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Unformatted text preview: Rural Health in China: Briefing Notes Series China’s Health Sector—Why Reform is Needed Health systems exist ultimately to improve population health through the timely provision of appropriate health care. The care must, of course, also be affordable—in part because otherwise people will be deterred from seeking care, but also because the pursuit of health cannot be at any price. Good health is desirable, but has to be balanced against other important goals, such as better nutrition, shelter, education, and so on. Ideally, therefore, the cost of health care at the point of use will be low enough to enable households to restore their health and achieve some or all of these other goals—the so- called ‘financial protection’ goal of health systems. This Briefing Note * argues that while in the 1960s and 1970s China performed well on both health system objectives, in the 1980s it faltered, and in the 1990s it slipped still further. China’s increasingly weak performance is argued to reflect system-wide weaknesses in the health system. The cost of care has grown rapidly in recent years, deterring use of health services, and putting households who do use services at financial risk. The rise in the cost of care has coincided with falling health insurance coverage: health insurance has all but disappeared in rural areas, and is under a good deal of strain in urban areas. The way providers are paid encourages the provision of overly expensive care and discourages cost-consciousness. And the government is insufficiently engaged in areas where markets are known to perform badly. * This briefing note was prepared by World Bank staff, and is based loosely on an issues note prepared by Magnus Lindelöw and Adam Wagstaff. The findings, interpretations, and conclusions expressed herein are those of the authors, and do not necessarily reflect the views of the World Bank or those of its Executive Directors or the governments they represent, or the Government of China. The note forms part of the World Bank’s ongoing study on China's rural health sector. The study—referred to as the China Rural Health AAA (Analytical and Advisory Activities)—is being undertaken in collaboration with the Ministry of Health (MOH) and other government agencies, as well as with selected international partners. For further information, contact L. Richard Meyers ( [email protected] ). Goals and performance This Briefing Note is part of a broader series of Notes. It is intended to be an overview of the challenges facing the sector, and makes the case that reform is required. It does not make specific reform proposals, which will be the task of future Notes. Historic and recent performance on health outcomes Tracking health system performance in terms of health outcomes is hampered by a shortage of data that are comparable across countries and over time. Child mortality is one indicator that is widely available, and is widely accepted as a useful summary population health statistic. useful summary population health statistic....
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- Spring '08