Public Disclosure Copy The World Bank Implementation Status & Results Report China Health Reform Program (P154984) China Health Reform Program (P154984) EAST ASIA AND PACIFIC | China | Health, Nutrition & Population Global Practice | IBRD/IDA | Program-for-Results | FY 2017 | Seq No: 1 | SUBMITTED | ISR29331 | Implementing Agencies: Program Development Objectives Program Development Objective (from Program-for-Results Appraisal Document) To improve the quality of healthcare services and the efficiency of the healthcare delivery systems in Anhui and Fujian provinces. Overall Ratings Name Previous Rating Current Rating Progress towards achievement of PDO  --  Satisfactory Overall Implementation Progress (IP)  --  Satisfactory Overall Risk Rating  --  High Implementation Status and Key Decisions The China Health Reform Program for Results (PforR) was signed on June 30, 2017 but is not yet effective. The PforR supports the implementation of the 13th Five Year (2016-2020) Health Reform Plan in Anhui and Fujian provinces, with the aim of transforming the health service delivery system to address the emerging demographic and disease burden challenges, supported by institutional and policy reforms to facilitate this transformation. The three reform areas supported by this Program are: (i) comprehensive public hospital reform; (ii) establishment of a People Centered Integrated Care based service delivery system, with strengthened primary health care; and (iii) reinforcement of the cross-cutting policy, institutional and financial dimensions of the health reforms (e.g. governance and management systems, health information technologies, and human resources management). In addition, the Program will establish knowledge generation and learning networks, both nationally and internationally, to facilitate mutual learning and a wide dissemination of experiences. Since the program is not yet effective, it is too early to report progress. Preparations are currently underway for a program launch/training to be held either in Anhui province or in Beijing in September, in which officials from the central and two provincial governments, as well as relevant officials from all the prefectures in Anhui and Fujian, are expected to participate. The training will also include international and domestic experts, so that plans for effective technical assistance and implementation support to the program can be discussed and agreed. Data on Financial Performance Disbursements (by loan) Project Loan/Credit/TF Status Currency Original Revised Cancelled Disbursed Undisbursed Disbursed Not P154984 IBRD-87440 USD 600.00 600.00 0.00 0.00 600.00 0% Effective Key Dates (by loan) 8/22/2017 Public Disclosure Copy Page 1 of 8 Public Disclosure Copy The World Bank Implementation Status & Results Report China Health Reform Program (P154984) Project Loan/Credit/TF Status Approval Date Signing Date Effectiveness Date Orig. Closing Date Rev. Closing Date Not P154984 IBRD-87440 09-May-2017 30-Jun-2017 -- 31-Dec-2021 -- Effective Risks Systematic Operations Risk-rating Tool Risk Category Rating at Approval Previous Rating Current Rating Political and Governance  Moderate  --  Moderate Macroeconomic  Moderate  --  Moderate Sector Strategies and Policies  Moderate  --  Moderate Technical Design of Project or Program  High  --  High Institutional Capacity for Implementation and Sustainability  High  --  High Fiduciary  Substantial  --  Substantial Environment and Social  Moderate  --  Moderate Stakeholders  Low  --  Low Other  --  --  -- Overall  High  --  High Disbursement Linked Indicators (DLI) PHDLIPDOTBL  The County IDS system has been scaled up to at least 50 counties/districts in Anhui (Text) Baseline Actual (Previous) Actual (Current) Value 0 -- -- Date 09-May-2017 -- -- PHDLIPDOTBL  The integration of the management of the three health insurance schemes at the provincial level in Fujian is undertaken (Text) Baseline Actual (Previous) Actual (Current) Value NA -- -- Date 09-May-2017 -- -- 8/22/2017 Public Disclosure Copy Page 2 of 8 Public Disclosure Copy The World Bank Implementation Status & Results Report China Health Reform Program (P154984) PHDLIPDOTBL  Proportion of hospital discharges paid through case-based payment for all county-level public general hospitals and TCM hospitals (Text) Baseline Actual (Previous) Actual (Current) AH: 12 Value FJ: 3 -- -- Date 09-May-2017 -- -- PHDLIPDOTBL  Proportion of inpatients to be treated through standardized clinical pathways at county level public general hospitals (Text) Baseline Actual (Previous) Actual (Current) AH:4 Value FJ:0 -- -- Date 09-May-2017 -- -- PHDLIPDOTBL  Proportion of outpatient care delivered by primary care facilities (Text) Baseline Actual (Previous) Actual (Current) AH: 61 Value FJ: 51 -- -- Date 09-May-2017 -- -- PHDLIPDOTBL  Number of prefectures that manage Type II diabetes patients using the integrated NCD service package (Threshold value for a prefecture to qualify as using the integrated service package is 25% of tota (Text) Baseline Actual (Previous) Actual (Current) Value No minimum -- -- Date 09-May-2017 -- -- PHDLIPDOTBL  Number of counties that have established a county-township-village population health information system [Anhui] (Text) Baseline Actual (Previous) Actual (Current) 8/22/2017 Public Disclosure Copy Page 3 of 8 Public Disclosure Copy The World Bank Implementation Status & Results Report China Health Reform Program (P154984) Value No minimum -- -- Date 09-May-2017 -- -- PHDLIPDOTBL  Number of THCs / CHCs that have established primary care health information systems [Fujian] (Text) Baseline Actual (Previous) Actual (Current) Value No minimum -- -- Date 09-May-2017 -- -- PHDLIPDOTBL  Program experience sharing and dissemination (Text) Baseline Actual (Previous) Actual (Current) Value NA -- -- Date 09-May-2017 -- -- Results Results Area Intermediate Results Area Project Development Objective Indicators PHINDPDOTBL  Proportion of hospital discharges paid through case-based payment for all county-level public general hospitals and TCM hospitals (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value AH: 12 FJ: 3 -- -- AH: 32 FJ: 50 Date 09-May-2017 -- -- 31-Dec-2021 8/22/2017 Public Disclosure Copy Page 4 of 8 Public Disclosure Copy The World Bank Implementation Status & Results Report China Health Reform Program (P154984) PHINDPDOTBL  Proportion of inpatients to be treated through standardized clinical pathways at county level public general hospitals (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value AH: 4 FJ:0 -- -- AH:50 FJ: 50 Date 09-May-2017 -- -- 31-Dec-2021 PHINDPDOTBL  Proportion of outpatient care delivered by primary care facilities (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target AH: 61 FJ: 51 AH: 61.8 FJ: 55 Value -- -- Date 09-May-2017 -- -- 31-Dec-2021 PHINDPDOTBL  Number of prefectures that manage Type II diabetes patients using the integrated NCD service package (Threshold value for a prefecture to qualify as using the integrated service package is 25% of tota (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target AH: 6 FJ: 4 Value 0.00 -- -- Date 09-May-2017 -- -- 31-Dec-2021 Overall Comments Intermediate Results Indicators PHINDIRITBL  Growth rate of medical service revenue of public hospitals in the entire province (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target AH: 8% Value FJ: 8.88% -- -- <10% Date 09-May-2017 -- -- 31-Dec-2021 8/22/2017 Public Disclosure Copy Page 5 of 8 Public Disclosure Copy The World Bank Implementation Status & Results Report China Health Reform Program (P154984) PHINDIRITBL  Average length-of-stay for county level public hospitals (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target AH: 8.82 AH: 8 Value FJ: 7.41 -- -- FJ: 7.37 Date 09-May-2017 -- -- 31-Dec-2021 PHINDIRITBL  Number of counties that have public disclosure of quality report (e.g. ALOS, drug revenue as a proportion of hospital revenue, expenditure per visit for outpatient, expenditure per admission for inpat (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target AH: 55 AH: 61 Value FJ:10 -- -- FJ: 68 Date 09-May-2017 -- -- 31-Dec-2021 PHINDIRITBL  Proportion of labor based service revenue in total service revenue for all public hospitals in the province (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target AH: 25 AH: 30 Value FJ: 24.58 -- -- FJ: 30.00 Date 09-May-2017 -- -- 31-Dec-2021 PHINDIRITBL  Out-of-pocket payment as portion of the total inpatient services expenditure (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target AH: 42 AH: 37 Value FJ: 50.83 -- -- FJ: 48.83 Date 09-May-2017 -- -- 31-Dec-2021 PHINDIRITBL  Proportion of patients hospitalized within county (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target AH: 69 AH: 73 Value FJ: 63 -- -- FJ: 80 8/22/2017 Public Disclosure Copy Page 6 of 8 Public Disclosure Copy The World Bank Implementation Status & Results Report China Health Reform Program (P154984) Date 09-May-2017 -- -- 31-Dec-2021 PHINDIRITBL  Proportion of total Registered Physicians (assistant physician) and Registered Nurses practicing at the primary care facilities (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target AH: 26.80 Value FJ:29.09 -- -- increase Date 09-May-2017 -- -- 31-Dec-2021 PHINDIRITBL  Number of hypertension patients that are under standardized management (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target AH: 4500 000 AH: 4700 000 Value FJ: 1250 000 -- -- FJ: 1300 000 Date 09-May-2017 -- -- 31-Dec-2021 PHINDIRITBL  Number of counties that have established a county-township-village population health information system [Anhui] (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- -- 20.00 Date 09-May-2017 -- -- 31-Dec-2021 PHINDIRITBL  Number of THCs / CHCs that have established primary care health information systems [Fujian] (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value 0.00 -- -- 500.00 Date 09-May-2017 -- -- 31-Dec-2021 PHINDIRITBL  Number of prefectures achieving integration (at least of the management) of the health insurance schemes, thereby allowing unified payment arrangement for all providers (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value AH: 0 -- -- AH: 12 8/22/2017 Public Disclosure Copy Page 7 of 8 Public Disclosure Copy The World Bank Implementation Status & Results Report China Health Reform Program (P154984) FJ: 2 FJ: 10 Date 09-May-2017 -- -- 31-Dec-2021 PHINDIRITBL  Program experience sharing and dissemination (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value NA -- -- NA Date 09-May-2017 -- -- 31-Dec-2021 PHINDIRITBL  The county IDS system has been scaled up to at least 50 counties/districts in Anhui (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value NA -- -- NA Date 09-May-2017 -- -- 31-Dec-2021 PHINDIRITBL  The integration of the management of the three health insurance schemes at the provincial level in Fujian is undertaken (Text, Custom) Baseline Actual (Previous) Actual (Current) End Target Value NA -- -- NA Date 09-May-2017 -- -- 31-Dec-2021 Overall Comments 8/22/2017 Public Disclosure Copy Page 8 of 8