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Accra, Ghana October 19-23, 2009
Extending Health Insurance: How to Make It Work
DESIGN ELEMENT 8:M&E OF HEALTH INSURANCE SCHEMES - China Case
October 19-23
Hong Wang, MD, PhDHS202 project
Establishing “Rural Mutual Health Care” (RMHC)For the Chinese Farmers
Problem: Most Chinese farmers have lost their health insurance (Cooperative Medical System) after rural economic reform since 1980, which lead them, especially the poor, unable to get appropriate basic health service. Poverty due to illness become a significant problems in rural China
Goals: To demonstrate that Chinese farmers could get better basic health services with appropriate health reform strategies. Illness-caused poverty could be also alleviated by these approaches.
Means: Social experimental study: establishing the RMHC in pilot sites, which include: a prepaid financing system to cover basic health services, a farmer’s self-governed fund management entity to improve the efficiency and
transparency of the use of RMHC fund, salary+bonus payment system to control cost and improve quality of services
provided by rural doctors. Regulations on essential drug list and practice guideline for common diseases
Benefit package
Enrollment: Voluntary participation, family-based enrollment
Funding: Premium: 15 Yuan ($2) per person per year Government matching: 20 Yuan ($2.5) Yuan per person per year
Outpatient: Co-payment rate: 50% (village), 40% (township and above) No deductible; Ceiling: 300 Yuan
Inpatient: No deductible Co-payment rate: 50% (town), 40% (county and above) Ceiling: 350Yuan (town), 1850Yuan (county and above)
Type of Evaluation
Evaluation Pre-post with control – social experimental design
A1 A2
B2B2
Intervention group
Control group
Health insurance
5
Evaluation Design – detail
RMHC Intervention sites: 3 townships Fengsan Township in Guizhou Province; Tiechang and Zhangjiaxiang Townships in
Shannxi Province Avg income per person per year is about $200 Together: 60,000 population Began enrollment in Dec 2003 and started operation immediately
Control site: 3 townships Located in the same counties as intervention site with similar socio-demographic and
economic development No any health insurance scheme
Longitudinal household/individual surveys: Baseline: Nov/Dec 2002 Follow-ups: Nov/Dec 2004, 2005, 2006, 2007
6
7
Bottom poorest 25% population
Total expenditure After medical expenditure
665
900
Exp
endi
ture
leve
l
5.4% 9.6% 16.9% 22.6%Cumulative expenditure
665
900
Exp
endi
ture
Lev
el
5.4% 9.6% 16.9% 22.6%Cumulative Expenditure
665 Yuan, 4.2% poverty due to medical expenditure
900 Yuan, 5.7% poverty due to medical expenditure5.7%
4.2%
Poverty due to medical expenditure
The effects of RMHC on poverty reduction66
590
0E
xpen
ditu
re L
evel
5.4% 9.6% 16.9% 22.6%8.2 19.1%Cumulative Expenditure
665 Yuan, 4.2% due to medical expenditure, RMHC recovered 1.4%
900Yuan, 5.7% poverty due to medical expenditure, RMHC recover ed3.5%
With RMHC coverage
Accra, Ghana October 19-23, 2009
Extending Health Insurance: How to Make It Work
Thank you