1
Zhenzhong ZHANG, Yunping WANG
China National Health Development Research Center
Implementing Rapid Medical Security refo...
Outlines
 What are NCMS and MFA?
 Scaling up of rural Medical Security system
 Strategies for management of scaling up
2
What are NCMS and MFA?
Rural New Cooperative
Medical Scheme (NCMS)
Medical Financial Assistance
Scheme (MFA)
Objectives To...
What are NCMS and MFA?
4
New Cooperative
Medical Scheme
Demand side:
rural residents
Supplier: health
facilities
Governmen...
2003- 2009年全国新 合参合人数 化农 变
0. 8 0. 8
1. 8
4. 1
7. 3
8. 1 8. 3
0
1
2
3
4
5
6
7
8
9
2003年 2004年 2005年 2006年 2007年 2008年 2009年...
10
10
10
10
20
20
20
40
40
30
60
60
0
50
100
150
2003-
2005
2006-
2007
2008-
2009
2010-
2003- 2009年新农合人均筹资标准
农民缴纳 地方财政 中央财...
Real reimbursement rate of inpatients in 2008
Scaling up of NCMS
average
east
middle
west
Reflections on management of scaling up
8
( 1 ) From government side : changes in values/paradigms
 Recognition and highl...
1998
Basic Medical
Insurance for urban
employees has been
establihed
2002
NCMS and MA
proposed
2007
Urban residents medica...
10
( 2 ) Strategies employed in institutional change: learning by doing
 Health insurance reform: not realize in one leap...
11
( 3 ) Bridging the gap between research and policy
 All-around engagement of experts in the knowledge translation
proc...
12
( 4 ) Management structure
 Decentralized + Relatively centralized
 Cross-ministries cooperation
Reflections on manag...
13
( 5 ) Care for the engagement and voices of rural residents:
 No longer the passive policy accepters under typical
top...
[Country Name] 14
Thank you !
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Implementing Rapid Medical Security reform in China: Importance of a Learning Approach

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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. 1 Zhenzhong ZHANG, Yunping WANG China National Health Development Research Center Implementing Rapid Medical Security reform in China: Importance of a Learning Approach
  2. 2. Outlines  What are NCMS and MFA?  Scaling up of rural Medical Security system  Strategies for management of scaling up 2
  3. 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. 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
  5. 5. 2003- 2009年全国新 合参合人数 化农 变 0. 8 0. 8 1. 8 4. 1 7. 3 8. 1 8. 3 0 1 2 3 4 5 6 7 8 9 2003年 2004年 2005年 2006年 2007年 2008年 2009年 Populaton (100 mil.) Scaling up of NCMS 数据来源:根据卫生部农村卫生管理司、卫生部新型农村合作医疗研究中心 2004-2009 年统计数据整 理 Start PilotingStart Piloting Extend pilotingExtend piloting Universal coverage Universal coverage Population covered by NCMS from 2005-2009 94% Launched in Jul. 2003
  6. 6. 10 10 10 10 20 20 20 40 40 30 60 60 0 50 100 150 2003- 2005 2006- 2007 2008- 2009 2010- 2003- 2009年新农合人均筹资标准 农民缴纳 地方财政 中央财政 yuan Scaling up of NCMS Finance of NCMS per capita (2003-2009) Individual Local gov. Central gov.
  7. 7. Real reimbursement rate of inpatients in 2008 Scaling up of NCMS average east middle west
  8. 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. 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. 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. 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. 12 ( 4 ) Management structure  Decentralized + Relatively centralized  Cross-ministries cooperation Reflections on management of scaling up
  13. 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
  14. 14. [Country Name] 14 Thank you !

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