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Realigning Demand and Supply Side Incentives to Improve Primary Health Care Seeking in Rural China

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  • Timothy Powell‐Jackson
  • Winnie Chi‐Man Yip
  • Wei Han

Abstract

China's recent and ambitious health care reform involves a shift from the reliance on markets to the reaffirmation of the central role of the state in the financing and provision of services. In collaboration with the Government of the Ningxia province, we examined the impact of two key features of the reform on health care utilisation using panel household data. The first policy change was a redesign of the rural insurance benefit package, with an emphasis on reorientating incentives away from inpatient towards outpatient care. The second policy change involved a shift from a fee‐for‐service payment method to a capitation budget with pay‐for‐performance amongst primary care providers. We find that the insurance intervention, in isolation, led to a 47% increase in the use of outpatient care at village clinics and greater intensity of treatment (e.g. injections). By contrast, the two interventions in combination showed no effect on health care use over and above that generated by the redesign of the insurance benefit package. Copyright © 2014 John Wiley & Sons, Ltd.

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  • Timothy Powell‐Jackson & Winnie Chi‐Man Yip & Wei Han, 2015. "Realigning Demand and Supply Side Incentives to Improve Primary Health Care Seeking in Rural China," Health Economics, John Wiley & Sons, Ltd., vol. 24(6), pages 755-772, June.
    • Handle: RePEc:wly:hlthec:v:24:y:2015:i:6:p:755-772
    DOI: 10.1002/hec.3060
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    4. Yuan Xu & Ning Li & Mingshan Lu & Elijah Dixon & Robert P Myers & Rachel J Jelley & Hude Quan, 2017. "The effects of patient cost sharing on inpatient utilization, cost, and outcome," PLOS ONE, Public Library of Science, vol. 12(10), pages 1-16, October.
    5. Jinjing Wu & Shelby Deaton & Boshen Jiao & Zohn Rosen & Peter A Muennig, 2018. "The cost-effectiveness analysis of the New Rural Cooperative Medical Scheme in China," PLOS ONE, Public Library of Science, vol. 13(12), pages 1-13, December.
    6. Jacky MATHONNAT & Aurore PELISSIER, 2017. "How a Results-Based Financing approach can contribute to the health Sustainable Development Goals - Policy-oriented lessons: what we know, what we need to know and don’t yet know," Working Papers P204, FERDI.
    7. Yiwei Chen & Hui Ding & Min Yu & Jieming Zhong & Ruying Hu & Xiangyu Chen & Chunmei Wang & Kaixu Xie & Karen Eggleston, 2019. "The Effects of Primary Care Chronic-Disease Management in Rural China," NBER Working Papers 26100, National Bureau of Economic Research, Inc.
    8. Singh, Neha S. & Kovacs, Roxanne J. & Cassidy, Rachel & Kristensen, Søren R. & Borghi, Josephine & Brown, Garrett W., 2021. "A realist review to assess for whom, under what conditions and how pay for performance programmes work in low- and middle-income countries," Social Science & Medicine, Elsevier, vol. 270(C).
    9. Xiaojie Sun & Xiaoyun Liu & Qiang Sun & Winnie Yip & Adam Wagstaff & Qingyue Meng, 2016. "The Impact of a Pay‐for‐Performance Scheme on Prescription Quality in Rural China," Health Economics, John Wiley & Sons, Ltd., vol. 25(6), pages 706-722, June.
    10. Hao Zhang & Eddy van Doorslaer & Ling Xu & Yaoguang Zhang & Joris van de Klundert, 2019. "Can a results‐based bottom‐up reform improve health system performance? Evidence from the rural health project in China," Health Economics, John Wiley & Sons, Ltd., vol. 28(10), pages 1204-1219, October.

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