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The role of health system governance in strengthening the rural health insurance system in China
BACKGROUND: Systems of governance play a key role in the operation and performance of health systems. In the past six decades, China has made great advances in strengthening its health system, most notably in establishing a health insurance system that enables residents of rural areas to achieve acc...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5440979/ https://www.ncbi.nlm.nih.gov/pubmed/28532418 http://dx.doi.org/10.1186/s12939-017-0542-x |
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author | Yuan, Beibei Jian, Weiyan He, Li Wang, Bingyu Balabanova, Dina |
author_facet | Yuan, Beibei Jian, Weiyan He, Li Wang, Bingyu Balabanova, Dina |
author_sort | Yuan, Beibei |
collection | PubMed |
description | BACKGROUND: Systems of governance play a key role in the operation and performance of health systems. In the past six decades, China has made great advances in strengthening its health system, most notably in establishing a health insurance system that enables residents of rural areas to achieve access to essential services. Although there have been several studies of rural health insurance schemes, these have focused on coverage and service utilization, while much less attention has been given to the role of governance in designing and implementing these schemes. METHODS: Information from publications and policy documents relevant to the development of two rural health insurance policies in China was obtained, analysed, and synthesise. 92 documents on CMS (Cooperative Medical Scheme) or NCMS (New Rural Cooperative Medical Scheme) from four databases searched were included. Data extraction and synthesis of the information were guided by a framework that drew on that developed by the WHO to describe health system governance and leadership. RESULTS: We identified a series of governance practices that were supportive of progress, including the prioritisation by the central government of health system development and certain health policies within overall national development; strong government commitment combined with a hierarchal administrative system; clear policy goals coupled with the ability for local government to adopt policy measures that take account of local conditions; and the accumulation and use of the evidence generated from local practices. However these good practices were not seen in all governance domains. For example, poor collaboration between different government departments was shown to be a considerable challenge that undermined the operation of the insurance schemes. CONCLUSIONS: China’s success in achieving scale up of CMS and NCMS has attracted considerable interest in many low and middle income countries (LMICs), especially with regard to the schemes’ designs, coverage, and funding mechanisms. However, this study demonstrates that health systems governance may be critical to enable the development and operation of such schemes. Given that many LMICs are expanding health financing system to cover populations in rural areas or the informal sectors, we argue that strengthening specific practices in each governance domain could inform the adaptation of these schemes to other settings. |
format | Online Article Text |
id | pubmed-5440979 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-54409792017-05-24 The role of health system governance in strengthening the rural health insurance system in China Yuan, Beibei Jian, Weiyan He, Li Wang, Bingyu Balabanova, Dina Int J Equity Health Review BACKGROUND: Systems of governance play a key role in the operation and performance of health systems. In the past six decades, China has made great advances in strengthening its health system, most notably in establishing a health insurance system that enables residents of rural areas to achieve access to essential services. Although there have been several studies of rural health insurance schemes, these have focused on coverage and service utilization, while much less attention has been given to the role of governance in designing and implementing these schemes. METHODS: Information from publications and policy documents relevant to the development of two rural health insurance policies in China was obtained, analysed, and synthesise. 92 documents on CMS (Cooperative Medical Scheme) or NCMS (New Rural Cooperative Medical Scheme) from four databases searched were included. Data extraction and synthesis of the information were guided by a framework that drew on that developed by the WHO to describe health system governance and leadership. RESULTS: We identified a series of governance practices that were supportive of progress, including the prioritisation by the central government of health system development and certain health policies within overall national development; strong government commitment combined with a hierarchal administrative system; clear policy goals coupled with the ability for local government to adopt policy measures that take account of local conditions; and the accumulation and use of the evidence generated from local practices. However these good practices were not seen in all governance domains. For example, poor collaboration between different government departments was shown to be a considerable challenge that undermined the operation of the insurance schemes. CONCLUSIONS: China’s success in achieving scale up of CMS and NCMS has attracted considerable interest in many low and middle income countries (LMICs), especially with regard to the schemes’ designs, coverage, and funding mechanisms. However, this study demonstrates that health systems governance may be critical to enable the development and operation of such schemes. Given that many LMICs are expanding health financing system to cover populations in rural areas or the informal sectors, we argue that strengthening specific practices in each governance domain could inform the adaptation of these schemes to other settings. BioMed Central 2017-05-23 /pmc/articles/PMC5440979/ /pubmed/28532418 http://dx.doi.org/10.1186/s12939-017-0542-x Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Review Yuan, Beibei Jian, Weiyan He, Li Wang, Bingyu Balabanova, Dina The role of health system governance in strengthening the rural health insurance system in China |
title | The role of health system governance in strengthening the rural health insurance system in China |
title_full | The role of health system governance in strengthening the rural health insurance system in China |
title_fullStr | The role of health system governance in strengthening the rural health insurance system in China |
title_full_unstemmed | The role of health system governance in strengthening the rural health insurance system in China |
title_short | The role of health system governance in strengthening the rural health insurance system in China |
title_sort | role of health system governance in strengthening the rural health insurance system in china |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5440979/ https://www.ncbi.nlm.nih.gov/pubmed/28532418 http://dx.doi.org/10.1186/s12939-017-0542-x |
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