Health Systems Governance

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.

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.

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.

governments and community health committees) that influence supply-demand relations (Janovsky and Cassels 1996). Health services in low- and middle-income countries are often provided in the market, given that in many settings people secure access to health care by paying for services (Leonard et al. 2013). Indeed, such services may be provided in the public or private sector, the payments may be formal or informal, and the services may be formal or informal. The new rural cooperative medical scheme (NCMS) in China was established in 2003, as a flagship policy aimed at rural populations.

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.