Introduction
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Bank staff engaged in the ongoing study undertook various pieces of analytic work as part of their research activities that have helped to fill remaining knowledge gaps.10 Economists from the Bank team were invited to make presentations at several conferences, including a senior policy-maker seminar in 2005; a high-level roundtable on public finance cohosted by the Ministry of Finance (MOF) and the Bank in Beijing in 2006; the 2006 Beijing Forum; and a Colloquium on Future Directions for Health Care Reform in China held at St Anne’s College, Oxford, in 2008.11 In 2007, the Bank, the World Health Organization (WHO), and several Chinese universities were invited to prepare a paper for a high-level government task force charged by the Premier of China with preparing a new master plan for the health sector.
Overview of the Book This book represents the culmination of the World Bank’s analytic and advisory activities on China’s rural health sector. The book greatly benefited from an iterative review and consultation process. A first version was discussed within the World Bank in June 2006. A consultative draft was produced in fall 2006. Consultations with the Government of China and with other agencies, including the United Kingdom’s Department for International Development and the World Health Organization, took place at the end 2006 and at the beginning of 2007. Based on those consultations, a revised version was circulated for additional comment in summer 2007. Comments were incorporated into the manuscript in summer 2008, and this final version was revised and updated in the winter of 2008–09. The book is structured as follows. Chapter 2 (China’s Health Challenges at the Start of the New Millennium) begins by reviewing China’s pre-2000 health sector performance and the institutional issues that led to the need for significant reforms. The chapter examines why health outcomes were generally disappointing during an era in which it was widely assumed that social progress would follow close upon the heels of economic progress. The chapter looks at the prereform health care system in the context of collapsing rural health insurance, which was followed by transfer of the financing burden first to the provinces, then to health providers, and finally to the shoulders of individual households in need of health care. The chapter considers how out-of-pocket (OOP)