A growing number of developing countries are developing health insurance schemes to protect people, particularly the poor, from financial catastrophe caused by expensive medical care. Among them are China and Vietnam, which have experienced rapid economic development and dramatic social changes over the past two decades. All these changes have had profound implications for every aspect of people's lives. Health care financing reforms in the two countries have led health facilities to rely increasingly on user charges, which has resulted in greater financial difficulties in accessing health care, especially for the rural poor. Although the central governments of both countries have promoted the development of rural health insurance for many years, the po pulation coverage has been far from satisfactory, due to many political, socio-economic and managerial factors. The proposed research will promote equitable health care financing mechanisms in the two countries by developing and disseminating an evidence b ase for the design and implementation of sustainable and acceptable rural health insurance schemes. The research project will adopt a case study approach in which a number of study counties and districts where rural health insurance schemes already exist will be selected for implementing revised schemes that are feasible and meet the perceived needs of their target population. It will monitor and evaluate the effects of the schemes from the perspectives of equitable coverage, user satisfaction, efficie nt service use and provision, poverty reduction and sustainability. It is expected that the final project results (good practice and lessons learnt) will be disseminated to a wide audience and used to inform relevant policies on rural health insurance in China, Vietnam and other developing countries.
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