Abstract
We report the results of a review of the Chineseโ and Englishโlanguage literatures on service delivery in China, asking how well China's healthโcare providers perform and what determines their performance. Although data and methodological limitations suggest caution in drawing conclusions, a critical reading of the available evidence suggests that current health service delivery in China leaves room for improvement, in terms of quality, responsiveness to patients, efficiency, cost escalation, and equity. The literature suggests that these problems will not be solved by simply shifting ownership to the private sector or by simply encouraging providers โ public and private โ to compete with one another for individual patients. By contrast, substantial improvements could be (and in some places have already been) made by changing the way providers are paid โ shifting away from feeโforโservice and the distorted price schedule. Other elements of โactive purchasingโ by insurers could further improve outcomes. Rigorous evaluations, based on richer microโlevel data, could considerably strengthen the evidence base for service delivery policy in China. Copyright ยฉ 2007 by the International Bank for Reconstruction and Development/The World Bank, 1818 H Street, NW, Washington, DC 20433, U.S.A. Published by John Wiley & Sons, Ltd.