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Health Care for One Billion: Experimenting with Incentives for the Supply of Health Care in Rural China

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Despite successful economic reforms over the past two decades, China's health care system for the nearly one billion people that live and work in rural areas is broken. Having admitted that there is a crisis, the government is now committed to looking for solutions. In this proposal, we have two overall goals to help provide insights on part of the solution. Our first objective is to collect an updated wave of highly informative data in Year 1 to build on an existing set of data already collected by our study team (from 2004) to analyze the effects of key health policies and institutions that have emerged over the past several years, including the government's rural health insurance system, the privatization of rural clinics, and new investments into township hospitals. Our second, more forward-looking goal for Years 2 and 3 is to set up and introduce an initial experiment on incentives to study one of the most serious flaws in China's health system: the practice in which doctors both prescribe and derive significant profit from drugs. The main hypothesis to be tested is whether realigning doctors' financial incentives embedded in the current organization of China's rural health system influence: a) the way doctors treat and manage their patients; b) the time and effort doctors put into patient care; and c) patient satisfaction.

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