Equity and Public Governance in Health System Reform : Challenges and Opportunities for China

Equity and Public Governance in Health System Reform : Challenges and Opportunities for China

Achieving the objective of China's current health system reform, namely equitable improvements in health outcomes, will be difficult not least because of the continuously growing income disparities in the country. The analysis in this paper sh...

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Bibliographic Details
Main Authors:	Brixi, Hana, Mu, Yan, Targa, Beatrice, Hipgrave, David
Format:	Policy Research Working Paper
Language:	English
Published:	2012
Subjects:	ACCOUNTING BASIC EDUCATION BREAST CANCER CATASTROPHIC HEALTH EXPENDITURE CATASTROPHIC HEALTH SPENDING CENTRAL BUDGET CENTRAL GOVERNMENT SPENDING CHILD HEALTH CHILD MORTALITY CHILD MORTALITY RATES CHILD SURVIVAL CITIES CITIZEN CITIZENS COST-EFFECTIVENESS CULTURAL CHANGE DEATHS DELIVERY OF HEALTH CARE DETERMINANTS OF HEALTH DEVELOPMENT POLICY DEVELOPMENT STRATEGIES DOCTORS DRINKING WATER DRUGS ECONOMIC GROWTH ECONOMIC PERFORMANCE ENFORCEMENT OF LAWS EPIDEMIOLOGY EQUALIZATION ESSENTIAL MEDICINES ESSENTIAL SOCIAL SERVICES FAMILY MEMBERS FINANCIAL RESOURCES FISCAL DECENTRALIZATION FOLIC ACID GENERAL PRACTITIONERS GOVERNMENT AGENCIES GOVERNMENT INITIATIVES GOVERNMENT SPENDING HEALTH CENTERS HEALTH DATA HEALTH ECONOMICS HEALTH EDUCATION HEALTH EXPENDITURE HEALTH EXPENDITURE PER CAPITA HEALTH EXPENDITURES HEALTH FACILITIES HEALTH FINANCING HEALTH FUNDING HEALTH INDICATORS HEALTH INITIATIVES HEALTH INTERVENTIONS HEALTH OUTCOMES HEALTH REFORM HEALTH RESOURCES HEALTH SECTOR HEALTH SECTOR REFORM HEALTH SERVICE HEALTH SERVICE UTILIZATION HEALTH SERVICES HEALTH SPENDING HEALTH SYSTEM HEALTH SYSTEM PERFORMANCE HEALTH SYSTEM REFORM HEALTH SYSTEM STRENGTHENING HEPATITIS B HOSPITAL HOSPITALIZATION HOSPITALS HOUSEHOLD INCOME HOUSEHOLD LEVEL HOUSING HUMAN DEVELOPMENT HUMAN RESOURCES ILLNESSES IMMUNIZATION IMPROVEMENTS IN MORTALITY INCENTIVE STRUCTURES INCOME COUNTRIES INCOME HOUSEHOLDS INCOME POPULATION INEQUITIES INEQUITY IN HEALTH INFANT INFANT MORTALITY INFANT MORTALITY RATE INFANT MORTALITY RATES INFLATION INPATIENT CARE INSURANCE INSURANCE SCHEMES INTERVENTION JOURNAL OF MEDICINE LAWS LIVE BIRTHS LOCAL GOVERNMENTS LOW INCOME MACROECONOMIC PERFORMANCE MATERNAL MORTALITY MATERNAL MORTALITY RATE MATERNAL MORTALITY RATIO MATERNAL MORTALITY RATIOS MEDICAL BILLS MEDICAL EQUIPMENT MEDICAL INSURANCE MEDICINES MILLENNIUM DEVELOPMENT GOALS MINISTRY OF EDUCATION MINISTRY OF HEALTH MORTALITY MUNICIPALITIES NATIONAL DEVELOPMENT NATIONAL GOVERNMENT NATIONAL GOVERNMENTS NATIONAL HEALTH NATIONAL HEALTH SERVICE NATIONAL HEALTH SERVICES NATIONAL INITIATIVES NATIONAL LEVEL NATIONAL LEVELS NATIONAL POLICIES NATIONAL POLICY NATIONAL PRIORITIES NEWBORN NURSES OLD-AGE OUTPATIENT CARE PATIENT PATIENTS PENSIONS POCKET PAYMENT POCKET PAYMENTS POLICY DISCUSSIONS POLICY RESEARCH POLICY RESEARCH WORKING PAPER POPULATION GROUPS PRIMARY CARE PRIMARY HEALTH CARE PRIMARY HEALTH CARE SYSTEM PROGRESS PROVIDER PAYMENT PROVINCIAL GOVERNMENTS PUBLIC PUBLIC DEBATE PUBLIC EXPENDITURE PUBLIC EXPENDITURE ON HEALTH PUBLIC HEALTH PUBLIC HEALTH PROGRAMS PUBLIC HEALTH SPENDING PUBLIC HOSPITALS PUBLIC RESOURCES PUBLIC SECTOR PUBLIC SERVICE PUBLIC SERVICE DELIVERY PUBLIC SERVICES PUBLIC SPENDING QUALITY OF CARE RESOURCE ALLOCATION RESOURCE ALLOCATIONS RESPECT ROADS RURAL AREAS RURAL COUNTIES RURAL HEALTH CARE RURAL RESIDENTS RURAL WOMEN SAFE MOTHERHOOD SAFE WATER SANITATION SCREENING SERVICE DELIVERY SERVICE PROVIDERS SERVICE PROVISION SERVICE UTILIZATION SOCIAL DEVELOPMENT SOCIAL POLICY SOCIAL PROGRESS SOCIAL SECTOR SOCIAL SECTORS SOCIAL SERVICES TREASURY UNDER-FIVE MORTALITY UNFPA UNIVERSAL ACCESS URBAN AREAS URBAN COMMUNITY URBAN DEVELOPMENT URBAN INFRASTRUCTURE URBAN SERVICES VACCINATION WORLD HEALTH ORGANIZATION YOUNG CHILD
Online Access:	http://www-wds.worldbank.org/external/default/main?menuPK=64187510&pagePK=64193027&piPK=64187937&theSitePK=523679&menuPK=64187510&searchMenuPK=64187283&siteName=WDS&entityID=000158349_20110113134311 http://hdl.handle.net/10986/3303

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Summary:	Achieving the objective of China's current health system reform, namely equitable improvements in health outcomes, will be difficult not least because of the continuously growing income disparities in the country. The analysis in this paper shows that since 2000, disparity in selected health outcomes has been declining across provinces, largely due to earmarked central government allocations. By contrast, public expenditure on health is increasingly regressive (positively correlated with local income per capita) across provinces, and across prefectures and lower levels within provinces. The increasing inequity in public expenditure at sub-national levels indicates that incentives, responsibilities, and resources at sub-national levels are not well aligned with China's national priorities. To address the weaknesses in equity and efficiency that characterize China's health system and health outcomes, China's health system reform may require complementary reforms to improve governance for public service delivery across sectors.

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