Proposal title: Bringing health care to the vulnerable – developing equitable and sustainable rural health insurance in China and Viet Nam

Overall objective: The goal of the project is to contribute towards poverty reduction and health improvement for people living in the poor rural areas of developing countries. The overall objective of the project is to promote equity in health by making evidence available for health policy-makers for an effective, sustainable and affordable rural health care financing system in China and Viet Nam

Specific objectives

1. To carry out a situation analysis of perceived needs for rural health insurance and strengths and weaknesses of existing schemes.
2. To develop and implement pilot rural health insurance schemes that are feasible and meet the perceived needs of their target populations.
3. To monitor and evaluate the effects of the new schemes from the perspectives of equitable coverage, user satisfaction, efficient service utilization and provision, poverty reduction and sustainability.
4. To support the design and implementation of sustainable, equity-oriented rural health insurance schemes by effective dissemination of the research findings.

Abstract

A growing number of developing countries are developing health insurance schemes to protect people, particularly the poor, from financial catastrophe caused by expensive medical care. Among them are China and Viet Nam, which have experienced rapid economic development and dramatic social changes over the past two decades. All these changes have had profound implications for every aspect of people’s lives. Health care financing reforms in the two countries have led health facilities to rely increasingly on user charges, which have resulted in greater financial difficulties in accessing health care, especially for the rural poor.

Although the central governments of both countries have promoted the development of rural health insurance for many years, the population coverage has been far from satisfactory, due to many political, socioeconomic and managerial factors. The proposed research will promote equitable health care financing mechanisms in the two countries by developing and disseminating an evidence base for the design and implementation of sustainable and acceptable rural health insurance schemes. The research project will adopt a case study approach in which a number of study counties and districts where rural health insurance schemes already exist will be selected for implementing revised schemes that are feasible and meet the perceived needs of their target population. It will monitor and evaluate the effects of the schemes from the perspectives of equitable coverage, user satisfaction, efficient service use and provision, poverty reduction and sustainability. It is expected that the final project results (good practice and lessons learnt) will be disseminated to a wide audience and used to inform relevant policies on rural health insurance in China, Viet Nam and other countries with similar economies.