleisher and Prof. Min Qiang of Ohio University on human capital; (iv) Prof. Jing Jin of John Hopkins University and Prof. Heng-fu Zou of the World Bank on fiscal decentralization; and (v) Prof. Yiu Por Chen of DePaul University in Chicago on political decentralization. The policy implication of the thesis is that vulnerability can be reduced substantially through social service delivery. However, fiscal decentralization in China has led to the introduction of userfees which form a barrier for the poor, particularly in the rural areas. The fiscal decentralization policies therefore need be accompanied by a fiscal envelope for poor regions to ensure that basic services are available and accessible to all citizens
(Abstract) Based on the local archive and author's case studies in addition to a sample survey this paper will review the historical development of the cooperative health insurance system and analyze the problems emerging in the ongoing experiment of reestablishing the cooperative systems. It is concluded that the cooperative insurance neither can effectively disperse risks among participants within a village or a township, nor can it undertake the function of poverty reduction. This is because the scale of the population within a village or a township is small while the organizational costs of the cooperative insurance are relatively high. A way out of such difficulties is to build an integrated social health insurance system for both urban and rural people in highly industrialized counties. For the rest of the rural areas it is already proved that both the farmers households and the government at different levels are willing to pay to the health programs designed for preventing the most vulnerable groups from specific diseases. Certainly, a more economic and feasible practice for poverty reduction purpose is to set up both government and non-government relief funds to assist the poor to have access to the basic health care services.
The necessity to establish the rural health protection system in China and relevant policies (Lun jianli zhongguo nongcun jiankang baozhang zhidu zhi biyaoxing he xiangguan de zhengce wenti)
- Liu Yuanli
- Rao Keqin
- Hu Shanlian
Liu Yuanli, Rao Keqin and Hu Shanlian, 2001. The necessity to establish the rural health protection system in China and relevant policies (Lun jianli zhongguo nongcun jiankang baozhang zhidu zhi biyaoxing he xiangguan de zhengce wenti), (Research Report), pp.7-9, presented at the International Symposium “Rural Basic Safety Nets in China”, July 9-10. Beijing
Management Bureau of the State Chinese Medicine Collection of Frequently Used Health Regulations and Rules (Changyong weisheng fagui huibian), Beijing: Law Press
- Public Ministry
- P R Health
- China
Ministry of Public Health of P. R. China, Management Bureau of the State Chinese Medicine, 2002. Collection of Frequently Used Health Regulations and Rules (Changyong weisheng fagui huibian), Beijing: Law Press. National Bureau Statistics, Statistical Yearbook of China, 1999 and 2002, Beijing: China Statistics Press