Title:	The Effects of Social Health Insurance Reform on People’s Out-of-Pocket Health Expenditure in China
Authors:	Kai Liu
Keywords:	Effects of Social
Issue Date:	2016
Publisher:	Springer
Description:	The new healthcare reform in China has entered its seventh year. Despite the earlier debate on the direction of healthcare reform towards marketization or public welfare, social health insurance (SHI) has become a central measure in response to the plight of “difficult access to and unaffordable cost of healthcare”. With the coverage of social health insurance gradually expanding to include almost the entire population, research in recent years has attempted to evaluate the effectiveness and efficiency of the health insurance scheme as a key strategy of reform. However, systematic research with rigorous data and theoretical discussion about the operation and implementation of social health insurance are still rare. This book distinguishes itself among all researches of China’s healthcare reform with four prominent strengths. First, it asks an important but insufficiently studied question: Why does the application of social health insurance in China turn out to work against its original will to reduce the cost of healthcare, but instead lead to the inflation of medical expenditure, especially individuals’ out-of-pocket spending (OOPS)? The book is devoted to deciphering this paradox through comprehensive analyses and thoughtful interpretation of empirical data. Second, it attempts to understand the mechanism of the actual operation of social health insurance via a unique angle, the theoretical perspective of institutional arrangements. Through investigation of the mediating role of reimbursement, behavior management and purchasing mechanism of the social health insurance, the book clearly demonstrates the paths by which participation in social health insurance leads to increased out-of-pocket spending of patients. Third, it employs a mixed-methods design to delineate the full picture of the operation of social health insurance. In addition to the sophisticated quantitative analyses using the nationally representative data, China Health and Retirement Longitudinal Study (CHARLS), what makes this book outstanding is the rich qualitative data collected from the author’s immersion in the daily practice of health facilities for four months of intensive fieldwork. The observation of everyday administration of social health insurance agencies and health facilities, as well as the communications with multiple stakeholders with regard to their various experiences in the process, provides convincing explanations of why this unintended cost-inflating effect of social health insurance actually happens as a result of malfunctioned purchasing mechanism. Last, the book proposes a single payer model which provides valuable insights to the next stage of healthcare reform in China. Given the complicated interactions among multiple stakeholders revealed in the study, it suggests establishing a strong and unified social health insurance purchaser to overcome the drawbacks of fragmented small-scale social health insurance agencies and to mobilize greater resources for raising the benefits of reimbursement. Eventually, the reform shall lead to a healthy and active social health insurance governance system
URI:	http://10.6.20.12:80/handle/123456789/54268
ISBN:	978-981-10-1777-3
Appears in Collections:	Population Studies

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