Sukhan Jackson

Health payment-induced poverty under China’s New Cooperative Medical Scheme in rural Shandong

OBJECTIVE To measure the incidence and severity of health payment-induced poverty of rural households under the New Cooperative Medical Scheme (NCMS) in rural Shandong, China. METHOD We collected primary data from a household survey to identify catastrophic health payments and measure associated health payment-induced poverty in a county of Shandong province. From a stratified random cluster sample of 3101 households, 375 households that might be at risk of catastrophic payments were identified and interviewed. A validity test of the screening method was conducted, from which we obtained the adjusted total number of households with catastrophic payments in the sample of 3101. The health payment-induced poverty incidence and severity were compared without and with NCMS reimbursements. RESULTS Before the NCMS intervention, 5.06% of the sample households fell below the national poverty line due to health payments in 2004, compared with 4.03% after reimbursements. With NCMS reimbursements, the health payment-induced poverty gap of those households still remaining below the Chinese national poverty line dropped by 19.2% to an average of 977.2 Yuan. CONCLUSION Out-of-pocket health payments remain a severe burden for rural households. Financial protection from the NCMS was limited.

The political economy and socio‐economic impact of China's three Gorges dam

Over the past twenty years, Chinas gross domestic product has increased at an average annual rate of 9.8 per cent (China Statistical Bureau 1999, 57). To sustain such growth, the Chinese government has to make huge investments in economic infrastructure, especially transport, communications and electricity. By far its largest and most risky investment is the Three Gorges Dam. The success of the dam will enable future economic growth, but if it fails Chinas economy will falter. The industrial sector accounts for nearly 72 per cent of total energy consumption, driving at an average annual growth rate of 15 per cent for the past 20 years (China Statistical Bureau 1999, 424). Ranked second in the world, China in 1996 had an installed capacity of 236 million kilowatts of power (China Daily 29 July 1997, 5) but per capita generation was only 5 per cent and 20 per cent of the levels in the United States and South Korea respectively. Energy comes mainly from four sources: coal (75 per cent), petroleum (17.5 per cent), natural gas (1.6 per cent) and hydropower (5.9 per cent) (China Statistical Bureau 1997, 215). The use of hydropower is, in part, technologically inevitable because China has always relied on hydraulic technology for water conservancy, irrigation, flood control and navigation (Needham 1981). A monument to Chinese skills is the Dujiang dam on the upper reaches of the Yangtze River, built 2,200 years ago for flood control and irrigation and still in sound working condition. Constrained by a lack of finances in the past, China remains rich in untapped hydropower resources as only 30 per cent have been exploited, in contrast to industrialised countries in Europe and the United States where hydropower has already been fully exploited. However, the Chinese are now rapidly developing

Dams, development, and health: a missed opportunity.

The World Commission on Dams (WCD) was created in 1998 by the World Bank and the World Conservation Union with a 2-year mandate to study the performance of large dams and their impact on development. The resulting 448-page report derives from 17 exhaustive thematic reviews reports from India and China 2 working papers (on sex and health) 4 regional consultations 970 submissions 8 in-depth river-basin case studies and an audit of 125 large dams. The 12 WCD commissioners came from all sides of the debate. They documented a global inventory of 45000 large dams impoundments over 15 m in height or storing at least 3 million cu. m of water. The report was found to provide an excellent account of the complex impacts of dams; yet only 2 pages were allocated for discussing their impacts on health. This article examines the deficiency of the WCD report in analyzing health issues.

Doctor supply in Australia: rural–urban imbalances and regulated supply

We review the debate on the supply of doctors in Australia from an economic perspective. We focus on the supply between urban and rural areas and on Australia’s reliance on foreign-born overseas-trained doctors. Documented evidence shows that doctors are concentrated in cities and rural Australians have relatively poor access; and there is heavy reliance on the recruitment of foreign doctors. We suggest that besides training more local doctors, policy-making should include innovations to resolve the supply imbalance such as physician assistants and community pharmacy care in areas where access to general practitioners is often limited.

Malaria control and fever management in Henan Province, China, 1992

Henan Province, which once had the highest malaria prevalence in China, had only 318 reported cases in 1992. Our purpose was to investigate this late ‘consolidation phase’ of malaria control in Henan with reference to malaria surveillance. We conducted a questionnaire survey of village doctors in Shang Shi Qiao Township during the transmission period of 1992. Of the 732 recorded fever cases, 16 were probable malaria cases by clinical and treatment response criteria, but only one received a full course of antimalarials. Of the 732 patients, 61% had fever every day, 37% went for treatment the first day, 52% waited 2–3 days and 10% waited longer. One hundred and twenty‐eight patients took self‐medication before seeing the doctor. Blood examination was carried out in 526 (71%) fever cases but only four were positive, all for Plasmodium vivax. Our findings highlight problems relating to patient behaviour and motivation of village doctors, malaria treatment, surveillance and microscopy, rural migration, economic development and malaria transmission. All need to be considered for reforming the malaria control strategy in Henan Province.

Socio‐economic reforms in China’s rural health sector: Economic behaviour and incentives of village doctors

The post‐1978 micro‐economic reforms have dismantled China’s community‐funded rural health system, relying on paramedics called “barefoot doctors”. Examines the economic behaviour and incentives of village doctors (formerly “barefoot doctors”) as a response to a deregulated market and the private sector in the 1990s. The investigation of 519 village doctors showed that the occupation was male‐dominated. There was minimal labour mobility ‐ 86 per cent worked in the same village; 87 per cent were allocated land, but the majority spent 25 per cent or less of working hours on farming. Suggests that they should provide free patient services, and income should come from payment for medicine. In practice, monopolistic market situations enabled many to charge fees. To maximize income, 41 per cent of western medicine practitioners also sold Chinese medicinal herbs in competition with Chinese medicine practitioners. However, village doctors wanted more regulations on entry to the occupation and looked to government intervention to solve problems. Concludes with some policy implications drawing on the pursuit of private interests by village doctors.