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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In this commentary in Nature, the authors argue that the rapid expansion of health markets in Asia and Africa has made medicines, information and primary-care services available in all but the most remote areas. But it also creates problems with drug safety and efficiency, equity of treatment and the cost of care. Poorly trained practitioners often prescribe unnecessary pills or injections, with patients bearing the expense and the costs to their health. Counterfeit drugs are rife and drug resistance is growing. Bringing order to unruly health markets is a major challenge.
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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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Henry Lucas of IDS briefly presents work on the burden of chronic diseases for the rural poor in China at the 2011 iHEA conference. The study, led by Ding Shijun for the POVILL programme, showed that, where inpatient care did not involve surgery, the cost of outpatient care for chronic diseases was similar -- but not covered by insurance.
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This paper is concerned with the management of health system changes aimed at substantially increasing the access to safe and effective health services. It argues that an effective health sector relies on trust-based relationships between users, providers and funders of health services, and that one of the major challenges governments face is to construct institutional arrangements within which these relationships can be embedded.
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Xiao, Y. et al. (2011) Implementation of National Essential Drug Policy: Analysis from a Complex Adaptive Systems Perspective. Chinese General Practice, Volume 14, 5A: 1419-1421.
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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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China is managing major health system reforms against a background of rapid economic and institutional change. In doing so it is developing a learning approach to transition management and institution-building. This approach includes testing innovations at local level, encouraging learning from success, and then gradually building institutions that support new ways of doing things. Chinese policymakers and analysts are also developing strategies for drawing on international experience. Analysts from other countries and officials in organisations that support international health need to understand this approach if they are to strengthen mutual learning with their Chinese counterparts.
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This policy brief describes the experiences of a three-way partnership in the Basic Health Services Project and explores lessons for partnership-building elsewhere.
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China’s rural health system has experienced major problems in adapting to the emerging market economy. The central government has recognised that it needs to take action to ensure more equitable access to services. This policy briefing paper summarises lessons from a ten year project that piloted strategies for addressing these problems in 97 poor counties, home to 46.78 million people.
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Future Health Systems: Innovations for Equity (FHS) is working in six partner countries in Asia and Africa, focusing on strengthening the research–policy interface in relation to specific health system research projects. These projects present an opportunity to study the influence of stakeholders on research and policy processes.
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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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Using the examples of front-line health providers and health insurance, this paper discusses how China and India's different approaches have emerged from their own historical and political contexts and have led to different ways to address the main regulatory questions concerning quality of care, value for money, social agreement, and accountability.
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The success of China in its transition has received a great deal of attention from economists. At the same time, public health experts have accumulated evidence on setbacks within the Chinese health sector, particularly in rural areas. This paper puts these two bodies of knowledge together.
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China and Vietnam have adopted market reforms in the health sector in the context of market economic reforms. Vietnam has developed a large private health sector, while in China commercialization has occurred mainly in the formal public sector, where user fees are now the main source of facility finance.
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