Health affairs
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Surveys suggest that over the past five to ten years, the amount of health insurance premiums collected has grown at an average rate of 34 percent in India and 43 percent in China. A variety of public and private insurance schemes play important roles in enabling health care provision for unique populations in these two countries. This paper provides an overview of the trends in health insurance as a financing mechanism for health care in China and India. It suggests a broad policy approach to aligning and mobilizing forces that would allow segmented expansion of public and private health insurance.
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Contradictory goals plague China's pharmaceutical policy. The government wants to develop the domestic pharmaceutical industry and has used drug pricing to cross-subsidize public hospitals. ⋯ Pharmaceuticals account for about half of total health spending in China, representing 43 percent of spending per inpatient episode and 51 percent of spending per outpatient visit. Yet some essential medicines are unavailable or of questionable quality.
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Since its passage in April 2006, the Massachusetts health reform law (Chapter 58) has expanded affordable insurance coverage to 355,000 people. Major milestones have been achieved, including establishment of new coverage programs, merger of small-group and nongroup insurance markets, creation of an insurance "Connector," determination of affordability and penalty standards for an individual mandate, and launch of employer responsibility requirements. Key challenges remain, including full implementation of the individual mandate, cost control, and securing of long-term financing. Massachusetts health reform is offering valuable and important lessons for the nation.
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This paper examines delivery of public health care services in India, in the broader context of decentralization. It provides an overview of the basic features and recent developments in intergovernmental fiscal relations and accountability mechanisms, and it examines the implications of these institutions for the quality of public service delivery. It then addresses recent policy proposals on the public provision of health care, in the context of decentralization. Finally, it makes suggestions for reform priorities to improve public health care delivery.