Gansu Survey of Children and Families Papers


Do health sector reforms have their intended impacts?: The World Bank's Health VIII project in Gansu province, China

Document Type

Journal Article

Date of this Version



Reprinted from Journal of health economics 26, no. 3 (2007): 505-535.
Publisher URL:


This paper combines differences-in-differences with propensity score matching to estimate the impacts of a health reform project in China that combined supply-side interventions aimed at improving the effectiveness and quality of care with demand-side measures aimed at expanding health insurance and providing financial support to the very poor. Data from household, village and facility surveys suggest the project reduced out-of-pocket spending, and the incidence of catastrophic spending and impoverishment through health expenses. Little impact is detected on the use of services, and while the evidence points to the project reducing sickness days, the evidence on health outcomes is mixed.


Impact evaluation, Health sector reform, Catastrophic spending, Impoverishment, China



Date Posted: 18 December 2008

This document has been peer reviewed.