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China's 3 year, CN¥850 billion (US$125 billion) reform plan, launched in 2009, marked the first phase towards achieving comprehensive universal health coverage by 2020. The government's undertaking of systemic reform and its affirmation of its role in financing health care together with priorities for prevention, primary care, and redistribution of finance and human resources to poor regions are positive developments. Accomplishing nearly universal insurance coverage in such a short time is commendable. However, transformation of money and insurance coverage into cost-effective services is difficult when delivery of health care is hindered by waste, inefficiencies, poor quality of services, and scarcity and maldistribution of the qualified workforce. China must reform its incentive structures for providers, improve governance of public hospitals, and institute a stronger regulatory system, but these changes have been slowed by opposition from stakeholders and lack of implementation capacity. The pace of reform should be moderated to allow service providers to develop absorptive capacity. Independent, outcome-based monitoring and evaluation by a third-party are essential for mid-course correction of the plans and to make officials and providers accountable., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Single-payer health care systems consist of publicly financed insurance that provides basic benefits for all citizens. The design is intended to achieve universal coverage and allow greater cost control. Many states have attempted to reform their systems around single-payer principles, but none succeeded until Vermont enacted a law in May 2011. In this article we describe how our team developed a viable single-payer proposal that served as the foundation of Vermont's law. According to our estimates, after the first full year of operation in 2015, our proposed single-payer system is expected to produce an annual savings of 25.3 percent when compared to current state health spending levels; cut employer and household health care spending by $200 million; create 3,800 jobs; and boost the state's overall economic output by $100 million. We describe how this plan was designed, and we discuss lessons for other states considering health system reform.

This paper provides a survey of the recent empirical research on China's 'old' health system (i.e. prior to the spate of reforms beginning in 2003). It argues that this research has enhanced our understanding of the system prior to 2003, in some cases reinforcing conclusions (e.g. the demand-inducement associated with perverse incentives) while in other cases suggesting a slightly less clear storyline (e.g. the link between insurance and out-of-pocket spending). It also concludes that the research to date points to the importance of careful evaluation of the current reforms, and its potential to modify policies as the rollout proceeds. Finally, it argues that the research on the pre-2003 system suggests that while the recently announced further reforms are a step in the right direction, the hoped-for improvements in China's health system will far more likely occur if the reforms become less timid in certain key areas, namely provider payments and intergovernmental fiscal relations.

As Jin Ma and colleagues observe, an unfettered market approach in China has reduced access to care, increased patients' financial burden, and reduced emphasis on prevention and may have caused declines in quality and outcomes. A major driving force was that perverse incentives altered physicians' behavior toward self-interest at the expense of patients, even where professional ethics dictated otherwise. Other nations, including India, are grappling with the profit motive and its consequences. Chinese leaders are attempting to deal with these problems by expanding public investment and reducing perverse incentives. However, profit motives remain a powerful, potentially offsetting feature of a reformed system.

The Chinese government has committed to increasing government funding for health care by directing 1-1.5 percent of its gross domestic product to universal basic health care. However, China is at a loss as to how to transform its new money into efficient and effective health care. This paper critically examines the various options currently under heated debate in China. We argue that unless China tackles the root cause of unaffordable health care--rapid cost inflation caused by an irrational and wasteful health care delivery system--much of the new money is likely to be captured by providers as higher income and profits.

The article discusses issues on health services education and research in the U.S. and the proposed integrated delivery system (IDS) to address them. Topics include the costs of inefficiencies and wastes in the healthcare delivery system, the historical health services delivery issues, and the performance of health maintenance organizations (HMO).

The article discusses the appraisal of complex health-care reforms in China. It says that the country has launched a three-year reform plan worth 125 billion dollars in 2009 for a comprehensive universal health coverage by 2020. It cites that the government's systemic reform provided positive developments in health care including primary care, finance redistribution, and human resources. It adds that China must reform providers' incentive structures and implement a stronger regulatory system.

An increasing interest in initiating and expanding social health insurance through labor taxes in low- and low-middle-income countries goes against available empirical evidence. This article builds on existing recommendations by leading health financing experts and summarizes recent research that makes the case against labor-tax financing of health care in low- and low-middle-income countries. We found very little evidence to justify the pursuit of labor-tax financing for health care in these countries and persistent evidence that such policies could lead to increased inequality and fragmentation of the health system. We recommend that countries considering such policies heed the evidence on labor-tax financing and seek alternative approaches to health financing: primarily using general taxes or, depending on the context, general taxes combined with adequately regulated insurance premiums. [ABSTRACT FROM AUTHOR]

The authors reflect on global health partnerships and suggest this topic for the Group of Eight summit in Toyako, Japan which could offer an opportunity to articulate a world-wide commitment to learning about strategies for strengthening health care systems. The two previous efforts to improve health conditions in poor countries including the horizontal approach and the vertical approach are explored. The authors consider how climate change could cause adverse interactions between poverty and health. How a balanced approach is needed between a disease-specific strategy and system-based solutions for health system improvements is discussed.