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Public vs private administration of rural health insurance schemes: a comparative study in Zhejiang of China

Published online by Cambridge University Press:  04 October 2012

Xiaoyuan Zhou ,
Zhengzhong Mao ,
Bernd Rechel ,
Chaojie Liu ,
Jialin Jiang  and
Yinying Zhang
Xiaoyuan Zhou
Affiliation:
Lecturer, Huaxi School of Public Health, Sichuan University, Chengdu, China
Zhengzhong Mao*
Affiliation:
Professor, Huaxi School of Public Health, Sichuan University, Chengdu, China
Bernd Rechel
Affiliation:
Researcher, European Observatory on Health Systems and Policies, London School of Hygiene & Tropical Medicine, London, UK
Chaojie Liu
Affiliation:
Associate Professor, School of Public Health of La Trobe University, Melbourne, Australia
Jialin Jiang
Affiliation:
Lecturer, Huaxi School of Public Health, Sichuan University, Chengdu, China
Yinying Zhang
Affiliation:
Lecturer, Huaxi School of Public Health, Sichuan University, Chengdu, China
*
*Correspondence to: Professor Zhengzhong Mao, Vice president of Health Economics Association of China, Head of the Department of Health Economics, Huaxi School of Public Health, Sichuan University, Chengdu 610041, China. E-mail: zzzmao666@yahoo.com
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Abstract

Since 2003, China has experimented in some of the country's counties with the private administration of the New Cooperative Medical Scheme (NCMS), a publicly subsidized health insurance scheme for rural populations. Our study compared the effectiveness and efficiency of private vs public administration in four counties in one of China's most affluent provinces in the initial stage of the NCMS's implementation. The study was undertaken in Ningbo city of Zhejiang province. Out of 10 counties in Ningbo, two counties with private administration for the NCMS (Beilun and Ninghai) were compared with two others counties with public administration (Zhenhai and Fenghua), using the following indicators: (1) proportion of enrollees who were compensated for inpatient care; (2) average reimbursement–expense ratio per episode of inpatient care; (3) overall administration cost; (4) enrollee satisfaction. Data from 2004 to 2006 were collected from the local health authorities, hospitals and the contracted insurance companies, supplemented by a randomized household questionnaire survey covering 176 households and 479 household members. In our sample counties, private administration of the NCMS neither reduced transaction costs, nor improved the benefits of enrollees. Enrollees covered by the publicly administered NCMS were more likely to be satisfied with the insurance scheme than those covered by the privately administered NCMS. Experience in the selected counties suggests that private administration of the NCMS did not deliver the hoped-for results. We conclude that caution needs to be exercised in extending private administration of the NCMS.

Type
Articles
Information
Health Economics, Policy and Law , Volume 8 , Issue 3 , July 2013 , pp. 269 - 288
Copyright
Copyright © Cambridge University Press 2012 

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