Health Care for 1.3 Billion: An Overview of China’s Health System
What kind of a health care system do China’s 1.3 billion turn to when ill, injured, or in need of care? This article provides a brief overview of how China’s health system has transformed alongside China’s society and economy since the Mao era, including how the current system is financed, organized, regulated, and being reformed. It first provides a brief description of the Mao-era health system and China’s demographic and epidemiologic transitions. Then it gives an overview of China’s contemporary health care system, including the dramatic expansion of health insurance over the last eight years and the progress of national health system reforms initiated in 2009.
A condensed and revised version of this paper is published in The Milken Institute Review 2012 second quarter: 16-27.
Published: Eggleston, Karen. "Health care for 1.3 billion: An overview of China’s health system." (2012).
Cigarette Citadels, Remapping Theory and Policy, Cigarette Factories in and Outside of China
At present, the tobacco industry produces some six trillion cigarettes worldwide every year. Six trillion cigarettes per annum, each ready to release smoke filled with highly addictive nicotine and powerful carcinogens. A third of all these sticks were produced in China last year. In 2011, the world’s largest cigarette maker by volume, the China National Tobacco Corporation, contributed an all-time high of U.S. $214 billion in profits and taxes to the Chinese government, up 22 percent year-on-year. Currently the greatest cause of preventable death in the world, the cigarette is likely to kill ten times as many people in the 21st century as it did in the 20th century, epidemiologists tell us, with China bearing the largest burden. Until now, much global health research and intervention has focused with limited success on the cigarette consumer—addressing how one or another variable prompts people to take up or quit smoking, whether the cue for the consumer is biological, psychological, spatial, financial or symbolic. What though of the industrial sources of tobacco-related diseases? Where are the six trillion cigarettes that are released into circulation each year manufactured? Where are they rolled, wrapped, and boxed for shipment? This presentation will introduce the Cigarette Citadels Project, an innovative application of participatory GIS. With special attention given to China’s network of cigarette factories, Matthew Kohrman will explain how the Cigarette Citadels Project not only reveals conceptual roadblocks in public health policy but also lacuna in social theory pertaining to the state and the politics of life.
Matthew Kohrman joined Stanford’s faculty in 1999. His research and writing bring multiple methods to bear on the ways health, culture, and politics are interrelated. Focusing on the People's Republic of China, he engages various intellectual terrains such as governmentality, gender theory, political economy, critical science studies, and embodiment. His first monograph, Bodies of Difference: Experiences of Disability and Institutional Advocacy in the Making of Modern China, examines links between the emergence of a state-sponsored disability-advocacy organization and the lives of Chinese men who have trouble walking. In recent years, Kohrman has been conducting research projects aimed at analyzing and intervening in the biopolitics of cigarette smoking and production. These projects expand upon analytical themes of Kohrman’s disability research and engage in novel ways techniques of public health.
This event is part of the China's Looming Challenges series.
Philippines Conference Room
Matthew Kohrman
Stanford University
Department of Anthropology
Building 50, Central Quad
Stanford, California 94305-2034
Matthew Kohrman joined Stanford’s faculty in 1999. His research and writing bring multiple methods to bear on the ways health, culture, and politics are interrelated. Focusing on the People's Republic of China, he engages various intellectual terrains such as governmentality, gender theory, political economy, critical science studies, and embodiment. His first monograph, Bodies of Difference: Experiences of Disability and Institutional Advocacy in the Making of Modern China, examines links between the emergence of a state-sponsored disability-advocacy organization and the lives of Chinese men who have trouble walking. In recent years, Kohrman has been conducting research projects aimed at analyzing and intervening in the biopolitics of cigarette smoking and production. These projects expand upon analytical themes of Kohrman’s disability research and engage in novel ways techniques of public health.
Soft Budget Constraints and Ownership: Empirical Evidence from U.S. Hospitals
Consistent with the property rights theory of ownership incorporating soft budget constraints (SBCs), we find that controlling for SBCs, for-profit hospitals drop safety-net services more often and exhibit higher mortality rates, suggesting aggressive cost control that damages non-contractible quality.
Do Different Health Insurance Plans in China Create Disparities in Health Care Utilization and Expenditures?
Venue Changed to the Philippines Conference Room
China has recently reformed its health care system with the intent of providing universal coverage for basic health care to every Chinese citizen. Three separate health insurance plans have recently been launched to achieve this objective: the rural newly cooperative medical scheme, urban resident health insurance, and urban employee-based health insurance. Each plan differs substantially in terms of insurers, insured population, premiums, and benefits packages. Using data from the 2009 China Health and Nutrition Survey, Hai Fang will discuss a study that investigates whether and to what extend different health insurance plans have created disparities in health care utilization and expenditure.
Hai Fang is an assistant professor in the Department of Health Systems, Management, and Policy at the University of Colorado Denver, and a research associate in the Kennedy School of Government at Harvard University. He earned his doctorate in economics and master of public health from the State University of New York at Stony Brook in 2006. Before joining the University of Colorado Denver, he taught at the University of California, Davis, and the University of Miami. His research interests include health economics, labor economics, and public health.
Philippines Conference Room
Prescribing Institutions: Explaining the Evolution of Physician Dispensing (journal article)
Health systems provide a rich field for testing hypotheses of institutional economics. The incentive structure of current healthcare delivery systems have deep historical and cultural roots, yet must cope with rapid technological change as well as market and government failures. This paper applies the economic approach of comparative and historical institutional analysis (Aoki, 2001; Greif, 2006) to health care systems by conceptualizing physician control over dispensing revenues as a social institution. The theory developed—emphasizing the interplay between cultural beliefs, interest groups, technological change, insurance expansion and government financing—offers a plausible explanation of reforms since the 1960s separating prescribing from dispensing in societies such as Japan, South Korea, Taiwan and China. Technological change and adoption of universal coverage trigger reforms by greatly increasing the social opportunity costs of physician over-prescribing and reshaping the political economy of forces impinging on the doctor–patient relationship.