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Abstract
ABSTRACT Institutional barriers resulting from structural components in low and middle-income countries (LMICs) may impede the governance of a public health insurance (PHI) system during its primary phases. This study reports a mixed-method case study on cost containment challenges related to institutional barriers in the expansion of PHI in China. The quantitative analysis reveals that migrant patients with PHI who sought obstetric care in different areas during the examined period were institutionally considered out-of-pocket (cash) payers and paid an additional 28% in expenses. The qualitative findings corroborate the quantitative results, suggesting that there is widespread institutional discrimination against migrant patients, which extends beyond just one hospital. The ineffectiveness of policies designed to regulate physician behaviour in other regions can be attributed to the absence of interregional collaborative governance, which is hindered by institutional structural constraints. China has provided useful insights to LMICs regarding how to circumvent the institutional barriers that may inevitably arise during the development of PHI.
Published Version
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