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There has been a dramatic spread of health markets in much of Asia and Africa over the past couple of decades. This has substantially increased the availability of health-related goods and services in all but the most remote localities, but it has created problems with safety, efficiency and cost. The effort to bring order to these chaotic markets is almost certain to become one of the greatest challenges in global health.  This book documents the problems associated with unregulated health markets and presents innovative approaches that have emerged to address them. It outlines a framework that researchers, policy makers and social entrepreneurs can use to analyse health market systems and assess the likely outcome of alternative interventions. The book presents a new way of understanding highly marketised health systems, applies this understanding to an analysis of health markets in countries across Asia and Africa and identifies some of the major new developments for making these markets perform better in meeting the needs of the poor. It argues that it is time to move beyond ideological debates about the roles of public and private sectors in an ideal health system and focus more on understanding the operation of these markets and developing practical strategies for improving their performance.  This book is ideal reading for researchers and students in public health, development studies, public policy and administration, health economics, medical anthropology, and science and technology studies. It is also a valuable resource for policy makers, social entrepreneurs, and planners and managers in public and private sector health systems, including pharmaceutical companies, aid agencies, NGOs and international organisations.

Drug Law Reform in East and Southeast Asia is a multi-author look at drugs in East and Southeast Asia, on drug policy, patterns and trends, local problems, human rights abuses, treatment prospects, and potential reforms. From the history of drugs in Asia, the book examines recent trends in illicit drugs, especially the present enormous amphetamine problems. It addresses recent policy shifts, especially harm reduction responses to the devastating drug-associated HIV epidemics. It explores further necessary reform, especially in regard to the abysmally inhuman current emphasis on detention and the death penalty for drug offences, and present the most recent evidence on effective and humane approaches to drug treatments. As the first comprehensive collection on illicit drug and harm reduction in East and Southeast Asia, it will be a vital resource for health professionals, policymakers, and others working there—and elsewhere—on drug policy reform. As the first comprehensive collection on illicit drugs and harm reduction in East and Southeast Asia, it will be a vital resource for health professionals, policymakers, and others working on East and Southeast Asia—and elsewhere—on drug policy.

South Asia is a region of contrasts, with impressive technological achievements but also more than 40 percent of the world’s poor. These contrasts are evident in the health sector, which demonstrates large variations in health, nutrition, and fertility outcomes. Health Policy Research in South Asia showcases some of the innovative qualitative and quantitative research methodologies being used in South Asia to provide empirical guidance for health sector reform and policy development. The four research areas presented are analysis of inequality, expenditure analysis, private sector analysis, and consumer and provider perspectives. Salient themes emerge from the 12 health policy research activities reviewed and emphasize the importance of strengthening local capacity and building ownership:Governments can and should distribute subsidies in the health sector more efficiently and effectively. The private sector, which dominates service delivery in most of South Asia, requires a different set of public sector policy instruments. Informed consumers/citizens can and should play an important role in influencing health service delivery. Empirical research can and should provide policymakers with some of the tools needed to improve and monitor the performance of the sector.This book will be of interest to health sector policymakers and analysts, to academics and students in public health and health economics, and to anyone with an interest in the impact of health policy on development.

We analyse nine low-income and lower-middle-income countries in Africa and Asia that have implemented national health insurance reforms designed to move towards universal health coverage. Using the functions-of-health-systems framework, we describe these countries' approaches to raising prepaid revenues, pooling risk, and purchasing services. Then, using the coverage-box framework, we assess their progress across three dimensions of coverage: who, what services, and what proportion of health costs are covered. We identify some patterns in the structure of these countries' reforms, such as use of tax revenues to subsidise target populations, steps towards broader risk pools, and emphasis on purchasing services through demand-side financing mechanisms. However, none of the reforms purely conform to common health-system archetypes, nor are they identical to each other. We report some trends in these countries' progress towards universal coverage, such as increasing enrolment in government health insurance, a movement towards expanded benefits packages, and decreasing out-of-pocket spending accompanied by increasing government share of spending on health. Common, comparable indicators of progress towards universal coverage are needed to enable countries undergoing reforms to assess outcomes and make midcourse corrections in policy and implementation.

In 2009, China launched an ambitious health system reform that combined extending social health insurance scheme with improving efficiency, access and quality of care in the country. To assess the impact of the policy on efficiency and productivity change, we investigated the country’s health system performance at provincial levels during pre- and post-reform period. Outputs were measured using multiple health outcomes (namely, non-communicable diseases free healthy life years and infant and maternal survival rates), while health expenditure, number of medical personnel and hospital beds per 1000 residents were used as proxy measures for health inputs. Changes in productivity were quantified using a bootstrap Malmquist productivity index (MPI). The analysis focused on the period between 2004 and 2015. This was to capture pre- and post-policy implementation experience and to ensure that enough time was allowed for the policy to work through. Finally, a bootstrap Tobit regression model for panel data was applied to examine the potential effects of contextual factors on productivity change. The result showed that the reform has had negative effects on productivity. Only scale efficiency had improved steadily, but the decline in the scale of technological change observed during the same period meant that the progress in scale efficiency had been masked. Better economic performance (as measured by per capita Gross Domestic Product (GDP)) and higher human resource to capital investment ratio (as measured by density of medical staff per hospital beds) tended to boost productivity growth, while population aging, low educational attainment and higher percentage of out-of-pocket (OOP) payments had adverse effects. Improving health system productivity in China requires improving financial risk protection and maintaining proper balance between human and capital investment in the country.

This article examines the role of health governance in shaping the outcomes of healthcare reforms in China. The analysis shows that the failure of reforms during the 1980s and 1990s was in part due to inadequate attention to key aspects in health governance, such as strategic interactions among government, providers and users, as well as incentive structures shaping their preferences and behaviour. Although more recent reforms seek to correct these flaws, they are insufficiently targeted at the fundamental governance problems that beset the sector. The article suggests that the Chinese government needs to heighten its efforts to enhance health governance and change the ways providers are paid if it is to succeed in achieving its goal of providing health care to all at affordable cost.

This study examines the effects of health expenditure, energy consumption, CO2 emissions, population size, and income on health outcomes in 46 Asian nations between 1997 and 2019. Cross-sectional dependence (CSD) and slope heterogeneity (SH) tests are utilized due to the close linkages between Asian nations as a result of commerce, tourism, religion, and international agreements. The research uses unit root and cointegration tests of the second generation after validating CSD and SH issues. Due to the results of the CSD and SH tests, it is clear that conventional methods of estimation are inappropriate, so a new panel method, the inter autoregressive distributive lag (CS-ARDL) model, is used instead. In addition to CS-ARDL, the study’s results were checked with a common correlated effects mean group (CCEMG) method and an augmented mean group (AMG) method. According to the CS-ARDL study, higher rates of energy use and healthcare spending lead to better health outcomes for Asian countries over the long run. CO2 emissions are shown to be harmful to human health, according to the study. The influence of a population’s size on health outcomes is shown to be negative in the CS-ARDL and CCEMG, but favorable in the AMG. Only the AMG coefficient is significant. In most instances, the results of the AMG and CCEMG corroborate the results of the CS-ARDL. Among all the factors influencing life expectancy in Asian countries, healthcare spending is the most influential. Hence, to improve health outcomes, Asian countries need to take the required actions to boost health spending, energy consumption, and long-term economic growth. To achieve the best possible health outcomes, Asian countries should also reduce their CO2 emissions.

Low-and middle-income countries (LMICs) have been searching for effective strategies to reform their inefficient and wasteful public hospitals. Recently, China developed a model of systemic reforms called the Sanming model to address the inefficiency and waste at public hospitals. In this article, we explain and evaluate how the Sanming model reformed its 22 public hospitals in 2013 by simultaneously restructuring the hospital governance structure, altering the payment system to hospitals, and realigning physicians’incentives. By employing the difference-in-difference (DID) method and using the hospital-level data from 187 public hospitals in Fujian province, we find that the Sanming model has reduced medical costs significantly without measurably sacrificing clinical quality and productive efficiency. The systemic reform, on average, has reduced the medical care cost per outpatient visit and per inpatient admission by 6.1% (P-value = 0.0445) and 15.4% (P-value < 0.001), respectively. It is largely accomplished through a decrease in drug expenditures per outpatient visit and per inpatient admission of about 29% (P-value < 0.001) and 53% (P-value < 0.001). These results show that the Sanming model has achieved at least a short-term success in improving the performance of the public hospitals. These findings suggest that such a systemic transformation of public hospitals, where the governance structure, payment system and physician compensation methods are aligned, are crucial to improving their performance; it holds critical lessons for China and other LMICs. Les pays à revenu faible ou intermédiaire (PRFI) ont cherché des stratégies efficaces pour réformer leurs hôpitaux publics peu productifs et rentables. Récemment, la Chine a élaboré un modèle de réformes systémiques appelé le modèle Sanming pour remédier à l’inefficacité et au gaspillage dans les hôpitaux publics. Dans le présent article, nous expliquons et évaluons comment le modèle Sanming a réformé ses 22 hôpitaux publics en 2013 en restructurant simultanément la structure de gouvernance hospitalière, en modifiant le système de paiement des frais hospitaliers et en reconsidérant les mesures incitatives en faveur des médecins. En utilisant la méthode de l’écart dans les différences et en ayant recours aux données hospitalières provenant de 187 hôpitaux publics de la province de Fujian, nous constatons que le modèle Sanming a considérablement réduit les coûts médicaux sans sacrifier la qualité clinique et l’efficacité productive. En moyenne, la réforme systémique a réduit le coût des soins médicaux pour chaque cas de consultation externe et d’hospitalisation de 6,1% (valeur p=0,0445) et de 15,4% (valeur p<0,001) respectivement. Ce résultat est dû en grande partie à une diminution des dépenses en médicaments par consultation externe et par hospitalisation d’environ 29% (valeur p<0,001) et de 53% (valeur p<0,001). Ces résultats montrent que le modèle Sanming a réussi, tout au moins à court terme, à améliorer la performance des hôpitaux publics. Les résultats suggèrent également qu’une telle transformation systémique des hôpitaux publics est essentielle pour accroître leur performance, grâce à une amélioration de la structure de gouvernance, du système de paiement des frais et des méthodes de rémunération des médecins; elle comporte des enseignements cruciaux pour la Chine et pour d’autres pays à revenu faible ou intermédiaire. 中低收入国家 （LMICs） 一直在探索如何有效改革效率不高 且浪费资源的公立医院。近年来, 中国建立了体系改革的三明 模式来解决公立医院存在的问题。本文说明并评估三明模式 如何在2013年通过重组医院治理结构、调整医院支付体系和 提高医生激励改革了当地22家公立医院。我们采用双重差分 （DID）方法, 使用福建省187家公立医院的医院级数据, 发现 三明模式在显著降低医疗成本的同时, 并未明显牺牲医疗质量 和效率。体系改革使每人次门诊和住院的医疗成本平均降低 了6.1% （P=0.0445） 和15.4% （P值 < 0.001）, 主要是通过使 每人次门诊和住院的药品支出分别降低29% （P值 < 0.001） 和53% （P值 < 0.001）。上述结果显示, 三明模式至少短期实 现了公立医院绩效的改善。本研究发现提示, 治理结构、支付 体系和医生补偿联动的公立医院体系改革对改善公立医院绩 效至关重要, 对中国和其他LMICs有着重要启示。 Los países de ingresos bajos y medios (PIBM) han estado buscando estrategias efectivas para reformar sus hospitales públicos ineficientes. Recientemente, China desarrolló un modelo de reformas sistémicas llamado el modelo Sanming para abordar la ineficiencia y el desperdicio en los hospitales públicos. En este artículo, explicamos y evaluamos cómo el modelo Sanming reformó sus 22 hospitales públicos en 2013 al reestructurar simultáneamente la estructura de gobernanza del hospital, alterando el sistema de pago a los hospitales y realineando los incentivos de los médicos. Al utilizar el método de diferencia en diferencia (DED) y los datos de nivel hospitalario de 187 hospitales públicos de la provincia de Fujian, descubrimos que el modelo Sanming ha reducido significativamente los costos médicos sin sacrificar la calidad clínica y la eficiencia productiva medible. La reforma sistémica, en promedio, ha reducido el costo de la atención médica por visita ambulatoria y por ingreso hospitalario en 6.1% (valor P=0.0445) y 15.4% (valor P<0.001), respectivamente. Se logra en gran parte a través de una disminución en los gastos de medicamentos por visita ambulatoria y por ingreso hospitalario de aproximadamente 29% (valor P<0.001) y 53% (valor P<0.001). Estos resultados muestran que el modelo Sanming ha logrado al menos un éxito a corto plazo en la mejora del rendimiento de los hospitales públicos. Estos hallazgos sugieren que tal transformación sistémica de los hospitales públicos, donde la estructura de gobernanza, el sistema de pago y los métodos de compensación del médico están alineados, son cruciales para mejorar su desempeño. Estos hallazgos poseen lecciones críticas para China y otros PIBM.