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Do health sector reforms have their intended impacts ? The World Bank's Health VIII project in Gansu province, China

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  • Wagstaff, Adam
  • Yu, Shengchao

Abstract

The 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 Info

Paper provided by The World Bank in its series Policy Research Working Paper Series with number 3743.

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Date of creation: 01 Oct 2005
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Handle: RePEc:wbk:wbrwps:3743

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Keywords: Health Monitoring&Evaluation; Health Systems Development&Reform; Health Economics&Finance; Health Law; Housing&Human Habitats;

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References

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  1. 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.
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Citations

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Cited by:
  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. 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.
  7. 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.
  8. 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).
  9. 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.
  10. repec:hal:wpaper:halshs-00826822 is not listed on IDEAS
  11. 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).
  12. 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.
  13. 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.
  14. 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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