College of Public Management, South China Agricultural University, Guangzhou 510642, China.
Lingnan (University) College, Sun Yat-Sen University, Guangzhou 510275, China.
Int J Environ Res Public Health. 2020 Feb 26;17(5):1490. doi: 10.3390/ijerph17051490.
China's Serious Disease Insurance Scheme (SDIS) was set up to relieve the financial burdens on serious disease patients. It is a crucial part of the national basic medical insurance scheme, which is regarded as one of the largest government-funded social security programs in the world. The most significant institutional innovation of the SDIS is that the approach of a public-private partnership (PPP) is applied in an attempt to facilitate the efficiency of its implementation. The objective of this paper is to evaluate the implementation of the SDIS in China through PPPs, and to identify the problems to be tackled if the Chinese government intends to make such a plan work better for the majority of urban and rural residents. With the effective support from local officials and practitioners, the authors of this paper collected copies of SDIS contracts of multiple cities in Guangdong, one of the most developed provinces of China. Guided by a research framework drawn from the PPP literature, details of contract enforcement were also examined. The authors discovered that the role of local states is rather dominant; they have manipulated contract drafting and implementation. Additionally, current mechanisms for profit sharing, risk sharing, and information exchange have placed insurance companies in a rather disadvantageous situation. To achieve the sustainable development of the SDIS, the authors suggest that a further reform on implementation of a PPP must be pushed forward.
中国的重大疾病保险制度（SDIS）旨在减轻重大疾病患者的经济负担。它是国家基本医疗保险制度的重要组成部分，被认为是世界上最大的政府资助的社会保障计划之一。SDIS 的最大制度创新是采用公私合作伙伴关系（PPP）的方法，以提高其实施效率。本文旨在通过 PPP 评估中国 SDIS 的实施情况，并确定如果中国政府希望使该计划更好地为城乡居民服务，需要解决的问题。在当地官员和从业者的有效支持下，本文作者收集了中国最发达省份之一广东省多个城市的 SDIS 合同副本。本文作者以 PPP 文献中的研究框架为指导，还检查了合同执行的细节。作者发现，地方政府的作用相当主导；他们操纵了合同起草和执行。此外，当前的利润分享、风险分担和信息交流机制使保险公司处于相当不利的地位。为了实现 SDIS 的可持续发展，作者建议必须推进 PPP 实施的进一步改革。
