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| 1 |
ID:
092526
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2009.
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| Summary/Abstract |
China has recently unveiled an ambitious new health-care reform plan, entailing a doubling of government health spending as well as a number of concrete reforms. While the details of the plan have not yet been completely announced, we offer a preliminary assessment of how well the reform is likely to achieve its stated goal of assuring every citizen equal access to affordable basic health care. The reform is based on three fundamental tenets: strong role of government in health, commitment to equity, and willingness to experiment with regulated market approaches. Within this framework, the reform offers a number of laudable changes to the health system, including an increase in public health financing, an expansion of primary health facilities and an increase in subsidies to achieve universal insurance coverage. However, it fails to address the root causes of the wastes and inefficiencies plaguing China's health care system, such as a fragmented delivery system and provider incentives to over-provide expensive tests and services. We conclude that China should consider changing the provider payment method from fee-for-service to a prospective payment method such as DRG or capitation with pay-for-performance, and to develop purchasing agencies that represent the interests of the population so as to enhance competition.
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| 2 |
ID:
174743
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| Summary/Abstract |
Last year in this journal, I offered an explanation for America’s high health care costs rooted in the concept of “supply-side moral hazard,” and advocated for an all-payer system of price regulation as an appropriate policy response. The good news—particularly in the current time of pandemic—is that politicians and health services researchers are beginning to acknowledge the need for some form of price regulation. Legislative proposals thus far have focused narrowly on pharmaceutical prices and “surprise billing” for out-of-network charges. However, a few months ago, in March 2020, three Harvard researchers released a more comprehensive proposal. The bad news is that the proposal would preserve a large role for market forces, which, I argue here, amounts to going into battle against high health care costs with one hand tied behind your back. Furthermore, the reliance on private markets would lock in place the rampant inequality and Byzantine complexity bedeviling American health care.
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| 3 |
ID:
163507
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In order to change the situation that reimbursement rate of the new rural cooperative medical care system (NCMS) was too low to alleviate farmers medical burden, in August 2012, China began to expand the coverage of the NCMS to include the treatment of critical illnesses. Could more effective health insurance promote the consumption of rural residents? We studied the impact of the critical illness insurance (CII) on rural household consumption, and find that the CII increases per capita household daily consumption by >15%. But healthcare and medical expenditures have not been affected. Our comparison of outcomes for households with different levels of consumption and income shows the CII mainly promote the consumption of rural affluent family, but no incentive for poor family, resulting in deterioration of consumption inequality of rural households. The finding is robust to various alternative hypotheses and specifications.
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| 4 |
ID:
163337
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In the late 1990s, the Chinese government initiated dramatic reform in its state-sector enterprises, which caused millions of workers to lose their jobs. Using data obtained from the China Health and Nutrition Survey, we employ fixed-effect methods to explore the effects of displacement on the dismissed workers' health status. Our results show that these displaced workers are more likely to report having poor health and suffer from chronic conditions, such as hypertension and stroke. The effect on chronic conditions appears only in the long run. In addition, we find that the displaced workers are less likely to be covered by health insurance, less likely to see a doctor when they are ill, and more likely to engage in unhealthy behavior such as smoking, which may help explain the poor health outcomes of these individuals. Moreover, we show that the health effects are heterogeneous among different groups of individuals.
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| 5 |
ID:
139562
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| Summary/Abstract |
China's social health insurance has expanded dramatically over the past decade. The increasing number of beneficiaries and benefits, however, has aggravated rather than mitigated regional disparities in health care. How can the regional variation in Chinese social health insurance be explained? This paper argues that the subnational variation in China's social health insurance results from the policy choices of central and local states. The central leadership, which is concerned about regime stability, delegates substantial discretionary authority to local state agents to accommodate diverse social needs and local circumstances. Local officials, who care about their political careers in the centralized personnel system, proactively design and implement social health insurance policy according to local situations such as fiscal resources and social risk. In specifying the rationale, conditions and patterns of regional variation in Chinese social health insurance, this paper addresses the general issue of how political leaders in an authoritarian regime respond to social needs.
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| 6 |
ID:
156668
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| Summary/Abstract |
Frictions between China’s institutional legacies of the planned economy and the new trends of marketization, urbanization, and migration have shaped institutional change in social protection. Focusing on health and pension insurance, this study identifies a gradual process of functional integration, which overcomes the frictions and facilitates a dualization of benefits.
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| 7 |
ID:
143418
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| Summary/Abstract |
This paper aims to evaluate the impact of 1998 Chinese health care reform on out-of-pocket expenditure and on saving. Existing evidence on the results achieved by this reform in terms of reduction of out-of-pocket medical expenditures is still mixed and contradictory, and very little is known about the impact of these measures on the consumption and saving behavior of the Chinese population. To shed more light on this issue we use data collected in 1995 and 2002 by the Chinese Household Income Project (CHIP). Contrary to previous evidence, our findings suggest that the effects of the reform have been more articulated and heterogeneous. In fact, we find that once properly accounting for income distribution and unobserved heterogeneity (potentially induced by health status), out-of-pocket medical expenses and saving rate are affected by the reform in a differentiated way. In particular, we find that out-of-pocket expenses decrease only for high income individuals with good health status and the saving rate increases only for low income individuals with good health status. This result is actually worrisome, as it suggests that the public health coverage after the reform provides financial protection only to individuals that are relatively better off (with good health status and/or high income).
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| 8 |
ID:
142602
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| Summary/Abstract |
We used individual level survey data to examine the distribution of health insurance and other welfare programs by the Dravida Munnetra Kazhagam (DMK) government in Tamil Nadu. Core DMK supporters were more likely to receive welfare benefits than swing voters and opposition loyalists. Political analysis is important to understand motivations for establishing these programs.
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| 9 |
ID:
151562
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| Summary/Abstract |
Since the early 2000s, the Chinese government has undertaken a series of reforms in the health sector. Among these, the three most important have been concerned with medical insurance, hospital administration, and pharmaceutical policies. The aims of these reforms were to extend health insurance coverage, to increase the activities and the efficiency of the health establishments, and to improve patient care. This article focuses on two components of these reforms: the development of health insurance in rural areas and the policy on essential medicines in conjunction with hospital reforms. Our longstanding co-operation with a research team from Weifang University and with the Weifang Health Bureau allowed us to follow these reforms and collect data (primary source) from a sample of township hospitals from Weifang Prefecture. Those data allowed us to study their effects on health facilities' level of activity and efficiency. This article provides an overview of studies we carried out on these issues over the period from 2000 to 2012. Our analyses were mainly based on non-parametric models (Data Envelopment Analysis, Malmquist Index, and partial frontiers) and impact analyses, coupled with interviews with hospital staff and medical authorities. Results show that the development of health insurance in rural areas had a positive effect in greatly increasing the activities of the hospitals covered by our study. On the other hand, it did not have a positive influence on their efficiency, which declined in the period concerned. This result is to be explained by the fact that, even though staff activity increased, it remained low, since the observed increase in activity was not sufficient to make up for the parallel increase in staff numbers. Similarly, reforms in the hospital and pharmaceutical sectors had no effect on the township hospitals of our survey. In fact, in order to compensate for the observed reduction of hospital resources following the introduction of the reforms, on the one hand the government increased the subsidies allocated to township hospitals, and on the other hand the hospitals strongly innovated in sophisticated and expensive care, to the benefit of a relatively small number of patients. Therefore, there were some very positive steps forward, but they still call for a more nuanced assessment of the effects of the reforms.
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| 10 |
ID:
160092
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| Summary/Abstract |
The utilization of health care services by veterans has received much attention in recent years. However, the impact of the large array of factors affecting the veterans’ demand for health care services remains understudied. These factors include individual socio-demographic and economic characteristics, the availability of various sources of health insurance, and the prevalence of medical conditions. We use public data to analyze how veterans’ utilization of health care services varies with these factors. We also analyze how the reliance on VA services varies when alternative sources of health insurance are available to veterans. Based on the estimated relationships, we use a micro-simulation model to forecast future health care utilization, both inside and outside of VA.
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| 11 |
ID:
102245
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| Publication |
2010.
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| Summary/Abstract |
How can healthcare access for Chinese migrants be improved? Migrant workers face two types of healthcare-access exclusion in the workplace: one is financial (because of their income) and the other is social (because of the lack of social networks in the city). We use 2006 data from a survey of rural migrant workers conducted in five of the most economically-advanced cities. The empirical findings support the hypothesis of a return to the hometown for migrant workers with poor health. Apart from residency permits and income, the social integration of migrant workers is also found to be a decisive factor in healthcare access.
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| 12 |
ID:
126897
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| 13 |
ID:
147646
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| Summary/Abstract |
Most migrant workers in mainland China are officially covered by the New Rural Cooperative Medical System (NRCMS), a rural health insurance system that operates in their home communities. The NRCMS and the system of household registration (户口, hukou) are tightly linked and systemically interdependent institutions. Migrant workers have difficulties benefitting from this social protection because it remains spatially separated from them. Only a minority have access to urban health insurance systems. This paper sheds light on the institutional origins of the coverage problem of migrant workers and examines crucial policy initiatives that attempt to solve it. In the context of the ongoing hukou reforms, these policies aim to partially dissolve the systemic interdependence of hukou and health insurance. While the policies provide feasible, yet conflict-prone, solutions in short-distance and concentrated bilateral migration systems, covering migrants who cross provincial boundaries remains a challenge.
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| 14 |
ID:
163521
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| Summary/Abstract |
Policymakers are interested in the impact of health insurance on individuals’ medical expenditures—not only the average effect for the overall population, but also the possible heterogeneous effects for subgroups. This paper focuses on the heterogeneous impacts of a nationwide health insurance program in China, the New Rural Cooperative Medical Scheme, on its enrollees’ out-of-pocket (OOP) expenditures for different income groups, since previous studies find no significant reduction in OOP for the general population. We firstly develop a theoretical model, showing that the reduction in OOP for the rich would be greater. Then, we test the theoretical prediction using a unique sample. The empirical finding is consistent with the model prediction, and the pattern of income-dependent impacts is robust to different estimation strategies.
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| 15 |
ID:
178243
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| Summary/Abstract |
In December 2017, Congress repealed the individual insurance mandate penalty. Given the poor health status of veterans, their higher demands for health insurance, and the substantial number of uninsured veterans, the repeal of the individual mandate should have a significant impact on the veterans. This article investigates how the repeal of the individual mandate effective in January 2019 is likely to affect the number of uninsured veterans and their enrollments in Veterans Affairs (VA) insurance. By analyzing 52,692 nonelderly veterans in Florida and California from 2008 to 2017, the findings suggest that the repeal will lead to a considerable increase in the number of uninsured veterans. Veterans who are unemployed, poor, and suffering disabilities are more likely to sign up for the VA insurance than better-off veterans. Thus, one of the important functions of veteran health care is to serve as a social safety net for vulnerable veterans. Thus, the Veterans Health Administration should establish a policy to minimize the expected negative repercussions of the repeal.
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| 16 |
ID:
115083
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| Publication |
2012.
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| Summary/Abstract |
When did America quit bragging? When did we stop punching hardest, kicking highest, roaring loudest, beating the devil, and leaving everybody else in the dust?
We're the richest country on earth-four and a half percent of the world's people producing more than twenty percent of the world's wealth. But you wouldn't know from the cheapjack spending squabbles in Congress. We possess more military power than the rest of the planet combined. Though you couldn't tell by the way we're treated by everyone from the impotent Kremlin to the raggedy councils of the Taliban. The earth is ours. We have the might and means to achieve the spectacular-and no intention of doing so.
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| 17 |
ID:
091447
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| Publication |
2009.
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| Summary/Abstract |
The objective of this paper is to examine whether rural people of India depends more on the private healthcare tratment or not and in the era of declining public expenditure in the healthcare and privatization what the different types of financial avenues are available to them to meet the expanding healthcare cost. Another objective is to show how health insurance can help to meet the catastrophic healthcare expenses.
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| 18 |
ID:
129055
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| Publication |
2014.
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| Summary/Abstract |
Health insurance has been one of the major forms of health financing in China since the 1950s. Health insurance in China has seen dramatic shifts given the different economic and political contexts. From an almost universal coverage and access to health services in the pre-reforms period, China witnessed tremendous inequities in access with the breakdown of its collective financing structures and rising costs of health care in the 1980s and 1990s in both rural and urban areas with the onset of economic reforms. As a result policies in the late 1990s and 2000s shifted towards universalising access by introducing different insurance schemes for the urban and rural population. This article attempts to trace this transformation in insurance schemes through three distinct phases and draws lessons for access to health services.
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