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DESIGN ELEMENT 8: M&E OF HEALTH INSURANCE SCHEMES - China Case

DESIGN ELEMENT 8: M&E OF HEALTH INSURANCE SCHEMES - China Case. Hong Wang, MD, PhD HS202 project. October 19-23. Establishing “Rural Mutual Health Care” (RMHC) For the Chinese Farmers.

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DESIGN ELEMENT 8: M&E OF HEALTH INSURANCE SCHEMES - China Case

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  1. DESIGN ELEMENT 8:M&E OF HEALTH INSURANCE SCHEMES - China Case Hong Wang, MD, PhD HS202 project October 19-23

  2. 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

  3. 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)

  4. Type of Evaluation • Evaluation • Pre-post with control – social experimental design Health insurance Intervention group A1 A2 Control group B2 B2

  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 5

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  8. Bottom poorest 25% population 900 Expenditure level 665 5.4% 9.6% 16.9% 22.6% Cumulative expenditure Total expenditure After medical expenditure

  9. Poverty due to medical expenditure 900 Yuan, 5.7% poverty due to medical expenditure 5.7% 665 Yuan, 4.2% poverty due to medical expenditure 4.2%

  10. The effects of RMHC on poverty reduction With RMHC coverage 900Yuan, 5.7% poverty due to medical expenditure, RMHC recover ed3.5% 665 Yuan, 4.2% due to medical expenditure, RMHC recovered 1.4%

  11. Thank you

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