Fudan School of Public Health, Shanghai 200032, China.
Int J Health Plann Manage. 2011 Oct-Dec;26(4):357-78. doi: 10.1002/hpm.1028. Epub 2010 Mar 23.
In 2003, China launched the New Cooperative Medical Scheme (NCMS) as a form of health insurance for rural areas. Counties play an important part in the management of the system, raising issues over the capacity of local government to manage complex health insurance systems. This paper examines the extent and impact of county level managerial capacity to manage the NCMS. The paper is largely based on qualitative data but supported by quantitative data. Policy makers, NCMS administrators, health providers and residents were interviewed in May 2006 in six counties in rural China. Management capacity was defined as the capability to bring together and use resources to carry out responsibilities. The results are grouped into three areas of management capacity: staff, organizational and contextual. Respondents complained about inadequate staffing, poor organizational resources and conduct of responsibilities in areas such as premium collection and remuneration. Key problems in contextual capacity included: counties are restricted in their ability to use resources for management; counties lack support from other organizations and suffer from a conflict of responsibilities. This paper underlines the importance of effective management capacity for NCMS at the decentralized level and suggests pointers for the content and process of management capacity development.
2003 年，中国推出了新型农村合作医疗制度（NCMS）作为农村地区的医疗保险形式。县级政府在该制度的管理中扮演着重要的角色，这引发了人们对地方政府管理复杂医疗保险体系的能力的关注。本文探讨了县级管理能力在管理 NCMS 方面的程度和影响。本文主要基于定性数据，但也有定量数据的支持。2006 年 5 月，在 6 个中国农村县的政策制定者、NCMS 管理人员、卫生提供者和居民中进行了访谈。管理能力被定义为汇集和利用资源履行职责的能力。研究结果分为管理能力的三个领域：人员、组织和背景。受访者抱怨人员配备不足、组织资源匮乏以及在保费收缴和薪酬等方面履行职责的行为不佳。背景能力方面的主要问题包括：县级政府在管理方面使用资源的能力受到限制；县级政府缺乏其他组织的支持，并受到职责冲突的困扰。本文强调了有效管理能力在分散化层面上对 NCMS 的重要性，并为管理能力发展的内容和过程提供了指导。
