Accra, Ghana October 19-23, 200 9 Extending Health Insurance: How to Make It Work DESIGN ELEMENT 8: M&E OF HEALTH INSURANCE SCHEMES - China Case October.

Accra, Ghana October 19-23, 2009

Extending Health Insurance: How to Make It Work

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

October 19-23

Hong Wang, MD, PhDHS202 project

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

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)

Type of Evaluation

Evaluation Pre-post with control – social experimental design

A1 A2

B2B2

Intervention group

Control group

Health insurance

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

6

7

Bottom poorest 25% population

Total expenditure After medical expenditure

665

900

Exp

endi

ture

leve

l

5.4% 9.6% 16.9% 22.6%Cumulative expenditure

665

900

Exp

endi

ture

Lev

el

5.4% 9.6% 16.9% 22.6%Cumulative Expenditure

665 Yuan, 4.2% poverty due to medical expenditure

900 Yuan, 5.7% poverty due to medical expenditure5.7%

4.2%

Poverty due to medical expenditure

The effects of RMHC on poverty reduction66

590

0E

xpen

ditu

re L

evel

5.4% 9.6% 16.9% 22.6%8.2 19.1%Cumulative Expenditure

665 Yuan, 4.2% due to medical expenditure, RMHC recovered 1.4%

900Yuan, 5.7% poverty due to medical expenditure, RMHC recover ed3.5%

With RMHC coverage

Accra, Ghana October 19-23, 2009

Extending Health Insurance: How to Make It Work

Thank you