Do health sector reforms have their intended impacts ? The World Bank's Health VIII project in Gansu province, China
AbstractThe literature contains few impact evaluations of health sector reforms, especially those involving broad and simultaneous changes on both the demand and supply sides of the sector. This paper reports the results of a World Bank-funded health sector reform project in China known as Health VIII. On the supply-side, the project combined infrastructure investments (especially at the township level) with improved planning and management, including a referral system between township health centers and county hospitals, and interventions aimed at improving the effectiveness and quality of care, including the introduction of clinical protocols and essential drug lists. On the demand-side, the project sought to resurrect community health insurance, and to introduce a safety net for the very poor to provide them with financial assistance with their health care expenses. The evaluation reported here concerns just one of the project's seven provinces, namely Gansu, the reason being that no suitable data are available to undertake a rigorous evaluation in all provinces. This paper makes use of a panel dataset collected for quite another purpose but whose timing (just around the time the project started and four years later) and location (covering both project and non-project counties) makes it well-suited to the task. The paper compares estimates obtained using a variety of different estimators, including naïve single differences (before and after, and with and without the project), and differences-in-differences, adjusting for heterogeneity through both regression and matching methods. The results suggest that it makes a difference to the estimated impact of Health VIII which estimator is used, with the naïve single differences producing often markedly different estimates from the preferred approach of combining difference-in-differences with matching. The results further suggest that Health VIII has been mostly successful in its goals. The preferred estimator suggests that the project reduced illness among children, improved self-assessed health, and increased doctor visits among the population in general, and reduced the incidence of catastrophic health spending, defined as annual spending in excess of 10 percent of annual per capita income. But the project appears to have increased the development and use of high-level facilities, hastened the demise of the village clinic, and may have reduced immunization rates.
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Bibliographic InfoPaper provided by The World Bank in its series Policy Research Working Paper Series with number 3743.
Date of creation: 01 Oct 2005
Date of revision:
Health Monitoring&Evaluation; Health Systems Development&Reform; Health Economics&Finance; Health Law; Housing&Human Habitats;
Other versions of this item:
- Wagstaff, Adam & Yu, Shengchao, 2007. "Do health sector reforms have their intended impacts?: The World Bank's Health VIII project in Gansu province, China," Journal of Health Economics, Elsevier, Elsevier, vol. 26(3), pages 505-535, May.
- C72 - Mathematical and Quantitative Methods - - Game Theory and Bargaining Theory - - - Noncooperative Games
- D82 - Microeconomics - - Information, Knowledge, and Uncertainty - - - Asymmetric and Private Information; Mechanism Design
- L14 - Industrial Organization - - Market Structure, Firm Strategy, and Market Performance - - - Transactional Relationships; Contracts and Reputation
This paper has been announced in the following NEP Reports:
- NEP-ALL-2005-12-14 (All new papers)
- NEP-CNA-2005-12-14 (China)
- NEP-HEA-2005-12-14 (Health Economics)
- NEP-TRA-2005-12-14 (Transition Economics)
Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.:
- Lindelow, Magnus & Wagstaff, Adam, 2005. "Health shocks in China : are the poor and uninsured less protected ?," Policy Research Working Paper Series 3740, The World Bank.
- Guido W. Imbens, 2003.
"Nonparametric Estimation of Average Treatment Effects under Exogeneity: A Review,"
NBER Technical Working Papers
0294, National Bureau of Economic Research, Inc.
- Guido W. Imbens, 2004. "Nonparametric Estimation of Average Treatment Effects Under Exogeneity: A Review," The Review of Economics and Statistics, MIT Press, vol. 86(1), pages 4-29, February.
- Alberto Abadie & David Drukker & Jane Leber Herr & Guido W. Imbens, 2004. "Implementing matching estimators for average treatment effects in Stata," Stata Journal, StataCorp LP, StataCorp LP, vol. 4(3), pages 290-311, September.
- Yip, Winnie & Eggleston, Karen, 2004. "Addressing government and market failures with payment incentives: Hospital reimbursement reform in Hainan, China," Social Science & Medicine, Elsevier, Elsevier, vol. 58(2), pages 267-277, January.
- Richard Blundell & Lorraine Dearden & Barbara Sianesi, 2005. "Evaluating the effect of education on earnings: models, methods and results from the National Child Development Survey," Journal of the Royal Statistical Society Series A, Royal Statistical Society, vol. 168(3), pages 473-512.
- Sebastian Galiani & Paul Gertler & Ernesto Schargrodsky, 2005.
"Water for Life: The Impact of the Privatization of Water Services on Child Mortality,"
Journal of Political Economy, University of Chicago Press,
University of Chicago Press, vol. 113(1), pages 83-120, February.
- Sebastian Galiani & Paul Gertler & Ernesto Schargrodsky, 2002. "Water for Life: The Impact of the Privatization of Water Services on Child Mortality," Working Papers, Universidad de San Andres, Departamento de Economia 54, Universidad de San Andres, Departamento de Economia, revised Sep 2005.
- Carrin, Guy & Ron, Aviva & Hui, Yang & Hong, Wang & Tuohong, Zhang & Licheng, Zhang & Shuo, Zhang & Yide, Ye & Jiaying, Chen & Qicheng, Jiang & Zhaoyang, Zhang & Jun, Yu & Xuesheng, Li, 1999. "The reform of the rural cooperative medical system in the People's Republic of China: interim experience in 14 pilot counties," Social Science & Medicine, Elsevier, Elsevier, vol. 48(7), pages 961-972, April.
- Jalan, Jyotsna & Ravallion, Martin, 2001.
"Does piped water reduce diarrhea for children in rural India ?,"
Policy Research Working Paper Series
2664, The World Bank.
- Jalan, Jyotsna & Ravallion, Martin, 2003. "Does piped water reduce diarrhea for children in rural India?," Journal of Econometrics, Elsevier, Elsevier, vol. 112(1), pages 153-173, January.
- Marco Caliendo & Sabine Kopeinig, 2005.
"Some Practical Guidance for the Implementation of Propensity Score Matching,"
Discussion Papers of DIW Berlin
485, DIW Berlin, German Institute for Economic Research.
- Marco Caliendo & Sabine Kopeinig, 2008. "Some Practical Guidance For The Implementation Of Propensity Score Matching," Journal of Economic Surveys, Wiley Blackwell, Wiley Blackwell, vol. 22(1), pages 31-72, 02.
- Caliendo, Marco & Kopeinig, Sabine, 2005. "Some Practical Guidance for the Implementation of Propensity Score Matching," IZA Discussion Papers 1588, Institute for the Study of Labor (IZA).
- Winnie Yip & Karen Eggleston, 2001. "Provider payment reform in China: the case of hospital reimbursement in Hainan province," Health Economics, John Wiley & Sons, Ltd., vol. 10(4), pages 325-339.
- Lindeboom, Maarten & van Doorslaer, Eddy, 2004.
"Cut-Point Shift and Index Shift in Self-Reported Health,"
IZA Discussion Papers
1286, Institute for the Study of Labor (IZA).
- Lindeboom, Maarten & van Doorslaer, Eddy, 2004. "Cut-point shift and index shift in self-reported health," Journal of Health Economics, Elsevier, Elsevier, vol. 23(6), pages 1083-1099, November.
- Maarten Lindeboom & Eddy van Doorslaer, 2003. "Cut-point Shift and Index Shift in Self-reported Health," Tinbergen Institute Discussion Papers 03-042/3, Tinbergen Institute.
- Edward Miguel & Michael Kremer, 2004. "Worms: Identifying Impacts on Education and Health in the Presence of Treatment Externalities," Econometrica, Econometric Society, Econometric Society, vol. 72(1), pages 159-217, 01.
- Heckman, James J & Ichimura, Hidehiko & Todd, Petra E, 1997. "Matching as an Econometric Evaluation Estimator: Evidence from Evaluating a Job Training Programme," Review of Economic Studies, Wiley Blackwell, Wiley Blackwell, vol. 64(4), pages 605-54, October.
- Paul Gertler, 2004. "Do Conditional Cash Transfers Improve Child Health? Evidence from PROGRESA's Control Randomized Experiment," American Economic Review, American Economic Association, American Economic Association, vol. 94(2), pages 336-341, May.
- Ravallion, Martin, 2005.
"Evaluating anti-poverty programs,"
Policy Research Working Paper Series
3625, The World Bank.
- John Newman & Menno Pradhan & Laura B. Rawlings & Geert Ridder & Ramiro Coa & Jose Luis Evia, 2002. "An Impact Evaluation of Education, Health, and Water Supply Investments by the Bolivian Social Investment Fund," World Bank Economic Review, World Bank Group, World Bank Group, vol. 16(2), pages 241-274, August.
- A. Smith, Jeffrey & E. Todd, Petra, 2005.
"Does matching overcome LaLonde's critique of nonexperimental estimators?,"
Journal of Econometrics, Elsevier,
Elsevier, vol. 125(1-2), pages 305-353.
- Jeffrey Smith & Petra Todd, 2003. "Does Matching Overcome Lalonde's Critique of Nonexperimental Estimators?," University of Western Ontario, CIBC Centre for Human Capital and Productivity Working Papers, University of Western Ontario, CIBC Centre for Human Capital and Productivity 20035, University of Western Ontario, CIBC Centre for Human Capital and Productivity.
- Wagstaff, Adam & Pradhan, Menno, 2005. "Health insurance impacts on health and nonmedical consumption in a developing country," Policy Research Working Paper Series 3563, The World Bank.
- Meliyanni Johar, 2007.
"The Impact of the Indonesian Health Card Program: A Matching Estimator Approach,"
Discussion Papers, School of Economics, The University of New South Wales
2007-30, School of Economics, The University of New South Wales.
- Johar, Meliyanni, 2009. "The impact of the Indonesian health card program: A matching estimator approach," Journal of Health Economics, Elsevier, Elsevier, vol. 28(1), pages 35-53, January.
- Adam Wagstaff & Winnie Yip & Magnus Lindelow & William C. Hsiao, 2009. "China's health system and its reform: a review of recent studies," Health Economics, John Wiley & Sons, Ltd., vol. 18(S2), pages S7-S23, July.
- Moreno-Serra, R & Smith, PC, 2013. "Towards an index of health coverage," Working Papers, Imperial College, London, Imperial College Business School 10422, Imperial College, London, Imperial College Business School.
- Hong Wang & Winnie Yip & Licheng Zhang & William C. Hsiao, 2009. "The impact of rural mutual health care on health status: evaluation of a social experiment in rural China," Health Economics, John Wiley & Sons, Ltd., vol. 18(S2), pages S65-S82, July.
- Wagstaff, Adam & Lindelow, Magnus & Jun, Gao & Ling, Xu & Juncheng, Qian, 2009.
"Extending health insurance to the rural population: An impact evaluation of China's new cooperative medical scheme,"
Journal of Health Economics, Elsevier,
Elsevier, vol. 28(1), pages 1-19, January.
- Wagstaff, Adam & Lindelow, Magnus & Gao Jun & Xu Ling & Qian Juncheng, 2007. "Extending health insurance to the rural population : an impact evaluation of China's new cooperative medical scheme," Policy Research Working Paper Series 4150, The World Bank.
- Liu, Hong & Gao, Song & Rizzo, John A., 2011. "The expansion of public health insurance and the demand for private health insurance in rural China," China Economic Review, Elsevier, Elsevier, vol. 22(1), pages 28-41, March.
- Omar Galárraga & Sandra Sosa-Rubí & Aarón Salinas-Rodríguez & Sergio Sesma-Vázquez, 2010. "Health insurance for the poor: impact on catastrophic and out-of-pocket health expenditures in Mexico," The European Journal of Health Economics, Springer, Springer, vol. 11(5), pages 437-447, October.
- Liu, Hong & Fang, Hai & Zhao, Zhong, 2012.
"Urban-Rural Disparities of Child Health and Nutritional Status in China from 1989 to 2006,"
IZA Discussion Papers
6528, Institute for the Study of Labor (IZA).
- Liu, Hong & Fang, Hai & Zhao, Zhong, 2013. "Urban–rural disparities of child health and nutritional status in China from 1989 to 2006," Economics & Human Biology, Elsevier, Elsevier, vol. 11(3), pages 294-309.
- Chen, Yuyu & Jin, Ginger Zhe, 2012.
"Does health insurance coverage lead to better health and educational outcomes? Evidence from rural China,"
Journal of Health Economics, Elsevier,
Elsevier, vol. 31(1), pages 1-14.
- Yuyu Chen & Ginger Zhe Jin, 2010. "Does Health Insurance Coverage Lead to Better Health and Educational Outcomes? Evidence from Rural China," NBER Working Papers 16417, National Bureau of Economic Research, Inc.
- repec:hal:wpaper:halshs-00826822 is not listed on IDEAS
- Jean-Paul Fitoussi & Francesco Saraceno, 2008.
"The Intergenerational Content of Social Spending: Health Care and Sustainable Growth in China,"
Documents de Travail de l'OFCE, Observatoire Francais des Conjonctures Economiques (OFCE)
2008-27, Observatoire Francais des Conjonctures Economiques (OFCE).
- Jean-Paul Fitoussi & Francesco Saraceno, 2008. "The intergenerational content of social spending : health care and sustainable growth in China," Sciences Po publications 2008-27, Sciences Po.
- Hou, Xiaohui & Chao, Shiyan, 2011. "Targeted or untargeted? The initial assessment of a targeted health insurance program for the poor in Georgia," Health Policy, Elsevier, Elsevier, vol. 102(2), pages 278-285.
- Wagstaff, Adam, 2007. "Health insurance for the poor : initial impacts of Vietnam's health care fund for the poor," Policy Research Working Paper Series 4134, The World Bank.
- Galarrága, O & Sosa-Rubí, S. G & Salinas, A & Sesma, S, 2008. "The Impact of Universal Health Insurance on Catastrophic and Out-of-Pocket Health Expenditures in Mexico: a Model with an Endogoenous Treatment Variable," Health, Econometrics and Data Group (HEDG) Working Papers, HEDG, c/o Department of Economics, University of York 08/12, HEDG, c/o Department of Economics, University of York.
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