HEALTH CARE REFORM RESEARCH PAPER

Class
Background information
Health care reforms are a rubric term used to refer to the creation of
new or changes in the existing health policies. The institution that has
a lot of impact on health care reforms is usually the government. All
health care reforms aim at improving health service delivery through
various means. For instance, reforms could be targeting to reduce the
cost of health care to make it affordable to all the citizens. Another
objective can be to take health care services closer to the people
through public and private sector insurance programs. By and large,
health care reforms target to improve the quality of health care to
patients, make it accessible and affordable.
Health care reforms in the United States have been an active political
debate since the 19th century. Activist Dorothy Dix proposed a bill in
1884that was to benefit the indigent insane, the blind and the deaf
through federal land grants (Fincham 2009). President Franklin Pierce
vetoed it arguing that social welfare was the state’s responsibility
thus the federal government should not make such commitments.
The second wave of reforms was the progressive health reforms that
involved the governments running subsidized health care programs
(Docteur and Berenson 2009). Down the years to the current situation,
every president has been making an effort to coin the most favorable
health care plan for the citizens. The Obamacare debate since 2008 to
date suggests that health care reforms are not a one-time event but keep
changing with time.
China has undergone significant health care reforms since the 1940’s.
Rural Cooperative Medical System was established to promote access of
health care services in the rural areas. The RCMS had three tiers
including barefoot doctors trained in basic hygiene and traditional
Chinese medicine, township health centers and county hospitals. RCMS was
utilized successfully until the 1980’s. From that period, RCMS was
upgraded to the New Rural Cooperative Medical System (NRCMS) (Brown et
al 2012). RCMS was dominantly funded by the government NRCMS targeted
to make reforms to both the public and the private sector. In 2012, the
government announced the Healthy China 2020 initiative that is the
current health debate in China (Docteur and Berenson 2009).
This paper will deal with how the health care reforms of the United
States compare to health care reforms in China (Fincham 2009). On health
issues, the United States has been operating on modern medicine and
health care technology for centuries. It will be interesting to map out
the differences and similarities with the health reforms made in China
so far (Brown et al 2012). China has risen, from a traditional culture
to embrace modern medicine and technology. A comparison of their current
policies will offer sufficient information on the general status of
health policies in the world.
The United States contributes major influences in the world apart from
health reforms. China has also risen in political power and is capable
of making major influences globally. Both the United States and China
are forces to reckon with and that makes an analysis of any of their key
issues a matter of interest to the entire globe (Brown et al 2012). The
United States represents the developed countries and its progress in
health reforms may resonate with those in UK and Britain. China has been
experiencing accelerated growth but their progress can closely relate
with efforts in developing countries especially in Asia and Africa
(Docteur and Berenson 2009). This makes a comparison of their reforms an
overview of the world’s current achievement as far as health policies
are concerned.
To tackle this logically, this paper will have several sections. The
first section is the literature review. This will delve deep into the
history of both China and the United States and present facts regarding
health reforms (Brown et al 2012). After presenting the facts, there
will be a combined summary on both scenarios pointing out key
highlights. Lastly, the research question will be revisited, and the
hypothesis discussed in light of the facts availed by the literature
review.
Literature review
The United States
Among the very first efforts to have policies in the health sector, in
the United States were the 1854 Bill for the Benefit of the Indigent
Insane proposed by activist Dorothy Dix (Brown et al 2012). The bill
envisioned the insane, blind and deaf people obtaining benefits from the
federal government through the federal land grants. Both houses of
Congress passed the bill, but President Franklin Pierce refused to
assent to it. President Pierce believed that social welfare was the sole
responsibility of the state (Fincham 2009). That is the reason why he
refused to get the federal government involved in the affair.
This view did not last long. Immediately after the civil war ended, the
federal government established the first national medical care system
(Docteur and Berenson 2009). The system was known as Freedmen’s
Bureau. Under that system, the government constructed forty hospitals
and hired over one hundred and twenty physicians in 1865. The bulk and
urgency was to treat over one million sick people who were former slaves
(Brown et al 2012). The hospitals did not last long as most of them
closed down after five years. However, the Freedmen’s Hospital in
Washington remained operational until it became the Howard University in
the late nineteenth century.
During the early twentieth century, Progressivism was sweeping across
Europe and the United States. Many countries were signing their first
social welfare acts (Fincham 2009). This social welfare acts urged
governments to provide subsidized health care programs and also open
government-run health institutions (Brown et al 2012). There were
affordable sickness insurance schemes for urban US workers at this time.
That was the reason why a national insurance with universal coverage was
strongly opposed. It was a mere copying of the United Kingdom’s
National Insurance Act. Therefore, progressivism did not take root in
the United States.
One of the major obstacles to this government-based insurance was the
fact that employers had sick funds that covered their employees. That
meant that no employed person would purchase the cover (Brown et al
2012). The industrial workers in the United States had learned to
associate insurance with employers. Contrary, countries in Europe were
moving towards socialized health schemes (Docteur and Berenson 2009).
The only route to divert U.S employees towards socialized schemes was to
introduce the concept of third party health insurance. This worked in
the 1930’s.
After the Great Depression, most families and individuals could not
afford to pay for medical services. President Franklin Roosevelt
attempted to append provisions on his social security policy to include
publicly funded health care programs. The American Medical Association
amongst other key stakeholder in the industry strongly opposed that idea
terming it as ‘compulsory health insurance’. President Roosevelt had
the provision removed from the bill in 1935.
Around this time, individual hospitals and physician groups began
selling their own insurance programs. The first such insurance was the
Blue Cross. The Congress passed legislation in the 1940’s that allowed
this third party covers to thrive. After the Second World War, President
Harry Truman called for universal health care plan and defended it as
his Fair Deal. Nonetheless, that part of the Fair Deal was rejected
(Brown et al 2012). The only policies that passed included the National
Mental Health Act, and the Hospital Survey and Construction Act. In
1951, the IRS announced that group premiums paid by employers would be
tax deductible.
The 1960’s and 1970’s signify the civil rights era. The health care
system in the United States did not escape it (Docteur and Berenson
2009). Concerns were raised concerning individuals who could not afford
medical covers such as the handicapped and the elderly. President Lyndon
Johnson strategized for the Medicare and Medicaid reforms implementation
(Forman 2010). The proposal came under serious criticism similar to the
progressivism associating it with communism. The opposition and
criticism notwithstanding, the Medicare program was passed by the
legislation and signed into law in 1965. Medicare provided health
insurance covers for people aged 65 years and above, and others who
qualified through special criteria.
A major amendment was made to the Social Security Policy by President
Nixon in 1972. It was a bid to extend Medicare to persons under 65 years
but who had been disabled severely for two years (Forman 2010). The
cover would also benefit people at the end stage of renal disease. This
was a major boost to President Nixon’s bid for re-election. As a
matter of fact, he beat his opponent primarily because of his commitment
matters of national health.
President’s Kennedy and Jimmy Carter proposed amendments to the
Medicaid policies with a bias towards bipartisan universal health
insurance plan (Docteur and Berenson 2009). Carter suggested an
extension of Medicare to include the employer’s responsibility for
catastrophic private health insurance for their employees without cost
sharing (Fincham 2009). The health security express was another force
though it was never enacted into law. It served to sensitize why every
citizen needed to invest in an insurance cover.
The Patient’s Bill of Rights was debated upon in 2001. The ideas
behind it were borrowed from the Consumer’s Bill of Rights. It
suggested standardization of health care institutions and provision of
emergency medical services to all patients regardless of their health
insurance status (Brown et al 2012). The bill was vehemently opposed by
various interest groups, the American Medical Association and the
pharmaceutical companies. In 2002, the Patient’s Bill of Rights was
discarded after failing to pass through Congress (Docteur and Berenson
2009). However, several bills were passed during that era of President
Bush’s presidency including Improvement and Modernization Act, and
Medicare Prescription Drug. The Medicare Prescription Drug involved a
prescription plan for elderly and disabled Americans.
Several other acts have been introduced in the United States’ health
sector since then. Two of these are the United States National Health
Care Act (HR 676) and the Healthy Americans Act (S.334). The American
Health Insurance Plan (AHIP) has been active in proposing the necessary
reforms. In 2007, AHIP proposed for quality and safety improvement in
the United States’ health system. In 2008, they also announced a set
of proposals that would include setting a national goal in order to
reduce the projected growth in health care spending by 30% (Forman
2010).
An Economic Survey of the United States Health Care Reform was conducted
in 2008 by the Organization for Economic Cooperation and Development
(Docteur and Berenson 2009). The results have formed the new basis for
health care reforms from 2008 until now. Some of the recommendations
from the findings included an abolishment of the tax benefits earned by
companies from employer-based insurance plans (Brown et al 2012). The
suggestion was that those tax revenues should be used to subsidize for
individuals in purchasing insurance covers hoping that the subsidies
would act as incentives to purchase a health plan even for the low
income earners (Watson 2012).
China
People’s Republic of China became a state in 1949. The reform
available for discussion is dated 1949 going forward. Most Asian
countries are well known for wealthy cultures that cut across religion,
societal ethics and health issues (Chang 2013). This is the background
of China’s health reforms. Immediately after attaining independence,
China took health as a social welfare issue. That placed the burden on
the national government to undertake the necessary reforms to improve
the health care status of their citizens (Fincham 2009).
The first initiative was to launch the Rural Cooperation Medical System.
It was a three-tier system targeting improvement of rural health care
access. The system was to be supported financially by three sources. One
of the sources was the individual income contribution. Individuals would
access services at subsidized fees (Brown et al 2012). The second source
was the Village Collective Welfare Fund. There was to be a welfare fund
for each village to pool together resources to assist in footing medical
bills for needy persons and emergencies (Williams 2011). The third
source was subsidies from the national government. This would come in
terms of constructing and staffing and also paying employees. The Rural
Cooperation Medical System operated at three levels. Level one
practitioners were barefoot doctors (Chang 2013). These barefoot doctors
were experts in Traditional Chinese Medicine who were then trained on
basic hygiene. This level was the easiest and the most accessible for
individuals in the rural areas. Barefoot doctors were utilized to deal
with common ailments and minor injuries (Docteur and Berenson 2009).
At the second level were the township health centers. They were small
outpatient clinics that hired medical professionals through subsidies by
the government (Williams 2011). These clinics were utilized as support
to the barefoot doctors. They would deal with cases that were delicate
and required attention and expertise beyond the barefoot doctors. At the
top of the RCMS were the County hospitals. These were fully funded by
the government and offered services to critically ill patients. The
local government assisted the national government to run these hospitals
by providing manpower and other resources (Watson 2012).
Alongside the Rural Cooperation Medical System, public health campaigns
were held. These campaigns targeting the urban areas were to sensitize
people on environmental and personal hygiene to curb infections (Chang
2013). These efforts saw significant achievements in the health
situation. Life expectancy improved by almost double the number from 35
to 69 years. Prevalence to certain diseases also decreased
significantly. An example is prevalence to malaria that dropped from
5.55% to 0.3% of the total Chinese population. Infant mortality
decreased to 40 from 250 out of every 1000 live births (Twaddle 2002).
The agricultural sector underwent massive reforms in the 1980’s. Those
reforms destabilized the rural areas where income was based on
agriculture (Williams 2011). The people in the rural areas no longer
afforded to pay for medical services comfortably. That situation
necessitated a review of the Rural Cooperation Medical System. The
health care system went through an overhaul in 2003 when the New Rural
Cooperation Medical System was unveiled. Its focus was to make medical
services affordable to the rural poor (Docteur and Berenson 2009).
The New Rural Cooperation Medical System was different from the original
Rural Cooperation Medical System in a number of ways. First, the New
Rural Cooperation Medical System was a voluntary system as opposed to
the Rural Cooperation Medical System which was a government project with
little societal input (Gruber and Newquist 2011). The New Rural
Cooperation Medical System cuts across both the public and the private
sector and its implementation vary from county to county. From each
county, the hospitals are funded by contributions from individuals and
subsidies for the poor by the government (Chang 2013).
Despite its flexibility and advantages over the old system, the New
Rural Cooperation Medical System has been met by numerous challenges in
its implementation (Docteur and Berenson 2009). The biggest challenge is
funding that has limited its ability to provide adequate medical staff
and modern equipment in the health centers. It borrows the tier
structure from the old system. Although operations vary depending on the
location, the New Rural Cooperation Medical System has been found to
have a great effect at the local level (Fincham 2009). The structure
works that for services at the local hospital the bill is covered with
the scheme up to 70-80%. For services at the county hospitals, the cost
covered falls up to 60% and below. To access specialists in modern
hospitals, the patients bear most of the burden because the scheme only
covers 30% of the bill (Kronenfeld and Michael 2004).
The New Rural Cooperation Medical System is still operational to date.
It is only in 2012 that the Chinese government declared its endeavor to
pursue the ‘Healthy China 2020’ initiative. This is an ambitious
program that targets to provide universal health care access across all
China by the year 2020 (Halvorson 2007). It is integration of revised
policies on food and nutrition, agriculture and social marketing.
It gives special emphasis to chronic diseases and how they can be
prevented by adopting better lifestyles and healthy eating habits. It
addresses the main challenges in China. They are poor dietary choices,
physical inactivity and ignorance towards obesity. The program is very
strategic in its implementation (Docteur and Berenson 2009). For
instance, a large portion of its awareness is run by the media in order
to reach more people. Its emphasis is not on adherence to medical laws
but on change of mind set by the society and individuals towards being
responsible for one’s health.
Healthy China 2020’ acknowledges the looming rate of urbanizations.
Most of the urban areas are heavily influenced by the Western culture
especially as far as food is concerned. The fast food business is
reaping billions to the detriment of people’s health (Forman 2010).
The modernized mode of transport gives little opportunity for physical
exercise. This combined with poor diet is the single largest
contributing factor to the health crisis not only in China but around
the globe (Gruber and Newquist 2011). This program is creating awareness
of this fact and encouraging individuals to be wise around it. To ensure
their sustainability, China is building its health reforms on four
well-thought pillars. The first is healthcare financing (Chang 2013).
The key focus here is on how to increase the breadth and depth of health
insurance coverage. The breadth is related with how far the insurance
companies reach out to all and sundry across the country.
The depth is the variety of covers. The insurance companies should make
a variety of covers such as every individual can find one that suits
their needs (Jones Finer 2002). The objective is to have the entire
population embrace medical covers such they can become independent in
footing medical bills. Besides independence, they will also be assured
that they can access medical services whenever they need (Kronenfeld and
Michael 2004).
Still under healthcare financing, the program explores broader sources
of financing. Besides patient’s medical covers, the health
institutions require large amounts of money to run. There are various
sources that can contribute to their sustainability (Forman 2010). One
of them is the government setting aside funds for medical equipment
purchases and research. For the public hospitals, medical staffs are
government employees (Gruber and Newquist 2011). For specialized
services, most of the time medical covers do not cover special services
fully. Services like dialysis, organ transplants and chemotherapy can
receive funds to subsidize for patients in specified public hospitals
(Jones Finer 2002).
The second pillar is care delivery. Under care delivery, there are three
tenets. The first inherits the New Rural Cooperation Medical System of
establishing three-tier service delivery in the rural areas. This is to
ensure that China continues to reap from the good practices of previous
systems even with the new system (Kronenfeld and Michael 2007). The
second tenet is strengthening primary care services. These are the basic
health care services such as hygiene practices and campaigns, maternal
care, first aid and the likes. The third tenet is making urban and
community health centers dual referral (Halvorson 2007). This will act
in support of the local health centers for cases that need admission and
special equipment that the local hospitals may not have.
The third pillar is drugs supply. Key in this pillar is the drugs
procurement and supply process. For the public hospitals and the
subsidized local health care centers, the government is the sole
provider of drugs (Freeman III and Boynton 2011). The programs are keen
on the tendering process to ensure transparency and efficiency in the
whole process. Another important factor here is drug pricing. It is
important that the government has a hand in price setting such that the
private drug suppliers do not extort patients by setting exorbitant
prices ((Kronenfeld and Michael 2004). The government is also keen to on
ensure they reap any possible benefits from the pharmaceutical markets
(Gruber and Newquist 2011). This can only be enabled by maintaining a
professional business relationship with these companies, as well as
ensuring the personnel hired for this process are well versed in this
area, and also possess business acumen (Forman 2010).
The fourth and last pillar on these reforms is hospital reforms. The
primary matter of consideration is separation of ownership and
management. This will apply to both private and public health
institutions (Weber 2004). Every hospital regardless of the level in the
tier structure will be expected to be professionally managed by persons
that are qualified and competent in health management systems. Being a
medical professional will not be a qualification to run one’s own
clinic. This is a bid to standardize medical services across the country
and to minimize substandard services that put the patient’s lives at
risk (Freeman III and Boynton 2011).
To prove that the proposed health care program is not theoretical and to
stamp their commitment to its achievement, the Chinese government has
allocated $125 billion per year for its implementation(Gruber and
Newquist 2011). It has been apportioned carefully as follows: 47% of it
goes to health care provisions 46% is allocated to medical insurance
initiatives and the remaining 7% goes to public health (Forman 2010).
With this plan, it is expected that China will achieve the anticipated
level of disease prevention, and improve access to medical care in rural
areas.
The China Ministry of Health has been tasked to uproot the bad tooth
that has been dragging the health sector behind. One of the reforms
being undertaken currently is the provider payment system reform (Chang
2013). Public hospitals in China are known for underpaying their medical
workers which contributes towards professional negligence due to lack of
motivation. Medical staffs have been struggling to survive relying on
kick-back payments from wealthy patients (Docteur and Berenson 2009).
Cases of overpricing drugs and even overprescribing drugs have been
reported rampantly. By, developing a new and sustainable drug pricing
and staff payment system, such problems will be avoided (Jones Finer
2002).
Combined summary
It is evident from the literature review that the two countries are
undertaking reforms from two very different platforms. The United States
has been making adjustments to its Social Security Policy for over a
century now. Health care insurance has been the topic of discussion over
those decades (Freeman III and Boynton 2011). Efforts have not been to
establish anything new in the health sector, but rather revolving around
the same reforms trying to shape them to be favorable to the citizens.
In the United States, health care reforms are pretty much a political
affair. Even in the outline of the chronology of reforms, the most
logical flow has been outlining them from one presidential era to the
other (Halvorson 2007).
On the other hand, health care reforms in China have been part of a
growth process. It has been evolution from an agricultural state that
relied solely on traditional Chinese medicine (Docteur and Berenson
2009). The revolution from an agricultural to an industrial nation has
had a significant impact on health care reforms. The nation began from
scratch in 1949 by starting basic training on hygiene and establishing
local health centers that could offer basic services to the locals.
There has been numerous challenges owing to the simultaneous changes
occurring in the country besides health care reforms (Chang 2013).
China has been opening up slowly for business. Rapid urbanization has
been one of the things that have come together with the opening up
(Docteur and Berenson 2009). Environmental and drainage issues that
accompany rapid urbanization are some of the things health reforms have
had to factor in. The landing of multinational companies for business
has paved way for the Western Culture to set in. Subjects like
individual health insurance plans are new concepts to most of the
Chinese population especially in the rural areas (Halvorson 2007). This
means that China has limited time to deal with multiple factors
affecting health reforms.
To have such a promising health care initiative as ‘Healthy China
2020’ up and running, it speaks of China’s determination. The
initiative is competing with health reforms in countries such as the
United States that have been in stability for centuries before the
establishment of People’s Republic of China (Chang 2013). The rate of
success of previous health care systems such as the Rural Cooperation
Medical System, as well as  the New Rural Cooperation Medical System is
a confidence factor that the ‘Healthy China 2020’initiative is
achievable (Docteur and Berenson 2009).
While health reforms in the United States remain a political affair,
China’s social approach seems to be bearing much fruit. In the United
States, it is almost impossible to separate health care reforms with
politics (Chang 2013). No wonder health care proposals form a
presidential candidate’s campaign strategy. Time and time again,
presidential candidates have lost the elections for lack of convincing
health reform agendas. There is no bid for popularity involved in
China’s health care reforms (Fincham 2009). That could explain why
they have attained these levels of success and threaten to bypass the
superpowers in a short stint.
On individual grounds, China and the United States face completely
different challenges. Take China’s population for example, a single
country accounts for the population of several states in America
combined (Halvorson 2007). The government structures are also different.
For China, there is only the national government and the local
administration to deal with. The state and federal government structure
in the United States is a totally different scenario (Jones Finer 2002).
It has not been too difficult for China to decide on reforms, allocate
funds to them and implement them across all counties. The reason is that
decision-making is more centralized than in the United States. In the
United States, both the state and the federal government have to be in
agreement for implementation of policies in the local level (Fincham
2009). Passing the policies is a journey in itself. The two houses of
Congress have to pass the bill before it is passed on to the president
to assent.
World Health Organization (WHO) provides another factor that is
significant for comparison between these two superpowers. The factor is
pollution and to be precise air and water pollution. As earlier
mentioned, China has experienced a revolution from an agricultural to an
industrial economy. The rapid setting up of manufacturing companies has
been the largest contribution to the increase in air pollution. It has
been severe to the extent of forming a lasting fog. This level of air
pollution is bound to have an impact on the health status of Chinese
citizens. In 2002, 275600 deaths resulting from air pollution were
recorded. This were six times the death rate recorded in the United
States the same year. US recorded 41200 deaths resulting from urban
outdoor air pollution.
As regards water pollution, there was not a single death recorded in the
United States related to water pollution in 2002. Improvements on water
and sanitation in the United States stand at 100%. During the same year
in China, the level of water and sanitation had improved to 44%, but
still an estimated 95600 people died due to diarrhea. These challenges
in water and sanitation can be attributed to the rapid urbanization.
This means that clean water supply and drainage facilities are strained.
These pollution factors are a key factor of consideration for China in
their health reforms. The deaths and disability –adjusted life years
(DALY) from these environmental factors necessitate action. This
explains why China’s health budget has been on the increase because
the public health arm alone requires massive reforms. On the other hand,
the United States environmental and public health is stable. Cases of
water pollution are rare and incidental while air pollution is under
control. That explains why the focus of their reforms is in health
insurance because that is the area of need in their case.
The key challenge facing each of these nations point out another
difference. China is making all effort to provide health services to all
citizens wherever they are. Their key challenge is the fragmented health
system that comes with a lot of bureaucracies. The reforms are targeting
developing a centralized system of providing health care services. The
United States’ challenge is cost of health care. The fee per service
policy in operation currently makes medical services very costly. The
reform that would be most welcome in the United States is one addressing
the reduction of health care costs.
Another significant factor for comparison is medical service quality.
For the sake of this discussion, we shall use appointments and waiting
times as parameters. In China, doctor appointments are done one on one.
It is a common scenario for people to queue outside a big hospital
waiting to see the doctors they want in the morning. This is so because
these doctors see only a limited number of patients per day on first
come first served basis except for emergency cases. It is different in
the United States. For example, instead of going to health center and
queue for a long time, one can make a call or book an appointment
online. Another factor that saves on time in the United States is the
fact that a majority of the middle class have a personal doctor. They
only need to make a call and their medical issues are attended to from
their houses.
The final point of comparison is that the lobby groups have a huge say
in the United States. On several occasions, bills and proposals that
seemed favorable have failed to become law because of this long process
that gives for criticism to kill them. The American Medical Association
among others has been on the front line in punching holes to the
proposed health reforms from time to time. In China, capitalistic
tendencies play a role in the reforms. What the government has
identified as good for the people is being well received. This is the
reason why the world might be out to witness the greatest achievement in
healthcare coming from Asia and not from the West.
Bibliography
Brown, Ruth, Piriz, Dionisio, Liu Yuanyuan and Moore Jonathan. 2012.
Reforming Healthcare in China: Historical, Economic and Comparative
Perspectives. Michigan: Ford School of Public Policy.
Chang, Nai-Wen. 2013. A Comparison of Health Care Reform in Taiwan,
China, and United States. Atlanta: Georgia State University.
Docteur, Elizabeth and Berenson, Robert. 2009. How Does the Quality of
U.S. Health Care Compare Internationally? Timely Analysis of Immediate
Health Policy Issues. Washington: Urban Institute.
Fincham, Jack E. 2009. Health policy and ethics. London: Pharmaceutical
Press.
Forman, Lillian E. 2010. Health care reform. Edina, Minn: ABDO Pub.
Freeman III, Charles W. and Boynton, Xiaoqing Lu. 2011. Implementing
Health Care Reform Policies in China: Challenges and Opportunities.
Hongkon: Center for Strategic & international Studies.
Gruber, Jonathan, and H. P. Newquist. 2011. Health care reform: what it
is, why it`s necessary, how it works. New York: Hill and Wang.
Halvorson, George C. 2007. Health care reform now! a prescription for
change. San Francisco, CA: Jossey-Bass, a Wiley Imprint. HYPERLINK
“http://search.ebscohost.com/login.aspx?direct=true&scope=site&db=nlebk&
db=nlabk&AN=216637″
http://search.ebscohost.com/login.aspx?direct=true&scope=site&db=nlebk&d
b=nlabk&AN=216637 .
Jones Finer, Catherine. 2002. Social policy reform in China: views from
home and abroad. Aldershot, Hants: Ashgate.
Kronenfeld, Jennie Jacobs, and Michael R. Kronenfeld. 2004. Healthcare
reform in America: a reference handbook. Santa Barbara, Calif: ABC-CLIO.
Kronenfeld, Jennie Jacobs, and Michael R. Kronenfeld. 2007. Healthcare
reform in America: a reference handbook. Santa Barbara, Calif: ABC-CLIO.
Twaddle, Andrew C. 2002. Health care reform around the world. Westport,
Conn: Auburn House.
Watson, Peggy. 2012. Health Care Reform and Globalisation: The US, China
and Europe in Comparative Perspective. New York: Routledge.
Weber, Maria. 2004. Welfare, environment and changing US-Chinese
relations: 21st century challenges in China. Cheltenham [u.a.]: Elgar.
Williams, Richard Allen. 2011. Healthcare disparities at the crossroads
with healthcare reform. New York, NY: Springer.
PAGE * MERGEFORMAT 2

Close Menu