World Health Organization : Year 1996 ; World Health Organization, International Conference, Macroeconomic Development and the Health Sector.20: The Reform of the Rural Cooperative Medical System in the People’s Republic of China

By Wang Shucheng

Book Id: WPLBN0000136399
Format Type: PDF eBook:
File Size: 2.50 MB
Reproduction Date: 2005

Title:	World Health Organization : Year 1996 ; World Health Organization, International Conference, Macroeconomic Development and the Health Sector.20: The Reform of the Rural Cooperative Medical System in the People’s Republic of China
Author:	Wang Shucheng
Volume:
Language:	English
Subject:	Health., Public health, Wellness programs
Collections:	Medical Library Collection, World Health Collection
Historic Publication Date:
Publisher:	World Health Organization


Citation APA MLA Chicago Shucheng, B. W. (n.d.). World Health Organization : Year 1996 ; World Health Organization, International Conference, Macroeconomic Development and the Health Sector.20. Retrieved from http://gutenberg.cc/

Description
Medical Reference Publication

Excerpt
INTRODUCTION At the end of the seventies, China boasted a cooperative medical system that was in place in about 95% of villages. This system involved community participation and costsharing, and enabled access to basic health care to farmers. However, a break in this system occurred as the result of widespread market economic reforms. These reforms basically involved a shift from a communal to a household production system. As a result the collective way of financing rural health care was more or less abandoned and, by 1993, only 10% of villages remained covered by a cooperative medical system. However, the Government of the P.R. of China remained aware of the need to arrange for some form of social protectian against health care expenses, so that access to care could be secured. In March 1994, it initiated a RCMS Project to reestablish the rural cooperative medical system (RCMS). This Project is implemented on a pilot basis in 14 counties of 7 provinces. The present paper gives an overview of this Project, its results and its experience obtained from March 1994 until September 1995.

Table of Contents
contents INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1 . THE ECONOMY AND THE HEALTH CARE SYSTEM IN CHINA: A BRLEF OVERVIEW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1.1 Some salient features of the economy . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1.1.1 Labour fo~ce . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1.1.2 Level, growth and disnibution of the Gross Domestic Product . . . 2 1.1.3 Government finance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 1.1.4 Declining state ownership . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 1.1.5 The inflation problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 1.2 The health care system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 1.2.1 The health care delivery system . . . . . . . . . . . . . . . . . . . . . . . . 7 1.2.2 The health care financing system . . . . . . . . . . . . . . . . . . . . . . . 8 1.2.3 RCMS Policy 1950-1993 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 1.2.4 The urban-rural disparity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 2 . TI& RCMS PROJEn 1994-1997 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 2.1 Political process to reestablish the RCMS . . . . . . . . . . . . . . . . . . . . . . . 14 2.2 Responsibility for the RCMS Project . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 2.3 RCMS Project workplan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 2.4 Workplan implementation to date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 2.5 Activities regarding RCMS legislation . . . . . . . . . . . . . . . . . . . . . . . . . . 21 3 . RESULTS OF PREPARATORY HOUSEHOLD SURVEYS . . . . . . . . . . . . . . . . . 22 3.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ..... 22 3.2 Average income in 1993 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 3.3 Average health care expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 3.4 The structure of health care expenses . . . . . . . . . . . . . . . . . . . . . . . . . . 24 3.5 Non-use of publicly-provided health services . . . . . . . . . . . . . . . . . . . . . 25 3.5.1 The level of non-use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 3.5.2 The causes of non-use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 3.5.3 Attitudes about the RCMS . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 4 . INFORMATION FROM IMPLEMENTATION OF THE RCMS . . . . . . . . . . . . . 27 4.1 Variation in county design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 4.2 Population coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 4.3 Management level . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 4.4 Con~ributions to the RCMS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 4.5 Benefits and reimbursement structure . . . . . . . . . . . . . . . . . . . . . . . . . . 29 4.6 Provider payment arrangements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 4.7 Information system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30