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Health insurance reform for rural China is at a crossroads. The achievements of recent reform initiatives appear remarkable as measured by coverage through the New Cooperative Medical Scheme (NCMS). Yet there is little evidence that NCMS has made major strides toward reducing the financial risks of health care for the rural population. We argue that to improve the overall performance of the NCMS, more attention should be directed to improve insurance benefit package, strengthen the roles of government agencies as purchasers and third-party payers, reforming provider payment methods, as well as to establish a fiscal redistribution mechanism to reduce inequities in health financing arising from different regions of the country. Our critical assessment also points to the danger that this system may be trapped in a vicious cycle of increases in government subsidies and resulting cost escalations in health care due to strategic responses among health care providers, a factor that hitherto has been largely overlooked.

China's New Co-operative Medical Scheme (NCMS), a government-subsidized health insurance programme, was launched in 2003 in response to deterioration in access to health services in rural areas. Initially designed to cover inpatient care, it has begun to expand its benefit package to cover outpatient care since 2007. The impacts of this initiative on outpatient care costs have raised growing concern, in particular regarding whether it has in fact reduced out-of-pocket (OOP) payments for services among rural participants. This study investigates the impacts on outpatient costs by analysing data from an individual-level longitudinal survey, the China Health and Nutrition Survey, for 2004 and 2009, years shortly before and after NCMS began coverage of outpatient services in 2007. Various health econometrics strategies were employed in the analysis of these data, including the Two-Part Model, the Heckman Selection Model and Propensity Score Matching with the Differences-in-Differences model, to estimate the effects of the 2007 NCMS initiative on per episode outpatient costs. We find that NCMS outpatient coverage starting in 2007 had little impact on reducing its participants' OOP payments for outpatient services. The new coverage may also have contributed to an observed increase in total per episode outpatient costs billed to the insured patients. This increase was more pronounced among village clinics and township health centres—the backbone of the health system for rural residents—than at county and municipal hospitals.

The paper investigates the determinants of bribery in sub-Saharan Africa by using probit models and data from the World Bank's Enterprise Survey of 10,457 firms in 30 countries in sub-Saharan Africa from 2009 to 2013. By doing so we find that securing a government contract is the most significant motivation for bribery and that overall, the propensity to bribe depends on the size of the firm as well as the predictability of the regulatory environment. Our findings have similarities and differences compared to Asian firms. The paper also highlights that the incidence and the determinants of bribery vary across the four sub-regions. On the basis of this evidence we suggest that when it comes to anti-corruption strategies, one size does not fit all and that country-specific and region-specific strategies should be adopted to address context-specific needs and conditions.