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Engaging sub-national governments in addressing health equities: challenges and opportunities in China's health system reform

Brixi, Hana ; Mu, Yan ; Targa, Beatrice ; Hipgrave, David

Health policy and planning, 2013-12, Vol.28 (8), p.809-824 [Periódico revisado por pares]

England: Oxford University Press

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Título:
Engaging sub-national governments in addressing health equities: challenges and opportunities in China's health system reform
Autor: Brixi, Hana ; Mu, Yan ; Targa, Beatrice ; Hipgrave, David
Assuntos: Accountability ; Appropriations and expenditures ; Benefits ; Child Health Services ; Child, Preschool ; China ; China (People's Republic) ; China - epidemiology ; Decentralization ; Delivery of Health Care - economics ; Equality ; Evaluation ; Expenditure ; Expenditures ; Female ; Financing ; Government ; Government and politics ; Government spending ; Health ; Health administration ; Health care delivery ; Health care policy ; Health Care Reform ; Health costs ; Health disparities ; Health Expenditures ; Health policy ; Health Status Disparities ; Humans ; Income ; Inequality ; Infant ; Law ; Local Government ; Management ; Maternal Health Services ; Medical service ; Mortality - trends ; Original articles ; Performance management ; Policy implementation ; Provinces ; Public services ; Reforms ; Regulation ; Responsibility ; Studies
É parte de: Health policy and planning, 2013-12, Vol.28 (8), p.809-824
Notas: ObjectType-Article-1
SourceType-Scholarly Journals-1
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Descrição: China's current health system reform (HSR) is striving to resolve deep inequities in health outcomes. Achieving this goal is difficult not only because of continuously increasing income disparities in China but also because of weaknesses in healthcare financing and delivery at the local level. We explore to what extent sub-national governments, which are largely responsible for health financing in China, are addressing health inequities. We describe the recent trend in health inequalities in China, and analyse government expenditure on health in the context of China's decentralization and intergovernmental model to assess whether national, provincial and sub-provincial public resource allocations and local government accountability relationships are aligned with this goal. Our analysis reveals that government expenditure on health at sub-national levels, which accounts for ~90% of total government expenditure on health, is increasingly regressive across provinces, and across prefectures within provinces. Increasing inequity in public expenditure at sub-national levels indicates that resources and responsibilities at sub-national levels in China are not well aligned with national priorities. China's HSR would benefit from complementary measures to improve the governance and financing of public service delivery. We discuss the existing weaknesses in local governance and suggest possible approaches to better align the responsibilities and capacity of sub-national governments with national policies, standards, laws and regulations, therefore ensuring local-level implementation and enforcement. Drawing on China's institutional framework and ongoing reform pilots, we present possible approaches to: (1) consolidate key health financing responsibilities at the provincial level and strengthen the accountability of provincial governments, (2) define targets for expenditure on primary health care, outputs and outcomes for each province and (3) use independent sources to monitor and evaluate policy implementation and service delivery and to strengthen sub-national government performance management.
Editor: England: Oxford University Press
Idioma: Inglês

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Engaging sub-national governments in addressing health equities: challenges and opportunities in China's health system reform

Brixi, Hana ; Mu, Yan ; Targa, Beatrice ; Hipgrave, David

England: Oxford University Press

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