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Separation of regulation and application in health systems in China

Date: Poster sessions
Source: Forum 11
Authors: Jiang Qin, Faculty, Department of Health Policy and Management, School of Public Health, Shanghai Jiatong University, People's Republic of China


Separation of regulation and application in health systems requires properly separating inner regulation functions, which include functions of decision-making and supervision, from the application functions of government. After separation, regulation sectors are mainly responsible for making decisions, setting standards and establishing processes, while application organizations are mainly responsible for carrying out policies and service provision. In general, application organizations are either part of the government sector or nongovernment organizations that are authorized by the government.

Models were analysed for Shanghai, Wuxi, Haidian (Beijing), Suzhou and Weifang and results showed that current separation reforms focused on transformation of the government role to: 1) reinforce holistic administration in health systems from a macro perspective; 2) prioritize public health and basic health service provision; 3) reinforce entry and supervision of health facilities using legislation, regulation and performance assessment; 4) further public health facility reform to improve governance using proper incentives. The performance of these pilots needs to be further assessed.

Separation reform was inadequate and segmented. Most domestic separation reforms were property rights reforms of public health facilities.

Borrowed experiences were used in local reforms without considering their historical background and context. Segmented policies and reforms were proposed based on the sector's preferences and lack of a core policy-making level, which made for inconsistencies of policy-making and application.

The paper offers a suggested model for separation reform.