The Rural Health Reforms of the 2000s
39
at the local level were collected through a questionnaire administered to local government officials in October 2005. Provincial governments sent the questionnaire to the Bureau of Civil Affairs in 2,659 rural counties, of which 1,645 (62 percent) completed the form. The work was overseen, with the support of MOCA, by the Institute of Social Development and Public Policy at Beijing Normal University, with extensive input from the World Bank. In contrast to the NRCMS study, no household data were collected, and no qualitative study was undertaken. Box 3.2 summarizes contemporaneous program financing, assistance, and coverage and disbursements. Medical Assistance impacts (for example, on service utilization and poverty) were not evaluated for this study, and they have yet to be examined by others. One reason to suspect a limited impact is the fact that the budget per person uncovered by the study is small, equivalent to less than half of 1 percent of total health expenditure in rural China. Even in terms of spending per person in the target population, the expenditure is small. In 2006, the Medical Assistance rural budget per person in the principal target population—Di Bao, Te Kun, and Wu Bao beneficiaries—was just Y 18. Even if the entire budget had been devoted to these households, the program would have had only enough to pay for the household contribution to NRCMS (Y 10) and just Y 8 for out-of-pocket payments. To put this in perspective, according to the 2006 Rural Household Survey, households in the poorest fifth of the rural population spent an average of Y 100 out-of-pocket on health care. The high per-episode figures in
Box 3.2
Medical Assistance circa 2005 Financing. The Medical Assistance budget (equivalent to Y 1.2 per rural resident in 2006, Y 890 million in total in rural areas)28 was financed mostly by central, provincial, and county government sources, but also supplemented by contributions from townships, lotteries, donations, and development assistance. Findings showed the MA budget to be inversely related to per capita county income until the upper county quintile, which had the largest budget per capita. Township contributions, lottery contributions, and donations were largest in the richest fifth of counties. Central government funding varied relatively little with county income. (continued)