A presentation by Zhenzhong ZHANG and Yunping WANG of the China National Health Development Research Center. This was given at a Future Health Systems Consortium organised event at the Global Symposium on Health System Research.
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Implementing Rapid Medical Security reform in China: Importance of a Learning Approach
1. 1
Zhenzhong ZHANG, Yunping WANG
China National Health Development Research Center
Implementing Rapid Medical Security reform in
China: Importance of a Learning Approach
2. Outlines
What are NCMS and MFA?
Scaling up of rural Medical Security system
Strategies for management of scaling up
2
3. 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 Affairs
3
4. What are NCMS and MFA?
4
New Cooperative
Medical Scheme
Demand side:
rural residents
Supplier: health
facilities
Government
Fiscal inputFiscal input
Medical Financial
Scheme
Fiscal input for NCMS premiumFiscal input for NCMS premium
Services PurchaseServices Purchase
Premium
contribution
Premium
contribution
Reimburse-
ment for HE
Reimburse-
ment for HE
Fiscal inputFiscal input
Fiscal inputFiscal input
paymentpayment
8. Reflections on management of scaling up
8
( 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
9. 1998
Basic Medical
Insurance for urban
employees has been
establihed
2002
NCMS and MA
proposed
2007
Urban residents medical
insurance system has been
established
GDP
Reflections on management of scaling up
10. 10
( 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 sinceⅧ
1998.
“Pilot comes first” and then spread incrementally to avoid
massive cost of the reform.
Reflections on management of scaling up
11. 11
( 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
12. 12
( 4 ) Management structure
Decentralized + Relatively centralized
Cross-ministries cooperation
Reflections on management of scaling up
13. 13
( 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