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The policy process and policy context of NCMS and MFA in China

Vientiane, Oct. 2008

Wang Yunping , CHEI

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What is NCMS &MFA?• NCMS (Rural New Cooperative Medical Scheme) - based on government organization, guidance and support; - financed by individuals, collectives and the government; - target at all rural residents, but with voluntary participation; - pooling funds against medical expenses of major illness;• MFA (Rural Medical Financial Assistance Scheme ) - financed by government revenues & volunteer donations - target at rural HH entitled to “Five-Guarantees” & “Minimum

living standard” , special poor HH - financial assistance in (pay the premium for NCMS, pay the

co-payment in NCMS, secondary assistance after NCMS reimbursement for some specific major illness )

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The policy development of NCMS & MFA

1990 2007

1996first national health conference:the principles of rebuilding CMS

1999misunderstanding and improper implementation of alleviating farmers' burden by local government

2000Focus event: issue concerning agriculture, countryside and farmers exploded

2001Focus event: report on current rural health by Li Jiange stired the attention from central government

200216th NCCPC “ Xiao Kang Society”

2003Opinions on implementing NCMS and MFA, MOH MOCA

20066th plenum of 16th CCCPC, “ harmonious society” ,“ universal coverage of essential health care”

2004MOH, MOCA

2005MOH, MOF, documents on funds regulation

2002“ Decisions on further strengthening the rural health work” , CCCPC&SC

2006MOH & etc.,

"Notice on Accelerating Pilot Work of NCMS"

2003SARS outbroke

1996Decison on alleviating farmers' financial burden

1990 - 2000field studis by WB, WHO, DFID,Rand corporation,and etc., MOH

1997CCCPC,SC,MOH propose to rebuild CMS

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Research questions How have been the policy process of the rural New

Cooperative Medical Scheme (NCMS) and rural Medical Finance Assistance Scheme (MFA) developing at national level?

What are the impact of policy context on the policy process of NCMS and MFA?

What are the impact of the interplay of relevant stakeholders on the policy process of NCMS and MFA?

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Research methods Literature review: documents/published papers/gray

reports/ news

Key informants interview: officials from MOH, MOCA, MOF and their local Bureaus; hospital managers (county/township)

Group discussion: rural residents

Participatory observation research: policy seminar by MOCA, relevant workshops

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Main findings 1: impact of the transitional policy context

Impact of economic transition: - the urban-rural dualistic structure; - sufficient revenues

Impact of social structure transformation: - “strong state, weak society” to “limited state, weak society ”; - inequitable share of social assets; - health issues ranked top of most crucial social problems;

Impact of changes in decision-making model and policy paradigm: - “individual decision making” – “Party leadership makes the decisions

jointly”-”more participatory and internal democratic decision making”; - policy paradigms shift from “policies centered on economic growth” to

“harmonious development”;

Impact of overall health sector reform: - priority of rural health increased

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Inside the government circle:

• Stakeholders: central/local government; different ministries/departments

• In common: state public interests; maintain/gain political support, advance their political careers, expend their resources Diversity: - central government: show its great commitment; pull the local input; strengthen the supervision - Local government: assessment of cost-benefit

- MOH: inconsistent role in managing interests of supply/demand side - MOCA: ensure rural poor’s equal access, efficient use of MFA fund - MOF: finance according to the priority - MOA: reduce rural residents’ financial burden

Main findings 2: Stakeholder analysis

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Outside the government circle:

• Think-tanks: policy “gatekeepers”

• Delegates of the NPC and CPPCC: complex role in representing the interest of public/certain social groups

• Health providers: - potentially major influence in policy implementation; - balance between maximizing their interests and serving the public

interest

• Rural residents: - difficult to form a united front with an influential voice; - passive recipients of policies

Main findings 2: Stakeholder analysis

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Challenges in further analysis

How to track and evaluate the influence of the stakeholders on rural health process in such a rapid transitional context?

How to capitalize on the rising citizen consciousness in the development of rural health policy ?

- Improve the governance structure? - Adjust the governance tools?

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Thanks !

Thanks!

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