The effort to cut out-of-pocket medical expenses and the political constraints : examples from the New Cooperative Medical Scheme in China

Abstract

This master thesis examines the impact of the New Cooperative Medical Scheme (NCMS) on rural residents' out-of-pocket medical expenses (OOP) in China. The thesis first uses quantitative methods to identify the statistical relationships between NCMS and rural OOP and finds that enrolling in NCMS is associated with higher OOP. Then, using the 2009 reform, also known as Healthy China 2020, as a starting point, the thesis further explores the factors behind the resistance to the reform efforts to cut down OOP. By utilizing two political science theories - institutional layering and policy feedback - the thesis finds that the 2009 reform has so far failed to achieve noticeable reductions in OOP because, on the one hand, fierce institutional competitions has transformed NCMS into a fragmented program with too many veto players; on the other hand, policy feedback effects, under which previous policies continue to influence the trajectory of future policy-making decisions, strengthen particular interest groups and force the reform to make compromises.