FACILITATOR’SNOTESON:
“HealthInsurance:RuralHealthCarein China”
1. Objectives
Thiscasestudyaimstoprovokediscussion aboutthefactorsinfluencing thelikely successof communitypre-paymentschemes.Itpromptsparticipantsto considerhow toaddresssomeoftheproblemsraised.
2. Description
Thecasestudyiswritten asaplay,setinruralareainChina. Theplaybrings two outsiders(onefromheadquarters andavisitorfromtheUS)toaruralvillagethatis holdingavillagemeetingtoconsiderhowtousethefundsgenerated fromthe Cooperative MedicalSystems,andwhetherornottore-vitalisethesystem.Various villagemembers presenttheirviewsonthesematters.Duringthemeetingasick personisbroughtin,andthetwooutsiders volunteer todrivehimforcare.Theyfirst trytofindthelocal‘doctor’(villagehealth worker),butwhenhecannotbefound they traveltoalocalhospital. Duringthecourseofthesejourneys theylearnmoreabout thevillagers’perceptionsandexperiencesoflocalhealthcare.
Thiscasestudymustfirstbereadbyallparticipants. Theninsmallgroupsof4-5 peopletheyshouldcharacterisethe mainproblemsfacedby thevillagersin financing their health care. They should also considerthe sorts of approachesthat be implemented to tackle these problems. A feed-back session should then allow plenarydiscussionofthegroups’analyses,withthefacilitatorfinallydrawingout someof the key issuesthat needto be consideredin relationto pre-payment schemes.
3. Preparationandlinkages
Thiscasestudycanbeusedbeforeorafterabroaderintroduction topre-payment mechanisms. Suchanintroductionshouldcovertheobjectivesofpre-payment systems, key issues in pre-payment scheme design, the key factors likely to influencetheirimpacts,andthebroaderrangeoffactorsinfluencing theirsuccessful implementation. Ifusedbeforesuchasession,participantswouldrequiresome familiaritywithhealthcarefinancingissuesandconcernsingeneral.Ifusedafter suchasession,thecasestudywouldallowparticipants toapplyknowledgealready gained.Overall,itcanusefullyformpartofaseriesofsessions onhealthcare financingtopics.
4. Timingandlogistics
Overall,theexerciseshouldtakearound2hours.
Participants shouldspendtheinitial15-20minutesreadingthecasestudyby themselves,andhighlightingkeyissuestoraiseindiscussion.Theninsmallgroups,
20minutesshouldbespentdevelopingafullsummaryofproblemsidentifiedfrom thecasestudy.Thegroupsshouldspendafinal20minutes thinking abouthowto tackletheseproblems.
Itisimportanttoavoidrepetitionandduplication inthefeed-backsession.One approachistosplitthefeed-backintotwoparts. First, askonegrouptoprovideafull feed-backoftheproblemstheyidentified.Othergroupscanthenbeaskedjusttoadd tothislist,ortoquestionorcontradict theinitialgroup.Second, askonegroup (differentfromthatthatinitiallypresentedproblems)topresentthesolutionsthe groupdiscussed–thenaskothergroupsjusttoquestion andaddtothefirstgroup’s presentation.Overall,thisfeed-backsessionshouldtakearound30-45minutes.
Inthefinal15minutesthefacilitatorshouldwrapupthediscussions byhighlighting thekeypointsraised,emphasizing thepriorityissuesandmakinglinkstoother sessionsonhealthcarefinancingissues.
5. Pointsfordiscussion
Thekeyissuesraisedintheplayinclude:
a)Contextofpoorruralvillagesinalow-incomecountry:
•Greaterlevelsofdiseaseburdenthanurban/morewealthyareas
•Lowerlevelsofhealthcareutilizationthanurban/morewealthyareas
•Verylowlevelsofhouseholdpercapitaincome
•Healthcarecostscanbecatastrophicforhouseholds,i.e.leadtodebtsand impoverishment
b)Roleandlimitsofpre-paymentschemesinpoor,ruralcommunities:
•Bypoolingresourcesamongpeople,supportthecostsofaccessingatleasta basicpackageofpreventivecareforall
•Benefitscoveredlimitedbythetotalrevenuethatcanbegeneratedinthisway
•Householdresourcesneedtobecomplementedbyotherfinancingsources
c)Factorsinfluencingcommunitywillingnesstopaypre-paymentpremia:
•Somepeoplemaypayandneverusehealthcare,sodonotseethebenefitsof paying
•Somepeopleseethebenefitofpayingarelativelysmallamounttogetatleast someprotectionfromtheunexpectedandoftenconsiderable ofseekingcarefor seriousillness
•Somepeopleseethebenefitsoffinancingpreventivecaretodaytoprevent illnesstomorrow
•Perceptionsaboutthereliabilityoftheadministrativearrangementsforthefund
(includingwhowillmakedecisions,andhowdecisionswillbemade)
•Perceptionsof thequalityof careavailablewithandwithouta pre-payment scheme
d)Factorsinfluencinghealthseekingbehaviour(perceivedqualityofcare):
•Availabilityofprovider
•Severityofillness
•Availabilityofequipment
•Priceofcare
•Transportcosts
Therearenoeasyorrightsolutionstomanyoftheseproblems!However,someof thekeyissuesthatwillalwaysbeimportantindeveloping solutionsacrosscontexts are:
•supplementingpre-paymentandothercommunityfinancingschemeswithfunds fromothersourcesassuchschemescannevergenerateenoughresources to coverthefullcostsofacomprehensivepackageofcare(forexample,ensuringa fairshareofavailabletaxresourcesareallocatedtoruralareasgiventheirlevel ofhealthneed,shareoftotalpopulationetc)
•determiningwhatlevelofpre-paymentvillagersarewillingtopay,thatwillnot compromisetheirhouseholdeconomicsecurity
•thinkingcarefullyabout howmuchrevenuecanberealisticallygeneratedthrough pre-paymentschemes,andsowhatbenefitscanbefundedthroughthem
•strengtheningqualityofcare,bothtoencouragepaymentforservicesandto ensurethattheavailableservicesareaseffectiveaspossible
•ensuringsound and acceptableadministrativeproceduresand personnel,to encouragepre-payment
•providinginformationand promotingdiscussionaboutthe benefitsof a pre- paymentschemerelativetonothavingone
This work is licensed under a
Creative Commons Attribution-NonCommercial-ShareAlike 2.5 South Africa License
December 2011
You are free:
to Share – to copy, distribute and transmit the work
to Remix – to adapt the work
Under the following conditions:
Attribution. You must at attribute the work in the manner specified by the author or licensor (but not in any way that at suggests that they endorse you or your use of the work)
Non-commercial. You m may not use this work for commercial purposes.
Share Alike. If you alter, transform, or build upon this work, you may distribute the resulting work but only under the same or similar license to this one.
• For any reuse or distribution, you must make clear to others the license terms of o this work. one way to do this is with a link to the license web page:
• Any of the above conditions can be waived if you get permission from the copyright holder.
• Nothing in this license impairs or restricts the authors’ moral rights.
• Nothing in this license impairs or restricts the rights of authors whose work is r referenced in this document.
• Cited works used in this document must be cited following usual academic conventions
• Citation of this work must follow normal academic conventions
Source work available at Vula. Permissions beyond the scope of this license may be available at
contact
We would appreciate your feedback for this Open Educational Resource (OER), by completing this form. Alternatively, you can email us at