Rural Health Policy Reform in China: The Impact on Primary Care Health Institutions.

摘要

China's New Rural Cooperative Medical Scheme (NCMS) aims to provide health insurance to 800 million rural citizens and correct distortions in rural Chinese health care. However, many questions about its impact on individuals and rural health care providers remain unanswered. The overall goal of this dissertation is to study the implementation of NCMS and its impact on all of the actors in China's rural health sector. To achieve my overall goal, I have four specific objectives, each pursued in the essays herein. The first objective is to determine the extent to which NCMS has been implemented in China's village households, and to examine the some of its strengths and weaknesses. The second is to measure the impact of NCMS and it's policy attributes on the most frequently visited primary health care providers in China: village clinics. My third objective is to examine the unique role of village clinics providing care and welfare benefits to the elderly, benefits that may be at risk under NCMS. Fourth, I measure the impact of NCMS and policy attributes on Township Health Centers (THCs), the main NCMS partner health facilities. Finally, in an appendix chapter, I place the recent health care reforms into a broader context of shifting public policy in China, and speculate on the potential implications of this policy shift.;To achieve my objectives, I use a nationally representative set of panel data collected in 100 villages drawn from 5 provinces in China. Detailed modules for each of the major actors - including individuals and their specific illness episodes, the clinics and hospitals they visit, and the county-level public health offices that cover them - allow me to paint a nuanced picture of China's rural health system in transition. I find that NCMS has reduced out of pocket medical spending and yielded meaningful reductions in household risk. However, current versions are not adequately meeting participants' need (and desire) for catastrophic illness coverage. Evidence suggests that better reimbursement rates may increase the important benefits the program has had for THC finances. The program must also be better calibrated to support village clinics through efficient outpatient reimbursement and subsidies to offset additional work requirements. This is particularly important given the unique welfare role played by clinicians in village communities.