Local Motivation and Distributive Choices

2020 ◽  
pp. 111-133
Author(s):  
Xian Huang
Keyword(s):  
Health Insurance ◽  
Regional Variation ◽  
Fiscal Decentralization ◽  
Social Health Insurance ◽  
Social Health ◽  
Local Policy ◽  
Policy Choices ◽  
Local Resources ◽  
The Masses ◽  
Local Leaders

Chapter 5 focuses on local leaders’ distributive motivations and policy choices in social welfare provision. The combination of political centralization and fiscal decentralization compels Chinese local leaders to specify major policies in local circumstances while balancing the Center’s mandates and directives with local resources and constraints. Drawing from qualitative evidence collected during fieldwork in China between 2009 and 2012, this chapter not only demonstrates the regional variation in local policy responses to the Center’s directive of stratified expansion of social health insurance but also provides examples of local calculations and policy choices in implementing the health insurance expansion. The reasons for the regional differences in local policy choices for social health insurance expansion are not only the disparities of local socioeconomic conditions and resources but also the contradiction embedded in the Chinese authoritarian regime’s distributive strategy: expanding basic benefits to the masses while maintaining the welfare privilege for the elites.

Four Worlds of Welfare: Understanding Subnational Variation in Chinese Social Health Insurance

2015 ◽  
Vol 222 ◽  
pp. 449-474 ◽  
Author(s):  
Xian Huang
Keyword(s):  
Health Insurance ◽  
Regional Variation ◽  
Social Health Insurance ◽  
Social Needs ◽  
Social Health ◽  
Social Risk ◽  
Political Careers ◽  
Regime Stability ◽  
Local Officials ◽  
State Agents

AbstractChina's social health insurance has expanded dramatically over the past decade. The increasing number of beneficiaries and benefits, however, has aggravated rather than mitigated regional disparities in health care. How can the regional variation in Chinese social health insurance be explained? This paper argues that the subnational variation in China's social health insurance results from the policy choices of central and local states. The central leadership, which is concerned about regime stability, delegates substantial discretionary authority to local state agents to accommodate diverse social needs and local circumstances. Local officials, who care about their political careers in the centralized personnel system, proactively design and implement social health insurance policy according to local situations such as fiscal resources and social risk. In specifying the rationale, conditions and patterns of regional variation in Chinese social health insurance, this paper addresses the general issue of how political leaders in an authoritarian regime respond to social needs.

Social Protection under Authoritarianism

2020 ◽  
Author(s):  
Xian Huang
Keyword(s):  
Health Insurance ◽  
Social Welfare ◽  
Social Protection ◽  
Social Health Insurance ◽  
Multilevel Governance ◽  
Social Health ◽  
Social Constraints ◽  
Welfare Provision ◽  
Trade Off ◽  
The Masses

Why would authoritarian leaders expand social welfare provision in the absence of democratization? What are the distributive features and implications of social welfare expansion in an authoritarian country? How do authoritarian leaders design and enforce social welfare expansion in a decentralized multilevel governance setting? This book identifies the trade-off authoritarian leaders face in social welfare provision: effectively balancing coverage and benefits between elites and masses in order to maximize the regime’s survival prospects. Using government documents, field interviews, survey data, and government statistics about Chinese social health insurance, this book reveals that the Chinese authoritarian leaders attempt to manage the distributive trade-off by a “stratified expansion” strategy, establishing an expansive yet stratified social health insurance system to perpetuate a particularly privileged program for the elites while building an essentially modest health provision for the masses. In China’s decentralized multilevel governance setting, the stratified expansion of social health insurance is implemented by local leaders who confront various fiscal and social constraints in vastly different local circumstances. As a result, there is great regional variation in the expansion of social health insurance, in addition to the benefit stratification across social strata. The dynamics of central-local interaction in enforcing the stratified expansion of social health insurance stands at the core of the politics of health reform in China during the first decade of the 2000s. This book demonstrates that the strategic balance between elites and masses in benefit distribution is delicate in authoritarian and decentralized multilevel governance settings.

Which Therapeutic Progress Shall be Paid by Social Health Insurance?

2007 ◽  
Author(s):  
Jürgen Wasem ◽  
Hans-Dieter Nolting ◽  
Yvonne Grabbe ◽  
Stefan Loos
Keyword(s):  
Health Insurance ◽  
Social Health Insurance ◽  
Social Health

scholarly journals Participatory and responsive governance in universal health coverage: an analysis of legislative provisions in Thailand

2021 ◽  
Vol 6 (2) ◽  
pp. e004117
Author(s):  
Aniqa Islam Marshall ◽  
Kanang Kantamaturapoj ◽  
Kamonwan Kiewnin ◽  
Somtanuek Chotchoungchatchai ◽  
Walaiporn Patcharanarumol ◽  
...  
Keyword(s):  
Health Insurance ◽  
Social Health Insurance ◽  
Universal Coverage ◽  
Civil Servant ◽  
Social Health ◽  
Health Coverage ◽  
Medical Benefit ◽  
The Social ◽  
Universal Health ◽  
Universal Coverage Scheme

Participatory and responsive governance in universal health coverage (UHC) systems synergistically ensure the needs of citizens are protected and met. In Thailand, UHC constitutes of three public insurance schemes: Civil Servant Medical Benefit Scheme, Social Health Insurance and Universal Coverage Scheme. Each scheme is governed through individual laws. This study aimed to identify, analyse and compare the legislative provisions related to participatory and responsive governance within the three public health insurance schemes and draw lessons that can be useful for other low-income and middle-income countries in their legislative process for UHC. The legislative provisions in each policy document were analysed using a conceptual framework derived from key literature. The results found that overall the UHC legislative provisions promote citizen representation and involvement in UHC governance, implementation and management, support citizens’ ability to voice concerns and improve UHC, protect citizens’ access to information as well as ensure access to and provision of quality care. Participatory governance is legislated in 33 sections, of which 23 are in the Universal Coverage Scheme, 4 in the Social Health Insurance and none in the Civil Servant Medical Benefit Scheme. Responsive governance is legislated in 24 sections, of which 18 are in the Universal Coverage Scheme, 2 in the Social Health Insurance and 4 in the Civil Servant Medical Benefit Scheme. Therefore, while several legislative provisions on both participatory and responsive governance exist in the Thai UHC, not all schemes equally bolster citizen participation and government responsiveness. In addition, as legislations are merely enabling factors, adequate implementation capacity and commitment to the legislative provisions are equally important.

scholarly journals Effects of cancer treatment on household impoverishment: a multicentre cross-sectional study in China

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e044322
Author(s):  
Wenqi Fu ◽  
Jufang Shi ◽  
Xin Zhang ◽  
Chengcheng Liu ◽  
Chengyao Sun ◽  
...  
Keyword(s):  
Health Insurance ◽  
Cancer Treatment ◽  
Cancer Patients ◽  
Social Health Insurance ◽  
Poverty Line ◽  
Post Treatment ◽  
Social Health ◽  
Daily Consumption ◽  
Out Of Pocket Payments ◽  
Per Capita

ObjectivesTo determine the incidence and intensity of household impoverishment induced by cancer treatment in China.DesignAverage income and daily consumption per capita of the households and out-of-pocket payments for cancer care were estimated. Household impoverishment was determined by comparing per capita daily consumption against the Chinese poverty line (CPL, US$1.2) and the World Bank poverty line (WBPL, US$1.9) for 2015. Both pre-treatment and post-treatment consumptions were calculated assuming that the households would divert daily consumption money to pay for cancer treatment.ParticipantsCancer patients diagnosed initially from 1 January 2015 to 31 December 2016 who had received cancer treatment subsequently. Those with multiple cancer diagnoses were excluded.Data sourcesA household questionnaire survey was conducted on 2534 cancer patients selected from nine hospitals in seven provinces through two-stage cluster/convenience sampling.Findings5.89% (CPL) to 12.94% (WBPL) households were impoverished after paying for cancer treatment. The adjusted OR (AOR) of post-treatment impoverishment was higher for older patients (AOR=2.666–4.187 for ≥50 years vs <50 years, p<0.001), those resided in central region (AOR=2.619 vs eastern, p<0.01) and those with lower income (AOR=0.024–0.187 in higher income households vs the lowest 20%, p<0.001). The patients without coverage from social health insurance had higher OR (AOR=1.880, p=0.040) of experiencing post-treatment household impoverishment than those enrolled with the insurance for urban employees. Cancer treatment is associated with an increase of 5.79% (CPL) and 12.45% (WBPL) in incidence of household impoverishment. The median annual consumption gap per capita underneath the poverty line accumulated by the impoverished households reached US$128 (CPL) or US$212 (WBPL). US$31 170 395 (CPL) or US$115 238 459 (WBPL) were needed to avoid household impoverishment induced by cancer treatment in China.ConclusionsThe financial burden of cancer treatment imposes a significant risk of household impoverishment despite wide coverage of social health insurance in China.

scholarly journals Social health insurance for the poor: lessons from a health insurance programme in Karnataka, India

2018 ◽  
Vol 3 (1) ◽  
pp. e000582 ◽  
Author(s):  
Neeraj Sood ◽  
Zachary Wagner
Keyword(s):  
Health Insurance ◽  
Financial Burden ◽  
Tertiary Care ◽  
Substantial Reduction ◽  
Unmet Need ◽  
Social Health Insurance ◽  
Well Being ◽  
Poverty Line ◽  
Social Health ◽  
The Poor

Life-saving technology used to treat catastrophic illnesses such as heart disease and cancer is often out of reach for the poor. As life expectancy increases in poor countries and the burden from chronic illnesses continues to rise, so will the unmet need for expensive tertiary care. Understanding how best to increase access to and reduce the financial burden of expensive tertiary care is a crucial task for the global health community in the coming decades. In 2010, Karnataka, a state in India, rolled out the Vajpayee Arogyashree scheme (VAS), a social health insurance scheme focused on increasing access to tertiary care for households below the poverty line. VAS was rolled out in a way that allowed for robust evaluation of its causal effects and several studies have examined various impacts of the scheme on poor households. In this analysis article, we summarise the key findings and assess how these findings can be used to inform other social health insurance schemes. First, the evidence suggests that VAS led to a substantial reduction in mortality driven by increased tertiary care utilisation as well as use of better quality facilities and earlier diagnosis. Second, VAS significantly reduced the financial burden of receiving tertiary care. Third, these benefits of social health insurance were achieved at a reasonable cost to society and taxpayers. Several unique features of VAS led to its success at improving health and financial well-being including effective outreach via health camps, targeting expensive conditions with high disease burden, easy enrolment process, cashless treatment, bundled payment for hospital services, participation of both public and private hospitals and prior authorisation to improve appropriateness of care.

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