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- Bogg, Lennart, et al.
(författare)
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The cost of coverage : rural health insurance in China
- 1996
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Ingår i: Health Policy and Planning. - : Oxford University Press. - 0268-1080 .- 1460-2237. ; 11:3, s. 238-52
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Tidskriftsartikel (refereegranskat)abstract
- China has undergone great economic and social change since 1978 with far reaching implications for the health care system and ultimately for the health status of the population. The Chinese Medical Reform of the 1980s made cost recovery a primary objective. The urban population is mostly protected by generous government health insurance. A high share government budget is allocated to urban health care. Rural cooperative health insurance reached a peak in the mid-1970s when 90% of the rural population were covered. In the 1980s rural cooperative health insurance collapsed and present coverage is less than 8%. The decline has been accompanied by reports of growing equity problems in the financing of and access to health care. This article is the first in a four-year study of the impact on equity of the changes in Chinese health care financing. The article examines the relationship between rural cooperative health insurance as the explanatory variable and health care expenditure, curative vs. preventive expenditure and tertiary curative care expenditure as dependent variables using a natural experimental design with a 'twin' county as a control. The findings support the hypothesis that cooperative health insurance will induce higher growth of health care expenditure. The findings also support the hypothesis that cooperative health insurance will lead to a shift from preventive medicine to curative medicine and to a higher level of tertiary curative care expenditure. The empirical evidence from the Chinese counties is contradicting World Bank health financing policies.
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| 2. |
- Xu, Biao, et al.
(författare)
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DOTS in China : Removing barriers or moving barriers?
- 2006
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Ingår i: Health Policy and Planning. - : Oxford University Press. - 0268-1080 .- 1460-2237. ; 21:5, s. 365-72
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Tidskriftsartikel (refereegranskat)abstract
- In 1992, China initiated its modern National TB Control Programme (NTP) with DOTS strategy through a project funded by a World Bank loan. Key motives for the revised NTP-DOTS were to reduce financial barriers to patients by removing fee charges for diagnosis and treatment, and to address regressive suppliers' incentives for appropriate referrals. This study aims to assess to what extent China's NTP subsidies are achieving the objective of removing financial barriers to care in terms of patients' expenditure. One county with NTP-DOTS - Jianhu - and one county without - Funing - were selected. A cohort of 493 tuberculosis patients newly diagnosed in 2002 was interviewed by questionnaire. The main outcome measure was tuberculosis patients' expenditure on medical care and transportation/accommodation from the onset of symptoms to treatment completion. During the follow-up period, Funing started implementing NTP-DOTS, which offered a possibility of longitudinal comparison both between counties and within county. Ninety-four per cent (465/493) of subjects were followed-up. The mean total patient's expenditure on TB medical care and transportation/accommodation before TB diagnosis was higher in Jianhu than in Funing (715 vs. 256CNY), whereas it was higher in Funing (835 vs. 157CNY) after diagnosis. After implementing NTP-DOTS in Funing, expenditure after diagnosis decreased slightly whereas expenditure before diagnosis increased remarkably. We found that the market incentive structures in the reformed health system appear to have a stronger regressive effect and may result in prolonged delays before effective treatment can be given. We believe that doctors adapt to new incentive structures, with bonus income being linked to the hospitals' fee-for-service revenue, and find new ways of keeping revenue at the old levels, which reduce or eliminate the intended effect of the subsidies. TB patients suffer a heavy economic burden even in counties where NTP-DOTS treatment is subsidized. The total patient expenditure was reduced only marginally, but shifted substantially from after diagnosis to before diagnosis. The shift could imply delays in diagnosis and treatment with an increased risk of infection transmission.
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| 3. |
- Säfström, Carl Anders
(författare)
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The European Knowledge Society and the Diminishing State Control of Education : The Case of Sweden
- 2005
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Ingår i: Journal of Education Policy. - : Informa UK Limited. - 0268-0939 .- 1464-5106. ; 20:5, s. 583-593
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Tidskriftsartikel (refereegranskat)abstract
- In this article I explore the changing relation between education and the state as this is expressed through a new language of education within Sweden, structured by terms such as the knowledge society, life-long learning and validation. I read closely a policy document on life-long learning, taking as my point of departure the 'authentic state', a state that is possible only when the desires of individuals for a good life are made the conditions of democratic society. What the reading illuminates is that what is taken for granted within the new language of education is instead an 'agentic' state in which the will of the individual is subordinated to the will of the state and that this is most profoundly expressed through the subject position offered the individual, what I call Homo economicus. Thus the knowledge society tends to be a society that excludes the idea of education understood in any terms other than economic ones.
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