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It has been widely recognized that poor health is an important cause of poverty, especiallyamong the low- and middle- income countries. One of the reasons is the absence of publicfinancial protection against the medical consumption risk in these countries. This Phd dissertationis dedicated to discern the role that health insurance could play in the organization of healthfinancial protection system. The dissertation is composed of two parts. The first part discusses theproblems linking to the financing to medical consumption from a global point of view. Chapter 1brings theoretical discussions on three topics: 1) the specialties of medical consumption risks andthe difficulties in using private health insurance to manage medical consumption risks. 2) Therole of government and market in the distribution of health resources. 3) The options for theorganization of health financing system. Chapter 2 conducts a statistical comparison on theperformance of health financing systems in the countries of different social-Economic background.The discussion is carried out around three aspects of health financing: the availability of resources,the organization of health financing, and the coverage of financial protection. The second part ofthe dissertation studies the evolution of heath financing system in a specific country: China. Threechapters are assigned to this part. Chapter 3 introduces the history of Chinese health financingsystem since 1950s. It helps us to understand the challenges in health financing brought byeconomic reform. Chapter 4 carries out an empirical study on the distribution of health financingburden in China in the 1990s. It illustrates the direct results of the decline of public financing andincrease of direct payment. Chapter 5 presents health insurance reform that launched by thegovernment since the end of 1990s. An impact analysis is conducted on an original dataset of 24township hospitals in Weifang prefecture in the north of the China. The objective is to estimatethe impact of the implementation of New Rural Medical Cooperation System (NRMCS) on theactivities and financial structure of township hospitals. At last, we conclude that social healthinsurance (SHI) permits a sharing of health financial responsibilities between the service provider,the patient-Consumer, and the service purchaser. It can not only involve both public and privateagents into the collection of funds for health financing system, but also make each party moreaccountable due to the risks they bear from the result of medical consumption. Meanwhile it isnecessary to note that SHI is just one option among others to organize health financing system.The implementation of SHI requires a certain level of social-Economic development. SHI does notsystematically bring better performance on health financing if it is not accompanied by thereforms on provider payment or on service delivery system. Government commitment andinstitutional capacity are also key factors for the good function of the system. ; Il est admis qu'avoir une mauvaise santé est une des causes principales de pauvreté,particulièrement dans les pays à faible et moyen revenus. Une des raisons de ce constat est une absence de protection financière. L'objectif de cette thèse est de discerner le rôle que l'assurance maladie pourrait jouer dans l'organisation du système de protection financière de la santé. La thèse se compose de deux parties. La première partie aborde les problèmes liés au financement de santé d'un point de vue global. Le chapitre 1 apporte des discussions théoriques sur trois thèmes: 1) les spécificités des risques de la consommation médicale qui rendent la gestion du risque par l'assurance maladie privé difficile, 2) le rôle du gouvernement et du marché dans la répartition des ressources de santé. 3) les options pour l'organisation du financement de la santé. Le chapitre 2 présente une comparaison statistique sur la performance des systèmes de financement de la santé entre des pays à contextes socio-Économique différents. Les discussions sont menées autour de trois aspects du financement de la santé: la disponibilité des ressources,l'organisation du financement de la santé, et la couverture de la protection financière. La deuxième partie qui comporte trois chapitres étudie l'évolution du système de financement de la santé dans un pays donné: la Chine. Le chapitre 3 présente l'histoire du système de financement de la santé en Chine depuis 1950. Il nous aide à comprendre les défis dans le financement de la santé suscités par la réforme économique. Le chapitre 4 porte sur une étude empirique de la répartition de la charge financière de la santé en Chine dans les années 1990. Il illustre les résultats directs de la baisse du financement public et de l'augmentation des paiements directs sur le bienêtre de la population. Le chapitre 5 présente la réforme de l'assurance maladie lancée par le gouvernement depuis la fin des années 1990. L'objectif est d'estimer l'impact de la mise en oeuvre du nouveau système rural d'assurance médical (NRMCS) sur les activités et la structure financière de ces hôpitaux. Une analyse d'impact est réalisée sur un échantillon de 24 hôpitaux dans la préfecture de Weifang, au Nord de la Chine. Nous concluons que le système d'assurance maladie permet un partage des responsabilités financières entre prestataires de services, patient consommateurs et acheteurs de services. Elle inclut à la fois les agents publics et privés dans la contribution au financement de santé, ce qui rend chaque partie plus responsable vis-À-Vis de son comportement en raison des risques qu'il doit assumer du fait de la consommation médicale.Cependant, il est nécessaire de noter que l'assurance maladie sociale n'est qu'une option parmi d'autres systèmes de financement de la santé. La mise en oeuvre de ce système exige un certain niveau de développement socio-Économique. L'assurance maladie ne conduit pas systématiquement à une meilleure performance du financement de la santé si elle n'est pas accompagnée de réformes quant au paiement au fournisseur ou au système de prestation de services. L'engagement du gouvernement et des capacités institutionnelles sont également des facteurs clés pour le bon fonctionnement du système.

It has been widely recognized that poor health is an important cause of poverty, especially among the low- and middle- income countries. One of the reasons is the absence of public financial protection against the medical consumption risk in these countries. This Phd dissertation is dedicated to discern the role that health insurance could play in the organization of health financial protection system. The dissertation is composed of two parts. The first part discusses the problems linking to the financing to medical consumption from a global point of view. Chapter 1 brings theoretical discussions on three topics: 1) the specialties of medical consumption risks and the difficulties in using private health insurance to manage medical consumption risks. 2) The role of government and market in the distribution of health resources. 3) The options for the organization of health financing system. Chapter 2 conducts a statistical comparison on the performance of health financing systems in the countries of different social-economic background. The discussion is carried out around three aspects of health financing: the availability of resources, the organization of health financing, and the coverage of financial protection. The second part of the dissertation studies the evolution of heath financing system in a specific country: China. Three chapters are assigned to this part. Chapter 3 introduces the history of Chinese health financing system since 1950s. It helps us to understand the challenges in health financing brought by economic reform. Chapter 4 carries out an empirical study on the distribution of health financing burden in China in the 1990s. It illustrates the direct results of the decline of public financing and increase of direct payment. Chapter 5 presents health insurance reform that launched by the government since the end of 1990s. An impact analysis is conducted on an original dataset of 24 township hospitals in Weifang prefecture in the north of the China. The objective is to estimate the impact of the implementation of New Rural Medical Cooperation System (NRMCS) on the activities and financial structure of township hospitals. At last, we conclude that social health insurance (SHI) permits a sharing of health financial responsibilities between the service provider, the patient-consumer, and the service purchaser. It can not only involve both public and private agents into the collection of funds for health financing system, but also make each party more accountable due to the risks they bear from the result of medical consumption. Meanwhile it is necessary to note that SHI is just one option among others to organize health financing system. The implementation of SHI requires a certain level of social-economic development. SHI does not systematically bring better performance on health financing if it is not accompanied by the reforms on provider payment or on service delivery system. Government commitment and institutional capacity are also key factors for the good function of the system. ; L'objectif de cette thèse est discerner le rôle que l'assurance maladie pourrait jouer dans l'organisation du système de protection financière de la santé. La thèse se compose de deux parties. La première partie aborde les problèmes liés au financement de santé d'un point de vue global. Deux chapitres y consacrent. Le chapitre 1 apporte des discussions théoriques sur trois thèmes: 1) les spécificités des risques de la consommation médicale, 2) le rôle du gouvernement et du marché dans la répartition des ressources de santé. 3) les options pour l'organisation du financement de la santé. Le chapitre 2 présente une comparaison statistique sur la performance des systèmes de financement de la santé entre des pays à contextes socio-économique différents. La deuxième partie qui comporte trois chapitres étudie l'évolution du système de financement de la santé dans un pays donné: la Chine. Le chapitre 3 présente l'histoire du système de financement de la santé en Chine depuis 1950. Le chapitre 4 porte sur une étude empirique de la répartition de la charge financière de la santé en Chine dans les années 1990. Le chapitre 5 présente la réforme de l'assurance maladie lancée par le gouvernement depuis 2000. Une analyse d'impact est réalisée pour estimer l'impact de la mise en œuvre du nouveau système rural d'assurance médical (NRMCS) sur les activités et la structure financière de ces hôpitaux. Nous concluons que le système d'assurance maladie permet un partage des responsabilités financières entre prestataires de services, patient-consommateurs et acheteurs de services, ce qui rend chaque partie plus responsable vis-à-vis de son comportement. Cependant, il est nécessaire de noter que l'assurance maladie sociale n'est qu'une option parmi d'autres systèmes de financement de la santé. La mise en œuvre de ce système exige un certain niveau de développement socio-économique.

It has been widely recognized that poor health is an important cause of poverty, especiallyamong the low- and middle- income countries. One of the reasons is the absence of publicfinancial protection against the medical consumption risk in these countries. This Phd dissertationis dedicated to discern the role that health insurance could play in the organization of healthfinancial protection system. The dissertation is composed of two parts. The first part discusses theproblems linking to the financing to medical consumption from a global point of view. Chapter 1brings theoretical discussions on three topics: 1) the specialties of medical consumption risks andthe difficulties in using private health insurance to manage medical consumption risks. 2) Therole of government and market in the distribution of health resources. 3) The options for theorganization of health financing system. Chapter 2 conducts a statistical comparison on theperformance of health financing systems in the countries of different social-Economic background.The discussion is carried out around three aspects of health financing: the availability of resources,the organization of health financing, and the coverage of financial protection. The second part ofthe dissertation studies the evolution of heath financing system in a specific country: China. Threechapters are assigned to this part. Chapter 3 introduces the history of Chinese health financingsystem since 1950s. It helps us to understand the challenges in health financing brought byeconomic reform. Chapter 4 carries out an empirical study on the distribution of health financingburden in China in the 1990s. It illustrates the direct results of the decline of public financing andincrease of direct payment. Chapter 5 presents health insurance reform that launched by thegovernment since the end of 1990s. An impact analysis is conducted on an original dataset of 24township hospitals in Weifang prefecture in the north of the China. The objective is to estimatethe impact of the implementation of ...

It has been widely recognized that poor health is an important cause of poverty, especially among the low- and middle- income countries. One of the reasons is the absence of public financial protection against the medical consumption risk in these countries. This Phd dissertation is dedicated to discern the role that health insurance could play in the organization of health financial protection system. The dissertation is composed of two parts. The first part discusses the problems linking to the financing to medical consumption from a global point of view. Chapter 1 brings theoretical discussions on three topics: 1) the specialties of medical consumption risks and the difficulties in using private health insurance to manage medical consumption risks. 2) The role of government and market in the distribution of health resources. 3) The options for the organization of health financing system. Chapter 2 conducts a statistical comparison on the performance of health financing systems in the countries of different social-economic background. The discussion is carried out around three aspects of health financing: the availability of resources, the organization of health financing, and the coverage of financial protection. The second part of the dissertation studies the evolution of heath financing system in a specific country: China. Three chapters are assigned to this part. Chapter 3 introduces the history of Chinese health financing system since 1950s. It helps us to understand the challenges in health financing brought by economic reform. Chapter 4 carries out an empirical study on the distribution of health financing burden in China in the 1990s. It illustrates the direct results of the decline of public financing and increase of direct payment. Chapter 5 presents health insurance reform that launched by the government since the end of 1990s. An impact analysis is conducted on an original dataset of 24 township hospitals in Weifang prefecture in the north of the China. The objective is to estimate the impact of ...

In the rural health-care organization of China, township hospitals ensure the delivery of basic medical services. Particularly damaged by the economic reforms implemented from 1975 to the end of the 1990s, township hospitals efficiency is questioned, mainly with the implementation since 2003 of the reform of health insurance in rural areas. From a database of 24 randomly selected township hospitals observed over the period 2000-2008 in Weifang prefecture (Shandong), the study examines the efficiency of township hospitals through a two-stage approach. As curative and preventive medical services delivered at township hospital level use different production processes, two data envelopment analysis models are estimated with different orientation chosen to compute scores. Results show that technical efficiency declines over time. Factors explaining the technical efficiency are mainly environmental characteristics rather than internal factors, but our results suggest also that in the context of China, the efficiency of township hospitals is influenced by unobservable factors.

In the rural health-care organization of China, township hospitals ensure the delivery of basic medical services. Particularly damaged by the economic reforms implemented from 1975 to the end of the 1990s, township hospitals efficiency is questioned, mainly with the implementation since 2003 of the reform of health insurance in rural areas. From a database of 24 randomly selected township hospitals observed over the period 2000-2008 in Weifang prefecture (Shandong), the study examines the efficiency of township hospitals through a two-stage approach. As curative and preventive medical services delivered at township hospital level use different production processes, two data envelopment analysis models are estimated with different orientation chosen to compute scores. Results show that technical efficiency declines over time. Factors explaining the technical efficiency are mainly environmental characteristics rather than internal factors, but our results suggest also that in the context of China, the efficiency of township hospitals is influenced by unobservable factors.

International audience ; Township hospitals, which are an important link of the Chinese rural healthcare system, were affected by the successive socio-economic reforms since the 1980s. As a consequence, their utilization declined. From longitudinal data covering nine years (2000-2008) and 24 township hospitals randomly selected in Weifang prefecture (Shandong province, China), this article analyses the environmental and supply-side determinants of the volume of township hospitals curative activities, measured by the number of outpatient visits and that of discharged patients. The Hausman-Taylor and the Fixed-Effect Vector Decomposition estimators are used in order to cope with time-invariant variables. Results of the estimations are confronted and highlight similar outcomes. Findings show that the New Rural Cooperative Medical Scheme, introduced in 2003, has contributed to increase the activity of township hospitals, although financial barriers remain to the access to expensive medical services. The analyses underline also that referral practices between health facilities levels should be reinforced and that the size of the township hospitals needs to be adequate with environmental factors as they appear to be over-sized. ; Les hôpitaux municipaux, qui sont un maillon essentiel du système de santé rural Chinois, ont été affectés par les réformes économiques successives depuis les années 1980 et ont ainsi vu leur fréquentation s'affaiblir. À partir d'observations longitudinales sur neuf années (2000-2008) et 24 hôpitaux municipaux sélectionnés de façon aléatoire dans la préfecture de Weifang (Province du Shandong, Chine), cet article analyse les facteurs d'environnement et d'offre qui influencent le volume des activités curatives des hôpitaux municipaux, mesurépar le volume de consultations externes et d'hospitalisations. Afin d'estimer l'effet de variables invariantes dans le temps, deux estimateurs sont utilisés : Hausman-Taylor et Fixed-Effect Vector Decomposition. Les résultats des estimations des deux ...

International audience ; Township hospitals, which are an important link of the Chinese rural healthcare system, were affected by the successive socio-economic reforms since the 1980s. As a consequence, their utilization declined. From longitudinal data covering nine years (2000-2008) and 24 township hospitals randomly selected in Weifang prefecture (Shandong province, China), this article analyses the environmental and supply-side determinants of the volume of township hospitals curative activities, measured by the number of outpatient visits and that of discharged patients. The Hausman-Taylor and the Fixed-Effect Vector Decomposition estimators are used in order to cope with time-invariant variables. Results of the estimations are confronted and highlight similar outcomes. Findings show that the New Rural Cooperative Medical Scheme, introduced in 2003, has contributed to increase the activity of township hospitals, although financial barriers remain to the access to expensive medical services. The analyses underline also that referral practices between health facilities levels should be reinforced and that the size of the township hospitals needs to be adequate with environmental factors as they appear to be over-sized. ; Les hôpitaux municipaux, qui sont un maillon essentiel du système de santé rural Chinois, ont été affectés par les réformes économiques successives depuis les années 1980 et ont ainsi vu leur fréquentation s'affaiblir. À partir d'observations longitudinales sur neuf années (2000-2008) et 24 hôpitaux municipaux sélectionnés de façon aléatoire dans la préfecture de Weifang (Province du Shandong, Chine), cet article analyse les facteurs d'environnement et d'offre qui influencent le volume des activités curatives des hôpitaux municipaux, mesurépar le volume de consultations externes et d'hospitalisations. Afin d'estimer l'effet de variables invariantes dans le temps, deux estimateurs sont utilisés : Hausman-Taylor et Fixed-Effect Vector Decomposition. Les résultats des estimations des deux estimateurs sont similaires. Ils montrent que le système d'assurance mutualiste graduellement introduit à partir de 2003 influence positivement l'activité des hôpitaux municipaux, même s'il subsiste des barrières financières à l'accès aux soins de santé coûteux. L'analyse souligne aussi queles liens de référencement entre les différents niveaux de structures de santé devraient être renforcés et que la taille des hôpitaux municipaux, qui semble surestimée, doit être adaptée en fonction des facteurs environnementaux.

Since 2003, the New Rural Cooperative Medical Scheme is gradually implemented in China, in order first, to increase access of the poor to health services, reduce out-of-pocket expenditures and avoid catastrophic health expenditures and second to re-oriented patient to township hospitals. The paper estimates the impact of the New Rural Cooperative Medical Scheme on a sample of 24 township hospitals of Weifang prefecture (Shandong province), using a generalized form of differences-in-differences model on longitudinal data over the period 2000-2008. The estimations conclude to the significant and positive impact of the New Rural Cooperative Medical Scheme on inpatient activities and on the bed occupancy rate, and to the significant and negative impact on the average length of stay. As expected, the impact on inpatient activities is higher in poor areas than in non poor ones and the marginal impact is decreasing over time.

Since 2003, the New Rural Cooperative Medical Scheme is gradually implemented in China, in order first, to increase access of the poor to health services, reduce out-of-pocket expenditures and avoid catastrophic health expenditures and second to re-oriented patient to township hospitals. The paper estimates the impact of the New Rural Cooperative Medical Scheme on a sample of 24 township hospitals of Weifang prefecture (Shandong province), using a generalized form of differences-in-differences model on longitudinal data over the period 2000-2008. The estimations conclude to the significant and positive impact of the New Rural Cooperative Medical Scheme on inpatient activities and on the bed occupancy rate, and to the significant and negative impact on the average length of stay. As expected, the impact on inpatient activities is higher in poor areas than in non poor ones and the marginal impact is decreasing over time.

Assessing the cost of vaccine preventable diseases (VPD) surveillance is becoming more important in the context of the Global Polio Eradication Initiative (GPEI) funding transition, since GPEI support to polio surveillance helped the incremental building of VPD surveillance systems in many countries, including low income countries such as Nepal. However, there is limited knowledge on the cost of conducting VPD surveillance, especially the national cost for surveillance of multiple vaccine-preventable diseases. The current study sought to calculate the economic and financial costs of Nepal's comprehensive VPD surveillance systems from July 2016 to July 2017. At thecentral level, all surveillance units were included in the sample. At sub-national level, a purposive sampling strategy was used to select a representative sample from locations involved in conducting surveillance. The sub-national sample costs were extrapolated to the nationwide VPD surveillance system. Nepal's total annual economic cost of VPD surveillance was USD 4.81 million or USD 0.18 per capita, while the total financial cost was USD 4.38 million or USD 0.16 per capita. Government expenditures accounted for 56% of the total economic cost, and World Health Organization accounting for 44%. The biggest cost driver was personnel accounting for 51% of the total economic cost. WHO supported trained surveillance personnel through donor funding, mainly from Global Polio Eradication Initiative. As a polio transition priority country, Nepal will need to make strategic choices to fully self-finance or seek full donor support or a mixed-financing model as polio program funding diminishes.