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Objectives – Purchasing has been promoted as a key policy instrument to improve health system performance. Despite its widespread adoption, there is little empirical evidence on how it works, the challenges surrounding its implementation, its impact, and the preconditions for it to function effectively, particularly in low- and middle-income settings. The objective of this chapter is to analyze critically the extent to which purchasing could be, and has been used strategically in China and to identify modifications that are needed for purchasing to be effective in assuring that the government's new funding for health care will result in efficient and effective health services.

Methods – We present a conceptual framework for purchasing, which identifies three critical principal–agent relationships in purchasing. We draw on evidence from secondary data, results of other research studies, interviews, and the impact evaluation of a social experiment in rural China that explicitly used purchasing to improve quality and efficiency. This information is used to examine purchasing relationships in urban social health insurance (SHI), the rural medical insurance scheme, and purchasing of public health services.

Findings – To date, use of strategic purchasing is limited in China. Both the urban and the rural health insurance schemes act as passive third-party payers, failing to take advantage of the opportunities to strengthen incentives to improve quality and efficiency. This may be because as government agencies, the extent to which the Ministries of Health and Labor and Social Security can act independently from provider interests, or act in the best interest of the population, is unclear. Other important challenges include ensuring adequate representation of the population's views and preferences and making better use of the leverage provided by purchasing to create appropriate provider incentives, through better integration of financing and improved coordination among purchasers.

Implications for policy – In designing purchasing arrangements, attention needs to be paid to all three principal–agent relationships. Successful purchasing appears to require mechanisms to mobilize and represent community preferences and more strategic contracting with providers. More research is needed to strengthen the evidence on which purchasing arrangements work, which do not work, and under what conditions different purchasing configurations can work most effectively.

With the rising of “religious fever” in China rural area, the authors inquire the reason why it happened. First, the authors explore the group characteristics which could affect both happiness and the religion belief of Chinese rural elderly. The authors analyze the micro-data of “thousand village surveys” data of Shanghai University of Finance and Economics by using Order Logit and Propensity Score Matching (PSM) method. These results show that when the elderly people have the following features related to health such as: feeling psychological loneliness, not obtaining the good management of chronic disease in the village, and not being participated in new rural cooperative medical system are more likely to believe in religious in the rural areas. And the authors also find these Chinese rural elderlies who believe in religion are less happy than atheism elderly actually (by PSM). Believing in religion is not the solution and maybe the way these elderly resorts to when they encounter health problem.

Based on the data from “Thousand village surveys” project of Shanghai University of Finance and Economics, we employ the ordered logistic method to do the empirical analysis on consumption, life and satisfaction (subjective well-being) of Chinese rural elderly. First, the result shows that the consumption (exclude medical expenses) has positive effect on the satisfaction of Chinese rural elderly, while the rural elderly are not preferred to compare with others. Good participation in social life and medical care condition could enhance the satisfaction of rural elderly. Second, the authors divided the sample into two groups as high-consumption group and low-consumption group. The result shows that the low-consumption group more tend to rely on their family members than high-consumption group. The authors suggest that in order to improve the rural elderly life satisfaction, the government needs to improve medical care system.

China’s new rural pension program (NRPP), a fully funded defined contribution plan among the rural residents with heavy government subsidy toward contributions, has expanded rapidly since its introduction in 2009, and is expected to achieve universal coverage by the end of 2012. Empirical evidence, however, shows that although those close to pension eligibility age are enthusiastic, take-up rate is low among younger people, and participants tend to choose plans with the least contribution requirements, threatening the long-term viability of the program. We calculate the net benefits of participation on behalf of rural residents and demonstrate that poor designs are responsible for these problems. A proper rate of return on individual investment is not only essential for encouraging participation and ensuring a higher replacement rate but will also require less government subsidy and relieve fiscal burdens on the government.

There is a tension between the literatures on incomplete contracting and transactions cost economics regarding the importance of ex post governance and the extent to which formal theories of incomplete contracting capture salient aspects of exchange relations. In this paper, we empirically examine how firms structure joint R&D agreements to illuminate how contracts can be incomplete and how governance can matter. We employ a dataset of 96 contracts to construct a taxonomy of the types of mechanisms firms use in organizing collaborative R&D, and indicate how groups of mechanisms line up with various types of contracting hazards. The results suggest that the allocation of property rights over innovations at the time of contracting between R&D partners is an important aspect of contract design. But they also suggest that weak property rights admit scope for other dimensions of contract. In particular, the research indicates that while knowledge spillovers may give rise to appropriability hazards, efforts to contain or channel knowledge spillovers may enable joint venture members to strategically block other members’ follow-on commercialization or research. Firms design joint R&D governance mechanisms to balance spillover hazards and strategic blocking.