Who are the biggest donors in Development Assistance for Health?
Though there has been considerable attention by
researchers to the impact of the rural health insurance schemes on coverage and
service utilization, the role of governance ”within the schemes, and of the
broader health system ”in designing and implementing these initiatives, has
received limited attention. Specifically, the governance processes underpinning
the formulation and implementation of the two health insurance schemes, as well
as the pathways through which governance has promoted positive outcomes are
insufficiently explored. This represents a considerable gap in knowledge,
hampering efforts to understand how the schemes have achieved many of their
objectives and what governance features may be needed for their implementation.
Filling this gap will provide evidence that is relevant to other low- and
middle-income countries (LMICs) considering similar strategies. Read more about
www.stravell.com here. The political move
towards universal coverage as a major health system goal has led many low- and middle-income
countries to initiate reform or improve their health financing system to expand
the breadth and depth of population coverage. Expanding health insurance
coverage to rural areas or the informal sector has often been an important
element of such strategies. China established the CMS and NCMS in different
historical stages, and both schemes contributed to an improved access to health
services, reduction of disease and alleviation of the financial burden for
rural residents. Crucially, CMS and NCMS are seen internationally as examples
of policy innovations that were rapidly scaled up to achieve near universal
coverage.
Crucially, CMS and NCMS are seen internationally as
examples of policy innovations that were rapidly scaled up to achieve near
universal coverage.
Expanding health insurance coverage to rural areas or
the informal sector has often been an important element of such strategies.
The institutional approach to
governance is referred to in the economics literature as ‘economic governance€™
given the focus on the rules underpinning demand and supply relations (Dixit
2009). This is important because health systems are economic systems, and
health care interactions are indeed framed in terms of supply and demand
relations and the intermediary organizations (e. g.
Achievements include extending insurance
coverage and improving access to health care for rural residents in China—a
group that has previously had only limited access to often rudimentary health
care—and alleviating the financial burden associated with seeking care. The NCMS builds on earlier experience with the
national cooperative medical system (CMS), which was created in the 1950s and
expanded to cover 90% of villages in less than 20 years.
Despite differences in their
structures and processes, the two schemes have many similarities in terms of
policy formulation andimplementation, especially featuring the policy
innovation and rapid scale up. At the same time, a number of low-income
countries have faced considerable challenges in achieving major improvements in
coverage and extending basic financial protection to their disadvantaged
populations despite long term efforts. In the last six decades, China has made
significant advances in health system strengthening and improving health
outcomes, despite suffering setbacks including political and socio-economic
crises. The development of a health insurance system for rural residents has
been an important means of expanding access to essential care.