We report the results of a review of the Chinese- and English-language literatures on service delivery in China, asking how well China's health-care providers perform and what determines their performance. Although data and methodological limitations suggest caution in drawing conclusions, a critical reading of the available evidence suggests that current health service delivery in China leaves room for improvement, in terms of quality, responsiveness to patients, efficiency, cost escalation, and equity. The literature suggests that these problems will not be solved by simply shifting ownership to the private sector or by simply encouraging providers - public and private - to compete with one another for individual patients. By contrast, substantial improvements could be (and in some places have already been) made by changing the way providers are paid - shifting away from fee-for-service and the distorted price schedule. Other elements of active purchasing by insurers could further improve outcomes. Rigorous evaluations, based on richer micro-level data, could considerably strengthen the evidence base for service delivery policy in China.

Payment incentives have significant consequences for the equity and efficiency of a health care system, and have recently come to the fore in health policy reforms. This paper first discusses the economic rationale for apparent international convergence toward payment systems with mixed demand and supply-side cost sharing. We then summarize the recent payment reforms undertaken in Taiwan, Korea and China. Available evidence clearly indicates that incentives matter, and that supply-side cost sharing in particular can improve efficiency without undermining equity. Further study and monitoring of quality and selection is warranted.

Reform of the welfare sector is an important yet difficult challenge for countries in transition from socialist central planning to market-oriented democracies. Here a scholar of the economics of socialism and post-socialist transition, and a health economist take on this challenge. They offer health sector reform recommendations for ten countries of Eastern Europe, drawn from nine guiding principles. The authors conclude that policymakers need to achieve a balance, both assuring social solidarity through universal access to basic health services and expanding individual choice and responsibility through voluntary supplemental insurance.