Xiao, Y, Husain, L and Bloom, G (2018) Evaluation and learning in complex, rapidly changing health systems, Globalization and Health, 14:112, DOI: 10.1186/s12992-018-0429-7
Healthcare systems are increasingly recognised as complex, in which a range of non-linear and emergent behaviours occur. China’s healthcare system is no exception. The hugeness of China, and the variation in conditions in different jurisdictions present very substantial challenges to reformers, and militate against adopting one-size-fits-all policy solutions. As a consequence, approaches to change management in China have frequently emphasised the importance of sub-national experimentation, innovation, and learning. Multiple mechanisms exist within the government structure to allow and encourage flexible implementation of policies, and tailoring of reforms to context. These limit the risk of large-scale policy failures and play a role in exploring new reform directions and potentially systemically-useful practices. They have helped in managing the huge transition that China has undergone from the 1970s onwards. China has historically made use of a number of mechanisms to encourage learning from innovative and emergent policy practices. Policy evaluation is increasingly becoming a tool used to probe emergent practices and inform iterative policy making/refining. This paper examines the case of a central policy research institute whose mandate includes evaluating reforms and providing feedback to the health ministry. Evaluation approaches being used are evolving as Chinese research agencies become increasingly professionalised, and in response to the increasing complexity of reforms. The paper argues that learning from widespread innovation and experimentation is challenging, but necessary for stewardship of large, and rapidly-changing systems.
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Liu T, Hao X and Zhang Z (2016) Identifying community healthcare supports for the elderly and the factors affecting their aging care model preference: evidence from three districts of Beijing, BMC Health Services Research, 16:1863, DOI: 10.1186/s12913-016-1863-y
The Chinese tradition of filial piety, which prioritized family-based care for the elderly, is transitioning and elders can no longer necessarily rely on their children. The purpose of this study was to identify community support for the elderly, and analyze the factors that affect which model of old-age care elderly people dwelling in communities prefer.
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This paper analyses the main policy documents of Urban Employee Basic Medical Insurance System (UEBMIS) over the past two decades and the institutional environment, experiences, and problems in the process of reform. The authors state that in the future, UEBMIS should proceed according to the guideline of ensuring basic demands, establishing a multi-level security system, and ensuring sustainability. It should also proceed according to the guideline of gradual advancement and piloting first. Top-level design and linkage reform should be improved, national data should be unified, and a data-evaluation system should be established.
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Through summarizing the new situation and new problems since the pilot implementation development of urban and rural medical insurance for catastrophic diseases in China, this article analyzes the nature of medical insurance for catastrophic diseases and the relationship among New Rural Cooperative Medical System and Basic Medical Insurance for urban residents, puts forward the main difficulties and the faced challenges in the development of medical insurance for catastrophic diseases.
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Establishment of medical security and assistance mechanisms for catastrophic diseases is the focus of health care reform to tackle the large medical expense burden. Based on sorting out the stage of the development of China's severe illness security policy, point out the cotent and difficulties of the connection of medical assistance and medical insurance for catastrophic diseases, analyse the main problems of medical assistance for catastrophic diseases and give appropriate policy recommendations.
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This journal article aims to evaluate the impact of the global budget on health care costs of one pilot hospital by comparatively analyzing the data before and after the policy implementation, and then put forward proposals and suggestion for the improvement of the policy.
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There is growing international concern about the threat to public health of the emergence and spread of bacteria resistant to existing antibiotics. An effective response must invest in both the development of new drugs and measures to slow the emergence of resistance. This paper addresses the former. It focuses on low and middle-income countries with pluralistic health systems, where people obtain much of their antibiotics in unorganised markets.
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In 2009 the government of China identified an essential drugs policy as one of five priority areas for health system reform. Since then, a national essential drugs policy has been defined, along with plans to implement it. As a large scale social intervention, the policy will have a significant impact on various local health actors. This paper uses the lens of complex adaptive systems to examine how the policy has been implemented in three rural Chinese counties. Using material gathered from interviews with key actors in county health bureaus and township health centers, we illustrate how a single policy can lead to multiple unanticipated outcomes. The complexity lens applied to the material gathered in interviews helps to identify relevant actors, their different relationships and policy responses and a new framework to better understand heterogeneous pathways and outcomes. Decision-makers and policy implementers are advised to embrace the complex and dynamic realities of policy implementation. This involves developing mechanisms to monitor different behaviors of key actors as well as the intended outcomes and unintended consequences of the policy.
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《卫生服务提供体系创新:公立医院法人化》系世界银行经济学家对多个发达国家(地区)和发展中国家(地区)的公立医院改革进行研究的一项成果。《卫生服务提供体系创新:公立医院法人化》清晰地提出了公立医院的改革目的，阐述了其改革的理论基础，提出了分析、评价公立医院改革的基本框架。强调只有外部环境和内部治理的制度安排相互作用和协调一致，公立医院的改革才能成功。《卫生服务提供体系创新:公立医院法人化》利用原苏东地区和拉丁美洲地区的综述及九个国家(地区)案例研究的数据，对公立医院组织变革的全球经验进行了比较分析。作者通过系统、翔实的资料和深入的分析向读者展示了英国、新西兰、澳大利亚、中国香港、马来西亚、新加坡、突尼斯、印度尼西亚和厄瓜多尔等九个国家(地区)的公立医院改革的鲜活案例。《卫生服务提供体系创新:公立医院法人化》对公立医院改革的研究者和实践者大有裨益。
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In this paper, we focus on financial protection in rural China, where 745 million–57% of the Chinese people–reside (National Bureau of Statistics of China, 2006). First, we illustrate the degree of financial protection that rural residents have after a series of reforms and changes since 1978. Then we review the current rural health insurance reforms as well as the results from the pilot programs. We conclude with recommendations for future policies and programs.
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Using data from the fourth China National Health Services Survey (NHSS) that was conducted in 2008, the authors conducted a tracer illness study of urban people with acute upper respiratory tract infections (URTI) to examine the factors that affect their use of different outpatient health care providers.
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Three key activities were undertaken by FHS during the initial phase of this five-year project. First, key considerations in strengthening evidence-policy linkages in health system research were developed by FHS researchers through workshops and electronic communications. Four key considerations in strengthening evidence-policy linkages are postulated: development context; research characteristics; decision-making processes; and stakeholder engagement. Second, these four considerations were applied to research proposals in each of the six countries to highlight features in the research plans that potentially strengthen the research-policy interface and opportunities for improvement. Finally, the utility of the approach for setting research priorities in health policy and systems research was reflected upon.
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