Daniele Brombal

The influence of the rural health security schemes on health utilization and household impoverishment in rural China: data from a household survey of western and central China

BackgroundThe New Rural Cooperative Medical Scheme (NRCMS, voluntary health insurance) and the Medical Financial Assistance (MFA, financial relief program) were established in 2003 for rural China. The aim of this study was to document their coverage, assess their effectiveness on access to in-patient care and protection against financial catastrophe and household impoverishment due to health spending, and identify the factors predicting impoverishment with and without these schemes.MethodsA cross-sectional household survey was conducted in 2008 in Hebei and Shaanxi provinces and the Inner Mongolia Autonomous Region using a multi-stage sampling technique. Information on personal demographic characteristics, chronic illness status, health care use, household expenditure, and household health spending were collected by interview.ResultsNRCMS covered 90.8% of the studied individuals and among the designated poor, 7.6% had their premiums paid by MFA. Of those referred for hospitalization in the year prior to the interview, 34.3% failed to comply, mostly (80.2%) owing to financial constraints. There was no significant difference in the unmet need for admission between the insured with NRCMS and the uninsured. Before reimbursement, the incidence of catastrophic health payment (household health spending more than 40% of households capacity to pay) and medical impoverishment (household per capita income falling below the poverty line due to medical expense) was 14.3% and 8.2%, respectively. NRCMS prevented 9.9% of the households from financial catastrophe and 7.7% from impoverishment, whereas MFA kept just one household from impoverishment and had no effect on financial catastrophe. Household per capita expenditure and household chronic disease proportion (proportion of members of a household with chronic illness) were the most important determinants of the unmet need for admission, risk of being impoverished and the chance of not being saved from impoverishment.ConclusionThe coverage of NRCMS among the rural population was high but not adequate to improve access to in-patient care and protect against financial catastrophe and household impoverishment due to health payment, especially for the poor and the chronically ill. Furthermore, MFA played almost no such role; therefore, the current schemes need to be improved.

Effect of household and village characteristics on financial catastrophe and impoverishment due to health care spending in Western and Central Rural China: A multilevel analysis

The study aimed to examine the effect of household and community characteristics on financial catastrophe and impoverishment due to health payment in Western and Central Rural China. A household survey was conducted in 2008 in Hebei and Shaanxi provinces and the Inner Mongolia Autonomous Region using a multi-stage sampling technique. Independent variables included village characteristics, household income, chronic illness status, health care use and health spending. A composite contextual variable, named village deprivation, was derived from socio-economic status and availability of health care facilities in each village using factor analysis. Dependent variables were whether household health payment was more than 40% of households capacity to pay (catastrophic health payment) and whether household per capita income was put under Chinese national poverty line (1067 Yuan income per year) after health spending (impoverishment). Mixed effects logistic regression was used to assess the effect of the independent variables on the two outcomes. Households with low per capita income, having elderly, hospitalized or chronically ill members, and whose head was unemployed were more likely to incur financial catastrophe and impoverishment due to health expenditure. Both catastrophic and impoverishing health payments increased with increased village deprivation. However, the presence of a village health clinic had no effect on the two outcomes, nor did household enrollment in the New Rural Cooperative Medical Scheme (national health insurance). Village deprivation independently increases the risk for financial hardship due to health payment after adjusting for known household-level factors. This suggests that policy makers need to view the individual, household and village as separate units for policy targeting.

Planning for a Sustainable Belt and Road Initiative (BRI): An Appraisal of the Asian Infrastructure Investment Bank (AIIB) Environmental and Social Safeguards

The Belt and Road Initiative (BRI) has been hailed by many as a game changer in the field of economy, capable to sustain growth in the Eurasian region. Many observers however are concerned about the environmental and social costs of the initiative. To what extent the BRI will pursue a development in tune with the environment and the needs of affected communities will largely depend upon the capacity of concerned actors to carry out integrated and inclusive environmental and social planning. A major role will be played by financial institutions funding the initiative. This chapter seeks to appraise the rationale, scope, legitimacy, and decision-making implications of environmental and social policies applicable to BRI projects. To pursue this aim, the Asian Infrastructure Investment Bank (AIIB) is taken as a case representative of current progress and challenges ahead. Findings indicate that AIIB’s environmental and social safeguards may constitute a tool to promote social inclusion and environmental protection within BRI projects. However, their effectiveness will depend from the Bank’s political commitment towards sustainability and its capacity to foster institutional change in client countries.

Chinese Studies in Venice: A Timeline of Change

Chinese Studies have historically been shaped by change in political, social, and scientific institutions. Since the ’80s, China’s emergence into the world stage and change in scientific paradigms have spurred debate about the epistemological foundations of the field. Sinologists have been confronted with the need of identifying pathways to ensure that the knowledge they produce is relevant for science and society. The engagement with theoretical and empirical approaches employed by different disciplines, most notably the social sciences, has been a key element to their endeavours. This paper contributes to this on-going reflection, by benchmarking recent changes in Chinese Studies at Ca’ Foscari University against global trends of evolution in area studies. Results show that the field has now multi-disciplinary features and has initiated a transition towards interdisciplinarity. By endorsing the holistic approach to knowledge informing this transition, scholars in the field may strengthen the centrality of Chinese Studies in scientific production processes concerned with the sinosphere. Summary