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This thesis tries to explain the Chinese health system since the 50s, and make an institutional analysis to understand how Chinese government reacted during different steps of development face to population's demand in terms of health protection. The purpose of this thesis is to associate an institutional analysis with a case study in Weifang in China to deeply understand chinese health system, at the meanwhile this thesis tries to provide useful support for other future studies on this subject. ; La thèse présente le système de santé en Chine à travers son évolution depuis les années 50 et en fait une analyse institutionnelle pour comprendre comment le gouvernement chinois a réagi pendant les différentes phases de développement face à la demande de la population en termes de protection sanitaire. L'idée de cette thèse est de combiner une analyse institutionnelle avec une étude de cas à Weifang en Chine pour comprendre en profondeur le système de santé Chinois, mais aussi pour essayer de fournir des supports utiles pour les autres études qui pourraient être menées sur ce sujet.

This thesis tries to explain the Chinese health system since the 50s, and make an institutional analysis to understand how Chinese government reacted during different steps of development face to population's demand in terms of health protection. The purpose of this thesis is to associate an institutional analysis with a case study in Weifang in China to deeply understand chinese health system, at the meanwhile this thesis tries to provide useful support for other future studies on this subject. ; La thèse présente le système de santé en Chine à travers son évolution depuis les années 50 et en fait une analyse institutionnelle pour comprendre comment le gouvernement chinois a réagi pendant les différentes phases de développement face à la demande de la population en termes de protection sanitaire. L'idée de cette thèse est de combiner une analyse institutionnelle avec une étude de cas à Weifang en Chine pour comprendre en profondeur le système de santé Chinois, mais aussi pour essayer de fournir des supports utiles pour les autres études qui pourraient être menées sur ce sujet.

Since the early 2000s, the Chinese government has undertaken a series of reforms in the health sector. Among these, the three most important have been concerned with medical insurance, hospital administration, and pharmaceutical policies. The aims of these reforms were to extend health insurance coverage, to increase the activities and the efficiency of the health establishments, and to improve patient care. This article focuses on two components of these reforms: the development of health insurance in rural areas and the policy on essential medicines in conjunction with hospital reforms. Our longstanding co-operation with a research team from Weifang University and with the Weifang Health Bureau allowed us to follow these reforms and collect data (primary source) from a sample of township hospitals from Weifang Prefecture. Those data allowed us to study their effects on health facilities' level of activity and efficiency. This article provides an overview of studies we carried out on these issues over the period from 2000 to 2012. Our analyses were mainly based on non-parametric models (Data Envelopment Analysis, Malmquist Index, and partial frontiers) and impact analyses, coupled with interviews with hospital staff and medical authorities. Results show that the development of health insurance in rural areas had a positive effect in greatly increasing the activities of the hospitals covered by our study. On the other hand, it did not have a positive influence on their efficiency, which declined in the period concerned. This result is to be explained by the fact that, even though staff activity increased, it remained low, since the observed increase in activity was not sufficient to make up for the parallel increase in staff numbers. Similarly, reforms in the hospital and pharmaceutical sectors had no effect on the township hospitals of our survey. In fact, in order to compensate for the observed reduction of hospital resources following the introduction of the reforms, on the one hand the government increased the subsidies allocated to township hospitals, and on the other hand the hospitals strongly innovated in sophisticated and expensive care, to the benefit of a relatively small number of patients. Therefore, there were some very positive steps forward, but they still call for a more nuanced assessment of the effects of the reforms. (China Perspec/GIGA)

Etudes & documents ; To cope with the rising price of drugs, in 2009 the Chinese government launched a large pharmaceutical reform. Its key element is the implementation of a National Essential Medicine List, leading to a reorientation of incentives for health services providers. Health facilities are not anymore allowed to make any profit on drug sales ("zero mark-up policy"), while this used to be their main source of financing. Different compensation schemes have been implemented by the authorities. In a context of refunding of the financing structure of health care facilities, it is crucial to understand how the reform has affected –or not- health care facilities activity and efficiency.This study relies on a survey data from a sample of 30 Township Hospitals of the rural prefecture of Weifang (Shandong province). Using a two-stage procedure, it aims at assessing the THs' technical efficiency scores and then at identifying the determinants of this efficiency. The first stage is realized with a non-parametric frontier approach, the so-called 'partial frontier' method, order-m to deal with the problem of dimensionality. The identification of the determinants of efficiency requires panel data models, with random individual effects. Results show that the average efficiency remains constant between 2006-09 and 2010-12, around 0.65. The most significant and robust factors of technical efficiency are the share of subsidies in the TH incomes for the first sub-period (negative effect), and the number of covered inhabitants per bed (positive effect). It suggests that drug reform hasn't improve primary health facilities efficiency, certainly because the reform did not tackle with success the issues of the financial barriers to universal access to healthcare -out-of-pocket payments from patients-, and of the perception of quality of public healthcare.

Etudes & documents ; To cope with the rising price of drugs, in 2009 the Chinese government launched a large pharmaceutical reform. Its key element is the implementation of a National Essential Medicine List, leading to a reorientation of incentives for health services providers. Health facilities are not anymore allowed to make any profit on drug sales ("zero mark-up policy"), while this used to be their main source of financing. Different compensation schemes have been implemented by the authorities. In a context of refunding of the financing structure of health care facilities, it is crucial to understand how the reform has affected –or not- health care facilities activity and efficiency.This study relies on a survey data from a sample of 30 Township Hospitals of the rural prefecture of Weifang (Shandong province). Using a two-stage procedure, it aims at assessing the THs' technical efficiency scores and then at identifying the determinants of this efficiency. The first stage is realized with a non-parametric frontier approach, the so-called 'partial frontier' method, order-m to deal with the problem of dimensionality. The identification of the determinants of efficiency requires panel data models, with random individual effects. Results show that the average efficiency remains constant between 2006-09 and 2010-12, around 0.65. The most significant and robust factors of technical efficiency are the share of subsidies in the TH incomes for the first sub-period (negative effect), and the number of covered inhabitants per bed (positive effect). It suggests that drug reform hasn't improve primary health facilities efficiency, certainly because the reform did not tackle with success the issues of the financial barriers to universal access to healthcare -out-of-pocket payments from patients-, and of the perception of quality of public healthcare.

Depuis le début des années 2000 la Chine s'est engagée dans une réforme ambitieuse et complexe de son système de santé. Cet article examine trois éléments clés du processus de réforme : la réforme du secteur hospitalier et de l'assurance maladie en zone rurale, et la refondation du système de prix des médicaments prescrits dans les hôpitaux. À partir d'études de cas réalisées dans la province du Shandong, il met en évidence certains effets très positifs des réformes, et pourquoi elles se sont traduites par une érosion de l'efficience dans les hôpitaux de premier niveau.