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The cost of coverage: rural health insurance in China
Karolinska institutet, Stockholm, Sweden.ORCID iD: 0000-0003-0368-050X
Department of Health Statistics and Community Medicine .
Shanghai Medical University, People's Republic of China.
Shanghai Medical University, People's Republic of China.
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1996 (English)In: Health Policy and Planning, ISSN 0268-1080, E-ISSN 1460-2237, Vol. 11, no 3, 238-52 p.Article in journal (Refereed) Published
Abstract [en]

China has undergone great economic and social change since 1978 with far reaching implications for the health care system and ultimately for the health status of the population. The Chinese Medical Reform of the 1980s made cost recovery a primary objective. The urban population is mostly protected by generous government health insurance. A high share government budget is allocated to urban health care. Rural cooperative health insurance reached a peak in the mid-1970s when 90% of the rural population were covered. In the 1980s rural cooperative health insurance collapsed and present coverage is less than 8%. The decline has been accompanied by reports of growing equity problems in the financing of and access to health care. This article is the first in a four-year study of the impact on equity of the changes in Chinese health care financing. The article examines the relationship between rural cooperative health insurance as the explanatory variable and health care expenditure, curative vs. preventive expenditure and tertiary curative care expenditure as dependent variables using a natural experimental design with a 'twin' county as a control. The findings support the hypothesis that cooperative health insurance will induce higher growth of health care expenditure. The findings also support the hypothesis that cooperative health insurance will lead to a shift from preventive medicine to curative medicine and to a higher level of tertiary curative care expenditure. The empirical evidence from the Chinese counties is contradicting World Bank health financing policies.

Place, publisher, year, edition, pages
Oxford University Press, 1996. Vol. 11, no 3, 238-52 p.
Keyword [en]
health insurance, equity, health financing, China, universal health coverage
National Category
Medical and Health Sciences
Research subject
Care Sciences
Identifiers
URN: urn:nbn:se:mdh:diva-11669DOI: 10.1093/heapol/11.3.238ISI: A1996VL03000002PubMedID: 10160371OAI: oai:DiVA.org:mdh-11669DiVA: diva2:394135
Projects
SAREC
Funder
Sida - Swedish International Development Cooperation Agency
Available from: 2011-02-03 Created: 2011-02-01 Last updated: 2015-08-05Bibliographically approved

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CiteExportLink to record
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Citation style
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