Implementing Rapid Medical Security reform in China: Importance of a Learning Approach

Zhenzhong ZHANG, Yunping WANG China National Health Development Research Center Implementing Rapid Medical Security reform in China: Importance of a Learning Approach

Outlines
What are NCMS and MFA?
Scaling up of rural Medical Security system
Strategies for management of scaling up

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

What are NCMS and MFA? Fiscal input Fiscal input for NCMS premium Services Purchase Premium contribution Reimburse-ment for HE Fiscal input Fiscal input payment New Cooperative Medical Scheme Demand side: rural residents Supplier: health facilities Government Medical Financial Scheme

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 Piloting Extend piloting Universal coverage Population covered by NCMS from 2005-2009 94% Launched in Jul. 2003

yuan Scaling up of NCMS Finance of NCMS per capita (2003-2009) Individual Local gov. Central gov.

Real reimbursement rate of inpatients in 2008 Scaling up of NCMS average east middle west

Reflections on management of scaling up
（ 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

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

（ 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 Ⅷ programme since 1998.
“ Pilot comes first” and then spread incrementally to avoid massive cost of the reform.

（ 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

（ 4 ） Management structure
Decentralized + Relatively centralized
Cross-ministries cooperation

（ 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

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Implementing Rapid Medical Security reform in China: Importance of a Learning Approach

by IDS on Nov 30, 2010

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