As part of our mandate to gather and disseminate evidence and knowledge from global RBF experiences, RBF Health regularly organizes events, including seminars and capacity building workshops.
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Analysis of Provider Payment Reforms on Advancing China’s Health (APPROACH): An Evaluation of County Hospitals

This seminar will present the results of the recently completed randomized impact evaluation of a provider payment project carried out in county hospitals in the rural areas of Guizhou province in China. This project switched the local rural health insurance - the New Rural Cooperative Medical Scheme (NCMS) - from fee-for-service payments for county hospitals to a global budget scheme in order to incentivize hospitals to act as gatekeepers, minimize out-of-county (OOC) referrals and reduce unnecessary expenditures for county hospital-based treatment. The intervention was implemented in two waves.  

Results indicate variable impact. For one set of intervention counties/hospitals, the results show that the provider payment intervention led to reduced OOC admissions. This finding is consistent with the government’s objective to build a “tiered delivery” system in China, that is, less complicated cases should be shifted from tertiary hospitals to secondary hospitals as a way to improve allocative efficiency. There is also some evidence to suggest that faced with a global budget, hospitals cost shift by prescribing more services/drugs that are not eligible for NCMS reimbursement, thus leading to increased out-of-pocket spending. This effect is weaker for hospitals of which NCMS payment represents a significant share of the hospitals’ revenue. We did not find evidence that the payment intervention led hospitals to improve their managerial capability, as measured by the World Management Survey instrument.   


Meeting number: 172 241 4812
Meeting password: wVJUuehB548


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Photo credit: UNICEF/UNI315089/Yuwei


Dr. Winnie Yip, Professor of Global Health Policy and Economics, Harvard School of Public Health

Dr. Winnie Yip is Professor of Global Health Policy and Economics at the Harvard School of Public Health. She is faculty director of the school-wide Harvard China Health Partnership that collaborates with a network of twelve academic and research institutions in China to conduct research that aims to improve affordable, effective and sustainable health care for the Chinese population, especially the rural population. More details of the research, training and events held by the Harvard China Health Partnership can be found: She is also the Acting Director of the Fairbank Center for Chinese Studies at Harvard University for 2020-2021.


Xiaohui Hou, Senior Economist, World Bank

Xiaohui Hou is a Senior Economist in the World Bank. She has worked on development issues in many developing countries in East Europe, South Asia and most recently in East Asia and Pacific region. Her fields of specialization include health financing, service delivery and overall health system strengthening. She has led World Bank lending operations, country health program development and several analytical flagship reports. She has published books, book chapters and journal papers in both economic and medical peer reviewed journals. She also taught as a visiting scholar in several universities. Xiaohui holds a Doctorate degree in the Health Services and Policy Analysis and a master’s degree in Economics from the University of California, Berkeley.


Aparnaa Somanathan, Practice Manager for Health, Nutrition and Population for East Asia and the Pacific, World Bank

Aparnaa Somanathan is the Practice Manager for Health, Nutrition and Population for East Asia and the Pacific at the World Bank. She has worked on health systems strengthening issues for over fifteen years in a range of countries including Bangladesh, China, Estonia, Georgia, Indonesia, Kazakhstan, Sri Lanka and Vietnam. She has also worked extensively on the implications of population ageing on health financing and service delivery. Aparnaa read economics at Cambridge University and holds a doctoral degree in International Health Economics and Policy from the Harvard School of Public Health. Aparnaa is the lead author of the 21014 World Bank publication titled, “Moving Towards Universal Coverage of Social Health Insurance in Vietnam: Assessment and Options”. She is also the co-author of: “Financing Health Care in the East Asia and Pacific: Best Practices and Remaining Challenges” with Jack Langenbrunner; and the publication, “Live Long and Prosper: Ageing in the East Asia and Pacific region” with Philip O’Keefe and others.


Analysis of Provider Payment Reforms on Advancing China’s Health (APPROACH): An Evaluation of County Hospitals
Analysis of Provider Payment Reforms on Advancing China’s Health (APPROACH): An Evaluation of County Hospitals