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Public vs private administration of rural health insurance schemes: a comparative study in Zhejiang of China

Published online by Cambridge University Press:  04 October 2012

Xiaoyuan Zhou ,
Zhengzhong Mao ,
Bernd Rechel ,
Chaojie Liu ,
Jialin Jiang  and
Yinying Zhang
Xiaoyuan Zhou
Affiliation:
Lecturer, Huaxi School of Public Health, Sichuan University, Chengdu, China
Zhengzhong Mao*
Affiliation:
Professor, Huaxi School of Public Health, Sichuan University, Chengdu, China
Bernd Rechel
Affiliation:
Researcher, European Observatory on Health Systems and Policies, London School of Hygiene & Tropical Medicine, London, UK
Chaojie Liu
Affiliation:
Associate Professor, School of Public Health of La Trobe University, Melbourne, Australia
Jialin Jiang
Affiliation:
Lecturer, Huaxi School of Public Health, Sichuan University, Chengdu, China
Yinying Zhang
Affiliation:
Lecturer, Huaxi School of Public Health, Sichuan University, Chengdu, China
*
*Correspondence to: Professor Zhengzhong Mao, Vice president of Health Economics Association of China, Head of the Department of Health Economics, Huaxi School of Public Health, Sichuan University, Chengdu 610041, China. E-mail: [email protected]
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Abstract

Since 2003, China has experimented in some of the country's counties with the private administration of the New Cooperative Medical Scheme (NCMS), a publicly subsidized health insurance scheme for rural populations. Our study compared the effectiveness and efficiency of private vs public administration in four counties in one of China's most affluent provinces in the initial stage of the NCMS's implementation. The study was undertaken in Ningbo city of Zhejiang province. Out of 10 counties in Ningbo, two counties with private administration for the NCMS (Beilun and Ninghai) were compared with two others counties with public administration (Zhenhai and Fenghua), using the following indicators: (1) proportion of enrollees who were compensated for inpatient care; (2) average reimbursement–expense ratio per episode of inpatient care; (3) overall administration cost; (4) enrollee satisfaction. Data from 2004 to 2006 were collected from the local health authorities, hospitals and the contracted insurance companies, supplemented by a randomized household questionnaire survey covering 176 households and 479 household members. In our sample counties, private administration of the NCMS neither reduced transaction costs, nor improved the benefits of enrollees. Enrollees covered by the publicly administered NCMS were more likely to be satisfied with the insurance scheme than those covered by the privately administered NCMS. Experience in the selected counties suggests that private administration of the NCMS did not deliver the hoped-for results. We conclude that caution needs to be exercised in extending private administration of the NCMS.

Type
Articles
Information
Health Economics, Policy and Law , Volume 8 , Issue 3 , July 2013 , pp. 269 - 288
Copyright
Copyright © Cambridge University Press 2012 

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References

Alcorn, T.Bao, B. (2011), ‘China progresses with health reform but challenges remain’, The Lancet, 377: 1557–1558.CrossRefGoogle ScholarPubMed
Babiarz, K. S., Miller, G., Yi, H., Zhang, L., Rozelle, S. (2010), ‘New evidence on the impact of China's New Rural Cooperative Medical Scheme and its implications for rural primary healthcare: multivariate difference-in-difference analysis’, British Medical Journal, 341: c5617.CrossRefGoogle ScholarPubMed
Bhattacharyya, O., Khor, S., McGahan, A., Dunne, D., Daar, A. S., Singer, P. A. (2010), ‘Innovative health service delivery models in low and middle income countries – what can we learn from the private sector?’, Health Research and Policy Systems, 8: 24.CrossRefGoogle ScholarPubMed
Brown, P. H.Theoharides, C. (2009), ‘Health-seeking behaviour and hospital choice in China's New Medical Cooperative System’, Health Economics, 18, Supplement 2: S47–S64.CrossRefGoogle Scholar
Bryce, M. (2000), ‘APHA shores up fragmenting industry for joint campaign to push private health care’, Healthcover, 10(1): 46–51.Google Scholar
Chen, W. (2007), ‘Strengthen rural security and improve the social security system (in Chinese)’, Insurance Studies, 7: 39–41.Google Scholar
Chernichovsky, D.Leibowitz, A. (2010), ‘Integrating public health and personal care in a reformed US health care system’, American Journal of Public Health, 100(2): 205–211.CrossRefGoogle Scholar
Duckett, S. J.Jackson, T. J. (2000), ‘The new health insurance rebate: an inefficient way of assisting public hospitals’, Medical Journal of Australia, 172: 439–442.CrossRefGoogle ScholarPubMed
Guo, Y. (2007), ‘An analysis of insurance company participation in the NCMS’, Modern Commercial Industry, 8: 41–42.Google Scholar
Hanlin, R., Chataway, J., Smith, J. (2007), ‘Global health public–private partnerships: IAVI, partnerships and capacity building’, African Journal of Medicine & Medical Sciences, 36, Supplement: 69–75.Google ScholarPubMed
Klotzbücher, S., Lässig, P., Qin, J., Weigelin-Schwiedrzik, S. (2010), ‘What is new in the “New Rural Co-operative Medical System”? An assessment in One Kazak County of the Xinjiang Uyghur Autonomous Region’, The China Quarterly, 201: 38–57.CrossRefGoogle Scholar
Lane, J-E. (2003), New Public Management, London: Routledge.Google Scholar
Lei, X.Lin, W. (2009), ‘The New Cooperative Medical Scheme in rural China: does more coverage mean more service and better health?’, Health Economics, 18, Supplement 2: S25–S46.CrossRefGoogle ScholarPubMed
Liu, J., Xu, L., Cao, X., Wang, X., Sun, H., Tang, C., Yang, Z., Song, X., Lv, M. (2008), Analysis of satisfaction about new cooperative medical scheme and its influencing factors in Weihai, China, Health Policy, 86(2–3): 239–244.CrossRefGoogle ScholarPubMed
Lv, Y. (2005), ‘The pros and cons of insurance company participation in NCMS’, Health Economic Studies, 3: 18–19.Google Scholar
Mao, Z.Jiang, J. (2005), ‘Comparative Research Project on the NCMS (in Chinese)’, Chinese Health Service Management, 21(7): 426–428.Google Scholar
McKee, M., Edwards, N., et al. (2006), ‘Public–private partnerships for hospitals’, Bulletin of the World Health Organization, 84(11): 890–896.Google ScholarPubMed
Meng, R., Luan, G.Honghui, S. (2007), ‘Implications of insurance company participation in the NCMS’, Economic Perspectives, 7: 41–43.Google Scholar
Ministry of Health and Ministry of Finance, Ministry of Agriculture (2003), Official Comments on the Establishment of the NCMS, Beijing: Ministry of Health.Google Scholar
Ostrom, V.Ostrom, E. (1999), ‘Public good and public choices’, in M. D. McGinnies (ed.), Polycentricity and Local Public Economies, Ann Arbor: University of Michigan Press, 75–104.Google Scholar
Palmer, N. (2000), ‘The use of private-sector contracts for primary health care: theory, evidence and lessons for low-income and middle-income countries’, Bulletin of the World Health Organization, 78(6): 821–829.Google ScholarPubMed
Rechel, B.McKee, M. (2009), ‘Health reform in central and eastern Europe and the former Soviet Union’, Lancet, 374(9696): 1186–1195.CrossRefGoogle ScholarPubMed
Schick, A. (1998), ‘Why most developing countries should not try New Zealand's Reforms’, The World Bank Research Observer, 13(1): 123–131.CrossRefGoogle Scholar
Shu, L. (2007), ‘The accessibility of insurance company participation in the NCMS’, New West, 8: 30.Google Scholar
Sun, Q., Liu, X., Meng, Q., Tang, S., Yu, B., Tolhurst, R. (2009a), ‘Evaluating the financial protection of patients with chronic disease by health insurance in rural China’, International Journal for Equity in Health, 8(42).CrossRefGoogle ScholarPubMed
Sun, X., Jackson, S., Carmichael, G., Sleigh, A. C. (2009b), ‘Catastrophic medical payment and financial protection in rural China: evidence from the New Cooperative Medical Scheme in Shandong province’, Health Economics, 18(1): 103–119.CrossRefGoogle ScholarPubMed
Tsui, A. S., Wang, H., Xin, K. (2006), ‘Organizational culture in China: an analysis of culture dimensions and culture types’, Management and Organization Review, 2(3): 345–376.CrossRefGoogle Scholar
Vargas, I., Vázquez, M., Mogollón-Pérez, A. S., Unger, J. P. (2010), ‘Barriers of access to care in a managed competition model: lessons from Colombia’, BMC Health Services Research, 10: 297.CrossRefGoogle Scholar
Wagstaff, A., Yip, W., Lindelow, M., Hsiao, W. (2009), ‘China's health system and its reform: a review of recent studies’, Health Economics, 18, Supplement 2: S7–S23.CrossRefGoogle ScholarPubMed
Walsh, K. (1995), Public Service and Market Mechanisms. Competition, Contracting and the New Public Management, Basingstoke: Macmillan.CrossRefGoogle Scholar
Wang, H., Gu, D.Dupre, M. E. (2008), ‘Factors associated with enrollment, satisfaction, and sustainability of the New Cooperative Medical Scheme program in six study areas in rural Beijing’, Health Policy, 85(1): 32–44.CrossRefGoogle ScholarPubMed
Wang, H., Ye, Y., Wang, S., Yue, Q., Luo, J. (2003), ‘A study of different rural economic status in NCMS (in Chinese)’, Chinese Health Economics Magazine, 5: 26–27.Google Scholar
Wang, Z., Wang, R.Chen, Y. (2005), ‘Improper participation of insurance companies in NCMS (in Chinese)’, Health Economic Studies, 6: 22–23.Google Scholar
Yip, W.Hsiao, W. C. (2009), ‘Non-evidence-based policy: How effective is China's new cooperative medical scheme in reducing medical impoverishment?’, Social Science & Medicine, 68(2): 201–209.CrossRefGoogle ScholarPubMed
You, X.Kobayashi, Y. (2009), ‘The new cooperative medical scheme in China’, Health Policy, 91(1): 1–9.CrossRefGoogle ScholarPubMed
Zhang, L., Cheng, X., Liu, X., Zhu, K., Tang, S., Bogg, L., Dobberschuetz, K. (2009), ‘Balancing the funds in the New Cooperative Medical Scheme in rural China: determinants and influencing factors in two provinces’, International Journal of Health Planning and Management, 25(2): 96–118.Google Scholar
Zhang, N.Zhang, Y. (2006), ‘The practice of insurance company participation in the NCMS’, Insurance Studies, 11: 47–55.Google Scholar
Zhang, X., Huang, J., et al. (2006), ‘The feasibility of insurance company participation in the NCMS (in Chinese)’, Health Economic Studies, 2: 46–48.Google Scholar
Zhou, X., Zhengzhong, M. (2009), ‘Literature review on the participation of insurance companies in the operation of the NCMS (in Chinese)’, Online Scientific Essays of China, A200812–2123.Google Scholar