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Building institutions for an effective health system: Lessons from China's experience with rural health reform

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  • Bloom, Gerald
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    This paper is concerned with the management of health system changes aimed at substantially increasing the access to safe and effective health services. It argues that an effective health sector relies on trust-based relationships between users, providers and funders of health services, and that one of the major challenges governments face is to construct institutional arrangements within which these relationships can be embedded. It presents the case of China, which is implementing an ambitious health reform, drawing on a series of visits to rural counties by the author over a 10-year period. It illustrates how the development of reform strategies has been a response both to the challenges arising from the transition to a market economy and the result of actions by different actors, which have led to the gradual creation of increasingly complex institutions. The overall direction of change has been strongly influenced by the efforts made by the political leadership to manage a transition to a modern economy which provides at least some basic benefits to all. The paper concludes that the key lessons for other countries from China's experience with health system reform are less about the detailed design of specific interventions than about its approach to the management of institution-building in a context of complexity and rapid change.

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    Article provided by Elsevier in its journal Social Science & Medicine.

    Volume (Year): 72 (2011)
    Issue (Month): 8 (April)
    Pages: 1302-1309

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    Handle: RePEc:eee:socmed:v:72:y:2011:i:8:p:1302-1309
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    1. Dong, Hengjin & Bogg, Lennart & Rehnberg, Clas & Diwan, Vinod, 1999. "Drug policy in China: pharmaceutical distribution in rural areas," Social Science & Medicine, Elsevier, vol. 48(6), pages 777-786, March.
    2. Fang, Jing, 2008. "The Chinese health care regulatory institutions in an era of transition," Social Science & Medicine, Elsevier, vol. 66(4), pages 952-962, February.
    3. Tibandebage, Paula & Mackintosh, Maureen, 2005. "The market shaping of charges, trust and abuse: health care transactions in Tanzania," Social Science & Medicine, Elsevier, vol. 61(7), pages 1385-1395, October.
    4. Peters, David H. & Muraleedharan, V.R., 2008. "Regulating India's health services: To what end? What future?," Social Science & Medicine, Elsevier, vol. 66(10), pages 2133-2144, May.
    5. Karen Eggleston & Li Ling & Meng Qingyue & Magnus Lindelow & Adam Wagstaff, 2008. "Health service delivery in China: a literature review," Health Economics, John Wiley & Sons, Ltd., vol. 17(2), pages 149-165.
    6. Douglass C. North, 2005. "Introduction to Understanding the Process of Economic Change," Introductory Chapters,in: Understanding the Process of Economic Change Princeton University Press.
    7. Dussault, Gilles, 2008. "The health professions and the performance of future health systems in low-income countries: Support or obstacle?," Social Science & Medicine, Elsevier, vol. 66(10), pages 2088-2095, May.
    8. 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 7-23, July.
    9. Cornwall, Andrea & Shankland, Alex, 2008. "Engaging citizens: Lessons from building Brazil's national health system," Social Science & Medicine, Elsevier, vol. 66(10), pages 2173-2184, May.
    10. Maureen Lewis, 2006. "Governance and Corruption in Public Health Care Systems," Working Papers 78, Center for Global Development.
    11. O'Donnell, Owen & van Doorslaer, Eddy & Rannan-Eliya, Ravi P. & Somanathan, Aparnaa & Adhikari, Shiva Raj & Akkazieva, Baktygul & Harbianto, Deni & Garg, Charu C. & Hanvoravongchai, Piya & Herrin, Ale, 2008. "Who pays for health care in Asia?," Journal of Health Economics, Elsevier, vol. 27(2), pages 460-475, March.
    12. Bruno Meessen & Gerald Bloom, 2007. "Economic Transition, Institutional Changes and the Health System: Some Lessons from Rural China," Journal of Economic Policy Reform, Taylor & Francis Journals, vol. 10(3), pages 209-231.
    13. Huang,Yasheng, 2008. "Capitalism with Chinese Characteristics," Cambridge Books, Cambridge University Press, number 9780521898102, December.
    14. Adam Wagstaff & Magnus Lindelow & Shiyong Wang & Shuo Zhang, 2009. "Reforming China's Rural Health System," World Bank Publications, The World Bank, number 2646, April.
    15. Bruno Meessen & Gerald Bloom, 2007. "Economic Transition, Institutional Changes and the Health System: Some Lessons from Rural China," Journal of Economic Policy Reform, Taylor and Francis Journals, vol. 10(3), pages 209-231.
    16. Bloom, Gerald & Standing, Hilary & Lloyd, Robert, 2008. "Markets, information asymmetry and health care: Towards new social contracts," Social Science & Medicine, Elsevier, vol. 66(10), pages 2076-2087, May.
    17. Bennett, Andrew & Elman, Colin, 2006. "Complex Causal Relations and Case Study Methods: The Example of Path Dependence," Political Analysis, Cambridge University Press, vol. 14(03), pages 250-267, June.
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