title: Realigning demand and supply side incentives to improve primary health care seeking in rural China.
abstract: China's recent and ambitious health care reform involves a shift from the reliance on markets to the reaffirmation of the central role of the state in the financing and provision of services. In collaboration with the Government of the Ningxia province, we examined the impact of two key features of the reform on health care utilisation using panel household data. The first policy change was a redesign of the rural insurance benefit package, with an emphasis on reorientating incentives away from inpatient towards outpatient care. The second policy change involved a shift from a fee-for-service payment method to a capitation budget with pay-for-performance amongst primary care providers. We find that the insurance intervention, in isolation, led to a 47% increase in the use of outpatient care at village clinics and greater intensity of treatment (e.g. injections). By contrast, the two interventions in combination showed no effect on health care use over and above that generated by the redesign of the insurance benefit package.
authors.affiliation: Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Timothy
authors.initials: T
authors.lastname: Powell-Jackson
authors.forename: Winnie Chi-Man
authors.initials: WC
authors.lastname: Yip
authors.forename: Wei
authors.initials: W
authors.lastname: Han
mesh_terms: D000293:Adolescent; D000328:Adult; D002204:Capitation Fee / Q000458:organization & administration; D002648:Child; D002681:China; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D007342:Insurance Benefits / Q000191:economics; D008297:Male; D008875:Middle Aged; D009042:Motivation; D009313:National Health Programs / Q000191:economics* / Q000458:organization & administration; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000191:economics* / Q000458:organization & administration; D019984:Quality Indicators, Health Care; D012052:Reimbursement, Incentive / Q000191:economics; D012424:Rural Population / Q000706:statistics & numerical data*
keywords: China; capitation payment; health insurance; impact evaluation; pay-for-performance