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.

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Presentation transcript:

Accra, Ghana October 19-23, Extending Health Insurance: How to Make It Work DESIGN ELEMENT 8: M&E OF HEALTH INSURANCE SCHEMES - China Case October Hong Wang, MD, PhD HS202 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 A1A2 B2 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

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Bottom poorest 25% population Total expenditure After medical expenditure Expenditure level 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 expenditure 5.7% 4.2% Poverty due to medical expenditure

The effects of RMHC on poverty reduction 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, Extending Health Insurance: How to Make It Work Thank you