Do Health Sector Reforms Have Their Intended Impacts? The World Bank’s Health VIII Project in Gansu Province, China

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dc.creatorYu, Shengchao
dc.creatorWagstaff, Adam
dc.date2012-06-20T15:03:58Z
dc.date2012-06-20T15:03:58Z
dc.date2005-10
dc.date.accessioned2026-07-01T01:31:25Z
dc.descriptionThe literature contains few impact evaluations of health sector reforms, especially those involving broad and simultaneous changes on both the demand and supply sides of the sector. This paper reports the results of a World Bank-funded health sector reform project in China known as Health VIII. On the supply-side, the project combined infrastructure investments (especially at the township level) with improved planning and management, including a referral system between township health centers and county hospitals, and interventions aimed at improving the effectiveness and quality of care, including the introduction of clinical protocols and essential drug lists. On the demand-side, the project sought to resurrect community health insurance, and to introduce a safety net for the very poor to provide them with financial assistance with their health care expenses. The evaluation reported here concerns just one of the project's seven provinces, namely Gansu, the reason being that no suitable data are available to undertake a rigorous evaluation in all provinces. This paper makes use of a panel dataset collected for quite another purpose but whose timing (just around the time the project started and four years later) and location (covering both project and non-project counties) makes it well-suited to the task. The paper compares estimates obtained using a variety of different estimators, including naïve single differences (before and after, and with and without the project), and differences-in-differences, adjusting for heterogeneity through both regression and matching methods. The results suggest that it makes a difference to the estimated impact of Health VIII which estimator is used, with the naïve single differences producing often markedly different estimates from the preferred approach of combining difference-in-differences with matching. The results further suggest that Health VIII has been mostly successful in its goals. The preferred estimator suggests that the project reduced illness among children, improved self-assessed health, and increased doctor visits among the population in general, and reduced the incidence of catastrophic health spending, defined as annual spending in excess of 10 percent of annual per capita income. But the project appears to have increased the development and use of high-level facilities, hastened the demise of the village clinic, and may have reduced immunization rates.
dc.formatapplication/pdf
dc.formattext/plain
dc.identifierhttp://documents.worldbank.org/curated/en/2005/10/6323675/health-sector-reforms-intended-impacts-world-banks-health-viii-project-gansu-province-china
dc.identifierhttps://hdl.handle.net/10986/8515
dc.identifierhttps://doi.org/10.1596/1813-9450-3743
dc.identifier.urihttp://hdl.handle.net/123456789/418888
dc.languageEnglish
dc.publisherWorld Bank, Washington, DC
dc.relationPolicy Research Working Paper; No. 3743
dc.rightsCC BY 3.0 IGO
dc.rightshttp://creativecommons.org/licenses/by/3.0/igo/
dc.rightsWorld Bank
dc.subjectASTHMA
dc.subjectCANCER
dc.subjectCATASTROPHIC HEALTH SPENDING
dc.subjectCLINICS
dc.subjectCOMMUNITY HEALTH
dc.subjectDEATHS
dc.subjectDEWORMING
dc.subjectDIABETES
dc.subjectDIAGNOSIS
dc.subjectDISEASE CONTROL
dc.subjectDOCTORS
dc.subjectDRUGS
dc.subjectEMPLOYMENT
dc.subjectFAMILIES
dc.subjectFINANCIAL PROTECTION
dc.subjectHEALTH CARE
dc.subjectHEALTH CENTERS
dc.subjectHEALTH DATA
dc.subjectHEALTH INSURANCE
dc.subjectHEALTH INSURANCE PROGRAM
dc.subjectHEALTH INTERVENTIONS
dc.subjectHEALTH OUTCOME INDICATORS
dc.subjectHEALTH OUTCOMES
dc.subjectHEALTH PROJECTS
dc.subjectHEALTH REFORM
dc.subjectHEALTH SECTOR
dc.subjectHEALTH SECTOR REFORM
dc.subjectHEALTH SERVICE
dc.subjectHEALTH SERVICES
dc.subjectHEALTH STATUS
dc.subjectHEALTH SYSTEM
dc.subjectHEALTH SYSTEM PERFORMANCE
dc.subjectHEALTH SYSTEM REFORM
dc.subjectHEALTH SYSTEMS
dc.subjectHOSPITAL BEDS
dc.subjectHOSPITALS
dc.subjectHOUSEHOLDS
dc.subjectIMMUNIZATION
dc.subjectINPATIENT CARE
dc.subjectINSURANCE COVERAGE
dc.subjectINTERVENTION
dc.subjectMEDICAL CARE
dc.subjectMEDICAL EXPENSES
dc.subjectMEDICINES
dc.subjectMENTAL ILLNESS
dc.subjectMORTALITY
dc.subjectNURSES
dc.subjectNUTRITION
dc.subjectOUTPATIENT CARE
dc.subjectPHARMACY
dc.subjectPOLICY RESEARCH
dc.subjectPRIVATE INSURANCE
dc.subjectPRIVATE SECTOR
dc.subjectPROBABILITY
dc.subjectPUBLIC HEALTH
dc.subjectQUALITY OF CARE
dc.subjectSAFETY
dc.subjectSCHOOL HEALTH
dc.subjectSOCIAL HEALTH INSURANCE
dc.subjectSOCIAL WELFARE
dc.subjectVACCINATIONS
dc.subjectVILLAGES
dc.subjectVISITS
dc.titleDo Health Sector Reforms Have Their Intended Impacts? The World Bank’s Health VIII Project in Gansu Province, China

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