|dc.description.abstract||The School o f Public Health o f the Shanghai Medical University (SMU) and the Institute of
Development Studies (IDS) are collaborating in a programme o f research on rural health
finance in China. The programme was developed in consultation with the Department of
Health Policy and Law o f the Ministry o f Public Health (MoPH). The aim is to contribute to
the formulation o f strategies for financing health services in poor areas that make it possible
for them to provide access for all, including the poor, to prevention and basic curative care at
During 1992 and 1993 the team analysed the data from a 20-county survey o f health utilisation
and expenditure that was carried out by the SMU during 1988. The findings have been
published in Chinese, in a collection o f articles in the May 1994 issue o f Health Economics
Research and in English in IDS Research Report no. 26.
The second phase o f the programme concentrates on the special problems o f health services in
poor rural areas. It began in 1993 and is scheduled to end in 1997. The work focuses on three
case studies. The reason for limiting the geographical scope o f the study is that the situation is
changing so rapidly in China, that the findings o f large scale surveys rapidly become obsolete.
Policy makers at national level have little knowledge about what is happening on the ground,
particularly in poor, relatively inaccessible counties. The aim o f the programme is to gain an
insight into the changes that are taking place and to identify the factors that have to be taken
into account in assessing the likely outcome o f a change in the system o f health finance. This
will make it possible for the research team to assist in the formulation o f realistic policies for
rural health finance.
The Health Departments o f three provinces, Guangxi, Guizhou and Shaanxi are participating
in the programme, and research institutions in each province are collaborating in the field work
and data analysis. One county has been selected in each province (Donglan, Shibing and
Xunyi). All three comity governments have expressed an interest in developing strategies for
improving health sector finance, and the health bureau o f each county has nominated officers
to participate in the research.
During 1993 and 1994, diagnostic studies were designed and carried out in the three study
counties. The major findings have been reported to the county governments and two o f the
counties have agreed to develop experimental health prepayment schemes, in collaboration
with the research team. In addition, a series o f workshops were held with national level policy
makers, senior researchers and managers o f provincial and county health services. These
meetings had two aims. Firstly, they provided an opportunity to consult with experienced
personnel on the design o f the research studies and to feed back to them the research findings.
Secondly, they provided a forum for the presentation o f papers by county level managers.
These papers identified problems and outlined strategies that have been taken to overcome
The research instruments for the county diagnostic studies were designed collaboratively by
researchers from SMU and IDS. The sources o f data included:
• routine reports from the county statistics bureau,
• routine financial data from the county government,
• financial and health service delivery data from all county-level health facilities, • routine financial data from a sample o f townships,
• structured interviews with key informants in the county government and county and
township level health facilities, and
• focus group discussions with health workers and users o f health services.
Each county diagnostic study was carried out by a team that included researchers from
Shanghai and the provincial research institute. Each team prepared a drafi report, in
collaboration with researchers from the IDS. All three county report team leaders participated
in a meeting at the IDS, during which the reports were finalised. This working paper provides
edited versions o f those reports, and is primarily intended to make more widely available the
wealth of data which they contain.||en_GB