implementing rapid medical security reform in china: importance of a learning approach
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Zhenzhong ZHANG, Yunping WANG China National Health Development Research Center
Implementing Rapid Medical Security reform in
China: Importance of a Learning Approach
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Outlines
What are NCMS and MFA?
Scaling up of rural Medical Security system
Strategies for management of scaling up
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What are NCMS and MFA?Rural New Cooperative Medical Scheme (NCMS)
Medical Financial Assistance Scheme (MFA)
Objectives To relieve the finacial burden of disease, improve the health status
To relieve disease-induced poverty and improve access to health service
Target population
Overall rural population the Five Guarantee Households, poor households
Financing individual contributions, subsidies from the collectives and government
government , donation from social sectors
Benefit package
catastrophic health expense (inpatient expenditure) + outpatient expenditure
catastrophic health expenses (inpatient/outpatient expenditure)
Responsible ministry
Ministry of Health Ministry of Civil Affairs3
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What are NCMS and MFA?
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New Cooperative Medical Scheme
Demand side: rural residents
Supplier: health facilities
Government
Fiscal input
Medical Financial Scheme
Fiscal input for NCMS premiumServices Purchase
Premium contribution
Reimburse-ment for HEFiscal input
Fiscal input
payment
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2003-2009年全国新农合参合人数变化
0. 8 0. 81. 8
4. 1
7. 38. 1 8. 3
0
1
2
3
4
5
6
7
8
9
2003年 2004年 2005年 2006年 2007年 2008年 2009年
Populaton (100 mil.)
Scaling up of NCMS
数据来源:根据卫生部农村卫生管理司、卫生部新型农村合作医疗研究中心 2004-2009年统计数据整理
Start Piloting
Extend pilotingUniversal coverage
Population covered by NCMS from 2005-2009
94%
Launched in Jul. 2003
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101010102020
2040
40
30
60
60
0
50
100
150
2003-2005
2006-2007
2008-2009
2010-
2003-2009年新农合人均筹资标准
农民缴纳 地方财政 中央财政
yuan
Scaling up of NCMS
Finance of NCMS per capita (2003-2009)
Individual Local gov. Central gov.
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Real reimbursement rate of inpatients in 2008
Scaling up of NCMS
average east middle
west
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Reflections on management of scaling up
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( 1) From government side: changes in values/paradigms
Recognition and highlight the health issues
From means of convoying economy reform to one of the ultimate
goals of socio-economic development
Government dominate, considering affordablity of socio-economic
development, seek consistent development in scale and speed
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1998Basic Medical
Insurance for urban employees has been
establihed
2002NCMS and MA
proposed
2007Urban residents medical
insurance system has been established
GDP
Reflections on management of scaling up
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( 2) Strategies employed in institutional change: learning by doing
Health insurance reform: not realize in one leap over one night
Programme foundations:
• simulation experiments in 10 counties by China Network for Training and Research on Health Economics and Financing from 1997-2002;
• experiment tracking studies of Health programme since Ⅷ1998.
“Pilot comes first” and then spread incrementally to avoid massive cost of the reform.
Reflections on management of scaling up
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( 3) Bridging the gap between research and policy
All-around engagement of experts in the knowledge translation
process
• Experts panel for central + provincial government
• Contracted responsibilities for experts:
policy design,
consultation in mplementation,
M&E and etc.
• Enhance policy makers’ capacities: problem identification,
prioritizing, taking actions with acquired resources
Reflections on management of scaling up
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( 4)Management structure
Decentralized + Relatively centralized
Cross-ministries cooperation
国务
院
财政部
农业部
民政部
卫生部
教育部
人事部
中医药局
食品药品监管局
扶贫办
残联
部际联席会议办公室
省(市)自治区卫生行政部门
卫生部新型农村合作医疗研究中心
省级合作医疗管理机构
地市级合作医疗管理机构
县级合作医疗管理机构
人口计生委
发展改革委
地市级卫生行政部门
县级卫生行政部门
Reflections on management of scaling up
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( 5) Care for the engagement and voices of rural residents:
No longer the passive policy accepters under typical
top-down model
Pay attentions to their need and interest
Promote better understandings of policies:
• Leaflets, bulletin, public media
• Nearby stories with positive incentives
Reflections on management of scaling up
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[Country Name] 14
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