+2:+($/7+:25.(56($51$/,9,1* ,1&+,1$ ,'6:RUNLQJ3DSHU * H U D O G % O R R P / H L \ D + D Q D Q G ; L D Q J / L 6800$5< 'XULQJ WKH SHULRG RI WKH FRPPDQG HFRQRP\ JRYHUQPHQW KHDOWK ZRUNHUV ZHUH SDLG WKH VDPH VDODU\ WKURXJKRXW&KLQD2YHUWKHSDVWWZHQW\\HDUVWKHJRYHUQPHQWKDVPDQDJHGDJUDGXDOOLEHUDOLVDWLRQRIWKH ODERXUPDUNHWDVSDUWRIWKHWUDQVLWLRQWRD¶VRFLDOLVWPDUNHWHFRQRP\·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·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·V5HSXEOLFRI&KLQD 'HSDUWPHQWRI+HDOWK3ROLF\7RQJML0HGLFDO8QLYHUVLW\:XKDQ3HRSOH·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·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igure 1, Influences on the behaviour of health workers Contractual relationship, with purchaser of services Immediate financial gain Constraints to opportunism (professional political, religious, local reputation ) HEALTH WORKER BEHAVIOUR Career incentives (financial and professional) Ethical considerations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· LQWHUHVWV WKDQ WR WKH SXEOLF +RZHYHU WKH ORQJWHUP VXUYLYDO RI KHDOWK FDUH SURIHVVLRQV GHSHQGV RQ WKH SXEOLF·V SHUFHSWLRQ RI WKHLULQWHJULW\DQGWKH\KDYHDVWDNHLQOLPLWLQJLQDSSURSULDWHEHKDYLRXU7KHUHLVOLWWOHNQRZOHGJHDERXWWKH SHUIRUPDQFHRIWKHVHERGLHVLQORZDQGPLGGOHLQFRPHFRXQWULHV6RPHVRFLHWLHVDOVRGHSHQGRQSROLWLFDORU UHOLJLRXVRUJDQLVDWLRQVWRLQGXFHKHDOWKZRUNHUVWRVHUYHSXEOLFQHHGV +HDOWK ZRUNHU EHKDYLRXU LV FRQVWUDLQHG E\ KDUGWRGHILQH FXOWXUDO IDFWRUV ,Q VRPH FRXQWULHV KHDOWK ZRUNHUV LQWHUQDOLVH D VHW RI PHGLFDO HWKLFV LQ RWKHUV WKH\ UHVSRQG WR SROLWLFDO RU UHOLJLRXV IDFWRUV ,Q H[FKDQJHWKH\KDYHKLJKVRFLDOVWDWXVDVWUXVWHGDGYLVRUV7KHYDOXHVRISURIHVVLRQDOVHUYLFHKDYHFRQWULEXWHG WR WKH SUHVHUYDWLRQ RI WKH HIIHFWLYHQHVV RI VHUYLFHV LQ VRPH FRXQWULHV ZKLFK H[SHULHQFHG SHULRGV RI DGPLQLVWUDWLYHFKDRV 7KLVFKDSWHUWHOOVKRZWKH&KLQHVHJRYHUQPHQWKDVWULHGWRHQVXUHZLGHVSUHDGDFFHVVWRH[SHUWKHDOWK FDUHDGYLFHDQGVHUYLFHVDWDWLPHRIZLGHUDQJLQJHFRQRPLFLQVWLWXWLRQDODQGSROLWLFDOFKDQJHLWGHVFULEHV WKHIDFWRUVZKLFKLQIOXHQFHGKHDOWKZRUNHUEHKDYLRXUGXULQJWKHSHULRGRIWKHFRPPDQGHFRQRP\LWWKHQ GLVFXVVHVKRZWKHVHIDFWRUVFKDQJHGGXULQJWKHWUDQVLWLRQWRDPDUNHW HFRQRP\ LW GHVFULEHV WKH OHJDO DQG LOOHJDOOLYHOLKRRGVWUDWHJLHVRIKHDOWKZRUNHUVGXULQJWKHODWWHUSHULRGDQGLWGLVFXVVHVWKHEOXUUHGERXQGDULHV EHWZHHQWKHWZRLQDVRFLHW\XQGHUJRLQJUDGLFDOUHIRUPV +($/7+:25.(56$1'7+(&200$1'(&2120< 7KHHFRQRPLFDQGLQVWLWXWLRQDOFRQWH[W 3ULRUWRWKHHFRQRPLFUHIRUPVRIWKHVWKHVWDWHEXUHDXFUDF\UXUDOFRPPXQHVDQG&RPPXQLVW3DUW\ GRPLQDWHG WKH &KLQHVH HFRQRP\ 7KH VWDWH EXUHDXFUDF\ ZKLFK LQFOXGHG VWDWHRZQHG HQWHUSULVHV ZDV RUJDQLVHG DFFRUGLQJ WR WKH SULQFLSOHV RI WKH FRPPDQG HFRQRP\ WKH QDWLRQDO JRYHUQPHQW VHW SULFHV DVVLJQHG ZRUNHUV WR HQWHUSULVHV VHW SD\ VFDOHV DQG FRQWUROOHG LQYHVWPHQW GHFLVLRQV ORZHU OHYHOV RI JRYHUQPHQWHQWHUSULVHVDQGLQGLYLGXDOVZHUHH[SHFWHGWRIXOILOSODQWDUJHWV 7KH UXUDO DUHDV ZHUH RUJDQLVHG LQWR FRPPXQHV ZKLFK PDQDJHG FROOHFWLYH SURGXFWLRQ 7KH\ XVHG D SRUWLRQ RI WKHLU RXWSXW WR ILQDQFH LQYHVWPHQW DQG ORFDO VHUYLFHV DQG GLVWULEXWHG WKH UHPDLQGHU WR WKHLU PHPEHUVLQSURSRUWLRQWRWKHQXPEHURIZRUNSRLQWVWKH\KDGDFFXPXODWHG0HPEHUVRIDFRPPXQHHDUQHG ZRUNSRLQWVIRUWLPHVSHQWRQYDULRXVFROOHFWLYHDFWLYLWLHV 7KH &RPPXQLVW 3DUW\ SOD\HG DQ LPSRUWDQW UROH LQ HFRQRPLF DQG VRFLDO DFWLYLWLHV ,WV FDGUHV GLUHFWO\ LQIOXHQFHGGHFLVLRQPDNLQJLQDOOLQVWLWXWLRQV7KHSROLWLFLVDWLRQRIHFRQRPLFOLIHUHDFKHGDKLJKSRLQWGXULQJ WKHODWHVDQGHDUO\VZKHQWKH&XOWXUDO5HYROXWLRQSXW¶SROLWLFVLQFRPPDQG· 2UJDQLVDWLRQDQGILQDQFHRIKHDOWKVHUYLFHVLQWKHV &KLQD·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¶WKUHHWLHU·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·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¶KLHUDUFKLFDOFRQWURO·DQG ¶VROLGDULW\·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igure 2, Influences on the behaviour of health workers in 1970s China Ethic of serving the people Health facility manager Supervision by higher levels of service HEALTH WORKER BEHAVIOUR Political cadres Labour Bureau (Financial incentives) (Professional regulation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¶SXWSROLWLFVLQFRPPDQG·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·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¶VRFLDOLVW PDUNHW HFRQRP\·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·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·%ULHQ7KLVOLPLWVWKHGHJUHHWRZKLFKORFDOVHUYLFHSURYLGHUVDUHDFFRXQWDEOHWRXVHUV ([WUDOHJDOSD\PHQWVIRUKHDOWKVHUYLFHV +HDOWK ZRUNHUV HPSOR\ D YDULHW\ RI VWUDWHJLHV WR DXJPHQW UHODWLYHO\ ORZ EDVLF JRYHUQPHQW VDODULHV +HDOWK IDFLOLWLHVOLNHDOORWKHUHQWHUSULVHVDUHSHUPLWWHGWRSD\ERQXVHVRXWRIVXUSOXVHDUQLQJV7KH\FDQEHDVODUJH DVWKHEDVLFVDODU\3DWLHQWVPD\DOVRJLYHWKHPJLIWVFDOOHG¶UHGSDFNDJHV·DQGVXSSOLHUVRIGUXJVHTXLSPHQW DQG VHUYLFHV PD\ SD\ WKHP ¶NLFNEDFNV·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¶UHGSDFNDJHV·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·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¶SUHVFULSWLRQ IHHV· IRU RUGHULQJ D SDUWLFXODU LQYHVWLJDWLRQRUGUXJ¶LQWURGXFWLRQIHHV·IRUVHQGLQJQHZSDWLHQWVRU¶UHIHUUDOIHHV·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¶GLVSHUVHGFRPSHWLWLRQ·+RZHYHUPDQ\SURYLGHUVGRQRWDFWDVLIWKHLURQO\PRWLYHVDUHILQDQFLDO)LJXUH LGHQWLILHVIDFWRUVZKLFKH[SODLQWKLV6RPHDUHGLPLQLVKHGYHUVLRQVRIWKHPDMRULQIOXHQFHVRQKHDOWKZRUNHUV GXULQJWKHVDQGRWKHUVDUHQHZ7KHGLVFXVVLRQLVFRPSOLFDWHGE\WKHUDSLGO\FKDQJLQJVWUXFWXUHRIWKH KHDOWKVHFWRU6LQFHWKHJRYHUQPHQWKDVHQDFWHGUHIRUPVRIPDQ\DVSHFWVRIKHDOWKVHFWRUPDQDJHPHQW ILQDQFHDQGUHJXODWLRQ Figure 3, Influences on the behaviour of health workers in 1990s China Health finance and management Regulatory Framework Local accountability structures Health facility manager Government Labour Bureau Price Bureau HEALTH WORKER BEHAVIOUR Financial incentives Criminal law Insurance bodies Professional regulation Ethics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¶YDJXHO\ GHILQHG FRRSHUDWLYHV·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·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·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·VSULQFLSDOFRPSODLQWDJDLQVWUHGSDFNDJHVLVWKDWWKH\FRQWUDGLFWLWVHIIRUWVWRNHHSWKH FRVWRIPHGLFDOFRQVXOWDWLRQVORZ7KHJRYHUQPHQWKDVWULHGWRVWRSWKLVSUDFWLFHDQGWKH'HSXW\0LQLVWHURI +HDOWKPDGHLWDSULRULW\DQWLFRUUXSWLRQWDVNLQ0R3+DQG7DR 7KH JRYHUQPHQW WUHDWV UHG SDFNDJHV DV XQHWKLFDO DQG XQSURIHVVLRQDO +HDOWK 'HSDUWPHQWV WDNH WKHP LQWRDFFRXQWLQHYDOXDWLQJKRVSLWDOSHUIRUPDQFHDQG+XQDQIRUH[DPSOHGRZQJUDGHVKRVSLWDOVZKHUHPRUH WKDQSHUFHQWRIHPSOR\HHVDFFHSWUHGSDFNDJHV/LX-4:DQJ+HDOWKIDFLOLWLHVDZDUGSUL]HV IRU¶KRQHVWPHGLFDOVHUYLFH·DQGUHZDUGVRIXSWRSHUFHQWWRKHDOWKZRUNHUVZKRUHIXVHDUHGSDFNDJHRU JLYH LW WR WKH DXWKRULWLHV 'DL :DQJ 7KH\ SXQLVK RIIHQGHUV ZLWK ILQHV ORVV RI ERQXVHV WHUPLQDWLRQ RI HPSOR\PHQW SRVWSRQHPHQW RI SURPRWLRQ GHPRWLRQ DQGRU ORVV RI WKH ULJKW WR SUHVFULEH GUXJVIRUXSWRD\HDU=KDQJ/XRDQG=KDQJ=-/X2QHUHFHQWVWUDWHJ\IRUWDFNOLQJWKLV SUREOHPKDVEHHQWRDVNSDWLHQWVDQGGRFWRUVWRVLJQDQDJUHHPHQWXQGHUWDNLQJQRWWRSD\RUUHFHLYHDUHG SDFNDJH6RQJ/LX;5 6RPH DQDO\VWV DWWULEXWH WKH JURZWK LQ UHG SDFNDJHV WR GLVWRUWLRQV LQ WKH KHDOWK FDUH PDUNHW +HDOWK IDFLOLWLHV FDQQRW FKDUJH HFRQRPLF IHHV IRU LQSXWV RI WLPH E\ KHDOWK ZRUNHUV 7KH\ KDYH FRPSHQVDWHG E\ VHOOLQJGUXJVDQGFKDUJLQJIRUWKHXVHRIVRSKLVWLFDWHGHTXLSPHQW+RZHYHUWKH\PRVWO\KDYHQRWEHHQDEOH WR PDWFK WKH OHYHOV RI SD\ RI SURILWDEOH HQWHUSULVHV +HDOWK ZRUNHUV KDYH VRXJKW DGGLWLRQDO LQFRPH IURP LQIRUPDOVRXUFHV7KHGLIIHUHQWV\VWHPVRIKHDOWKILQDQFHKDYHFUHDWHGGLIIHUHQWPDUNHWVIRUKHDOWKVHUYLFHV 3HRSOHZLWKKHDOWKLQVXUDQFHPRVWO\LQXUEDQDUHDVFDQHDVLO\DIIRUGDUHODWLYHO\PRGHVWUHGSDFNDJH7KH PDMRULW\RIWKHSRSXODWLRQZKRDUHXQLQVXUHGKDYHGLIILFXOW\PHHWLQJIRUPDOKRVSLWDOFKDUJHVDQGKDYHOLWWOH FDSDFLW\WRPDNHDGGLWLRQDOSD\PHQWV 9LHZHGIURPWKLVSHUVSHFWLYHUHGSDFNDJHVDUHDUHVSRQVHWRULJLGLWLHVLQWKHKHDOWKFDUHSULFLQJV\VWHP DQGWKHZLGHQLQJGLIIHUHQFHVLQOHYHOVRISD\7KH\KDYHLQWXUQLQFUHDVHGLQHTXDOLWLHVLQDFFHVVWRVHUYLFHV EHWZHHQUHVLGHQWVLQULFKDQGSRRUORFDOLWLHVDQGWKHLQVXUHGDQGXQLQVXUHGDQGPDJQLILHGWKHDWWUDFWLRQRI KHDOWK ZRUNHUV DZD\ IURP SRRU DUHDV 7KHLU H[LVWHQFH KLJKOLJKWV GLIILFXOW SROLF\ LVVXHV UHJDUGLQJ KHDOWK ZRUNHUSD\ 7KHQXPEHURISHRSOHDFWXDOO\SXQLVKHGLVVPDOO6KDQ[L6KDQGRQJDQG+HQDQ3URYLQFHVSXQLVKHGDQG UHVSHFWLYHO\LQ+XDQJHWDO=KDQJ+7:DQJ *RYHUQPHQWYLHZVNLFNEDFNVDVDIRUPRIEULEHU\6WDWH&RXQFLODQG6KLDQG&KR$ QXPEHU RI 0LQLVWULHV LQFOXGLQJ WKH +LJKHVW 3HRSOH·V 2IILFH RI WKH 3XEOLF 3URVHFXWRU DUH FRRUGLQDWLQJ HIIRUWVWRVWRSWKHP&KHQ-=XD7KH0LQLVWU\RI+HDOWKDQG3URYLQFLDO+HDOWK'HSDUWPHQWV KDYHDOVRFDUULHGRXWFDPSDLJQVWRVWRSNLFNEDFNV<DQJ7KHSXQLVKPHQWV LQFOXGH FRQILVFDWLRQ RI WKH NLFNEDFN ILQHV DQG SURVHFXWLRQ XQGHU WKH ¶/DZ $JDLQVW 8QIDLU &RPSHWLWLRQ·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¶GHPRFUDWLFVXSHUYLVLRQ·RIORFDOKHDOWKVHUYLFHV,QSUDFWLFHWKLVPD\PHDQWKDWFRPPXQLW\UHSUHVHQWDWLYHV ZLOOEHLQFOXGHGLQWKHPDQDJHPHQWFRPPLWWHHRIORFDOKHDOWKSUHSD\PHQWVFKHPHV0RVWORFDOLWLHVKDYHQRW \HWHVWDEOLVKHGPHFKDQLVPVWRLPSURYHDFFRXQWDELOLW\RIKHDOWKVHUYLFHSURYLGHUV 7+(&+$1*,1*62&,$/&2175$&7:,7++($/7+:25.(56 7KLVFKDSWHUKDVUHFRXQWHGKRZKHDOWKZRUNHUVKDYHDGDSWHGWRPDMRUHFRQRPLFDQGLQVWLWXWLRQDOFKDQJHV GXULQJ&KLQD·VWUDQVLWLRQWRDPDUNHWHFRQRP\&KLQDLQFRQWUDVWWRPDQ\RWKHUH[FRPPDQGHFRQRPLHV KDVSUHVHUYHGDQHIIHFWLYHKHDOWKVHFWRUGXULQJDWLPHRIJUHDWFKDQJH7KLVLVGXHWRDJUHDWH[WHQWWRLWV JRYHUQPHQW·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• &DQWKHREMHFWLYHVRISURYLGLQJDFFHVVWRKHDOWKVHUYLFHVIRUDOOVRFLDOJURXSVEHUHFRQFLOHGZLWKWKHQHHG WRSD\FRPSHWLWLYHVDODULHVWRKHDOWKZRUNHUV" • +RZVKRXOGKHDOWKZRUNHUSD\EHHVWDEOLVKHG"7RZKRPVKRXOGGLIIHUHQWFDWHJRULHVRIKHDOWKZRUNHUEH FRPSDUHG"6KRXOGKHDOWKZRUNHULQFRPHYDU\EHWZHHQULFKDQGSRRUORFDOLWLHV"7RZKDWH[WHQWVKRXOG JRYHUQPHQWLQWHUYHQHWRUHGXFHLQWHUUHJLRQDOLQHTXDOLWLHVLQSD\E\FRQWUROOLQJHDUQLQJVLQULFKDUHDVRU VXEVLGLVLQJKHDOWKZRUNHUVLQSRRUORFDOLWLHV" • +RZFDQWKHZLOOLQJQHVVRIULFKHUVRFLDOJURXSVWRSD\PRUHIRUKHDOWKVHUYLFHVEHUHFRQFLOHGZLWKWKH REMHFWLYHRIHQVXULQJDFFHVVWRVNLOOHGKHDOWKZRUNHUVIRUDOO"&DQKHDOWKZRUNHUVHDUQDGGLWLRQDOLQFRPH IURPIHHVZLWKRXWFUHDWLQJXQDFFHSWDEOHLQHTXDOLWLHV"6KRXOG¶SULYDWH·SDWLHQWVEHDVNHGWRSD\WKHIXOO FRVWRIIHHVUDWKHUWKDQPRGHVWUHGSDFNDJHV" • :KDWDUHWKHUHODWLYHUROHVRIJRYHUQPHQW SURIHVVLRQDO ERGLHV DQG FRPPXQLWLHV LQ VXSHUYLVLQJ KHDOWK ZRUNHUSHUIRUPDQFH" •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¶IRUPDO·SD\PHQWV7KHVHLQWXUQDUHEDVHGRQDQDVVXPSWLRQ DERXWKRZKHDOWKZRUNHUVVKRXOGEHSDLGDQGKRZWKH\VKRXOGSHUIRUP 7KHVLPSOHGLFKRWRP\EHWZHHQIRUPDODQGLQIRUPDOSD\PHQWVKDVEHFRPHEOXUUHGDVPDQ\FRXQWULHV KDYH LQFUHDVHG WKH UROH RI WKH PDUNHW LQ WKHLU HFRQRP\ *RYHUQPHQWV KDYH EHHQ XQZLOOLQJ RU XQDEOH WR ILQDQFH D KHDOWK VHUYLFH ZKLFK PHHWV WKH H[SHFWDWLRQV RI WKH ULFKHU PHPEHUV RI VRFLHW\ RU WR SD\ VDODULHV ZKLFKPHHWWKHH[SHFWDWLRQVRIKHDOWKZRUNHUVZLWKWKHPRVWPDUNHWDEOHVNLOOV7KLVKDVFUHDWHGDQLFKHIRU OHJDODQGRULOOHJDOPDUNHWVIRUKHDOWKVHUYLFHV,QVRPHFDVHVKHDOWKZRUNHUVVXSSOHPHQWEDVLFJRYHUQPHQW VDODULHV ZLWK LQFRPH HDUQHG OHJDOO\ RU LOOHJDOO\ IURP RWKHU VRXUFHV LQ RWKHU FDVHV WKH\ OHDYH SXEOLF HPSOR\PHQW7KHEDODQFHYDULHVEHWZHHQFRXQWULHV 7KHH[LVWHQFHRILQIRUPDOSD\PHQWVLVDVLJQRIWKHLQFUHDVLQJJDSEHWZHHQWKHYLHZRIWKHKHDOWKVHFWRU DVDIXOO\IXQGHGJRYHUQPHQWVHUYLFHDQGUHDOLW\7KH\DOVRUHIOHFWDVWUDLQLQWKHSUHVHQWFRQWUDFWEHWZHHQ JRYHUQPHQW DQG KHDOWK ZRUNHUV 7KH\ FDQQRW EH FRQWUROOHG VLPSO\ E\ SXQLVKLQJ RIIHQGHUV PRUH VWULFWO\ *RYHUQPHQWV KDYH WR UHYLVLW EDVLF TXHVWLRQV DERXW KRZ WKH\ VKRXOG PDNH WKH EHVW XVH RI WKHLU OLPLWHG ILQDQFLDODQGUHJXODWRU\SRZHUVWRLQIOXHQFHKHDOWKVHUYLFHSURYLGHUV 7KLV PD\ OHDG WR D UHGUDZLQJ RI WKH ERXQGDULHVEHWZHHQSXEOLFDQGSULYDWHVHFWRUVDQGDUHQHJRWLDWLRQRIWKHVRFLDOFRQWUDFWZLWKKHDOWKZRUNHUV 7KHUHODWLRQVKLSEHWZHHQKHDOWKZRUNHUVJRYHUQPHQWVDQGFLYLOVRFLHW\RUJDQLVDWLRQV DUH OLNHO\ WR FKDQJH FRQVLGHUDEO\LQ&KLQDDQGRWKHUORZDQGPLGGOHLQFRPHFRXQWULHVGXULQJWKHQH[WIHZ\HDUV 5()(5(1&(6 $UURZ . ¶8QFHUWDLQW\ DQG WKH :HOIDUH (FRQRPLFV RI 0HGLFDO &DUH· $PHULFDQ (FRQRPLF 5HYLHZ %ORRP * ¶)LQDQFLQJ 5XUDO +HDOWK 6HUYLFHV /HVVRQV IURP &KLQD· LQ &ROFORXJK HG 0DUNHWL]LQJ (GXFDWLRQDQG+HDOWK0LUDFOHRU0LUDJH"2[IRUG8QLYHUVLW\3UHVV %ORRP * DQG *X ; ¶+HDOWK VHFWRU UHIRUP OHVVRQV IURP &KLQD· 6RFLDO 6FLHQFH DQG 0HGLFLQH %ORRP*DQG7DQJ6¶5XUDOKHDOWKSUHSD\PHQWVFKHPHVLQ&KLQDWRZDUGVDPRUHDFWLYHUROHIRU JRYHUQPHQW·6RFLDO6FLHQFHDQG0HGLFLQH %RJJ / 'RQJ +- :DQJ ./ &DL :: DQG 'LZDQ 9 7KH FRVW RI FRYHUDJH UXUDO KHDOWK LQVXUDQFHLQ&KLQD+HDOWK3ROLF\DQG3ODQQLQJ &DUULQ * 5RQ $ <DQJ + HW DO ¶7KH UHIRUP RI WKH UXUDO FRRSHUDWLYH PHGLFDO V\VWHP LQ WKH 3HRSOH·V5SXEOLFRI&KLQDLQWHULPH[SHULHQFHLQSLORWFRXQWLHV·6RFLDO6FLHQFHDQG0HGLFLQH &KHQ+XL\DQJ¶2YHUVHHLQJ'UXJ.LFNEDFN·+HDOWK1HZV)HEUXDU\ &KHQ +XL\DQJ ¶7KH 6WDWH &RXQFLO 2IILFH $QQRXQFLQJ 7R &RQWLQXH 6WUDLJKWHQLQJ WKH 2UGHU RI 3KDUPDFHXWLFDO%XVLQHVV·+HDOWK1HZV0D\ &KHQ-X¶7KH.H\VWRQHRI$QWLFRUUXSWLRQLV6WLOOWR¶5HG3DFNDJH·LQ+HDOWK6HFWRU7KLV<HDUWKH 9LFH0LQLVWHU6XQ1RQJFKXQ·V/HFWXUHLQWKH7HOHSKRQH0HHWLQJRQ3URIHVVLRQDO0RUDO&RQVWUXFWLRQ· +HDOWK1HZV$SULO &KHQ-X¶)LUPO\6WRS'UXJ.LFNEDFN5HOHYDQW0LQLVWULHV7RJHWKHU+ROG0HHWLQJLQ7HOHYLVLRQDQG 7HOHSKRQH·+HDOWK1HZV-XQH &KHQ 0DROLDQJ ¶ =KHMLDQJ 6WULFWO\ 6WRSV .LFNEDFN :LQG\ LQ 3KDUPDFHXWLFDO 6HFWRU· +HDOWK 1HZV 2FWREHU &KHQ-XDQG6XQ&KDQJOLQ¶7KH5HG3DFNDJHZLWK%ORRG·+HDOWK1HZV-DQXDU\ &ROFORXJK&HGD3XEOLF6HFWRU3D\DQG$GMXVWPHQW5RXWOHGJH/RQGRQ &ROFORXJKHGE0DUNHWL]LQJ(GXFDWLRQDQG+HDOWK0LUDFOHRU0LUDJH"2[IRUG8QLYHUVLW\3UHVV &UHHVH$DQG.XW]LQ-/HVVRQVIURP&RVW5HFRYHU\LQ+HDOWK,Q0DUNHWL]LQJ(GXFDWLRQDQG+HDOWK LQ'HYHORSLQJ&RXQWULHVHG&&ROFORXJKSS&ODUHQGRQ3UHVV2[IRUG 'DL 6KRX]KHQJ ¶7R 'HGXFW D 3HUFHQWDJH IURP 5HG 3DFNDJH IRU $ZDUG WR WKH 'RFWRU ,V QRW $FFHSWDEOH·+HDOWK1HZV'HFHPEHU GH *H\QGW : =KDR ;< DQG /LX 6/ ¶)URP EDUHIRRW GRFWRU WR YLOODJH GRFWRU LQ UXUDO &KLQD· :RUOG%DQN7HFKQLFDO3DSHU1R:RUOG%DQN:DVKLQJWRQ 'HQJ::LONHV$DQG%ORRP*¶9LOODJHKHDOWKVHUYLFHVLQ&KLQD·,'6%XOOHWLQ )HQJ 7RQJTLDQJ DQG )HQJ =KDROL ¶7KLQNLQJ DERXW 5HG 3DFNDJH 3KHQRPHQRQ· &KLQHVH -RXUQDO RI +RVSLWDO0DQDJHPHQW *RQJ<:LONHV$DQG%ORRP*¶+HDOWK+XPDQ5HVRXUFH'HYHORSPHQWLQ5XUDO&KLQD·+HDOWK3ROLF\ DQG3ODQQLQJ *XR <XOL ¶-LDQJTL $ 6RFLRORJLFDO $QDO\VLV RQ 5HG 3DFNDJH 3KHQRPHQRQ· &KLQHVH +HDOWK (FRQRPLFV +DR 0R HW DO ¶ 3UREOHPVROYLQJ LQ FRRUGLQDWLRQ ZLWK VRFLHW\ WKH FRUQHUVWRQH RI VXVWDLQDEOH GHYHORSPHQWIRUKHDOWKLQGXVWU\·&KLQHVH-RXUQDORI+RVSLWDO$GPLQLVWUDWLRQ +DR0RHWDO¶$3ROLF\$QDO\VLVRQ:HOOUHJXODWHG'HYHORSPHQWRI'UXJ0DUNHW·,QSUHVV +HDOWK 1HZV $JHQF\ ¶7KH 1DWLRQDO 3ODQQLQJ &RPPLWWHH 5HOHDVHV 1HZ $GPLQLVWUDWLYH 3ROLF\ RQ 'UXJ3ULFH·+HDOWK1HZV'HFHPEHU +VLDR : ¶&RPPXQLW\ +HDOWK &DUH· 3DSHU SUHVHQWHG DW WKH ,QWHUQDWLRQDO 6HPLQDU RQ )LQDQFLQJ DQG 2UJDQL]DWLRQRI+HDOWK&DUHIRUWKH3RRU5XUDO3RSXODWLRQLQ&KLQD%HLMLQJ2FWREHU +XDQJ5XR\LQJ¶7KH7HDFKLQJ+RVSLWDORI7LDQMLQJ0HGLFDO8QLYHUVLW\/DXQFKHV¶$ZDUG)XQG·IRU WKH'RFWRUZLWK*RRG3URIHVVLRQDO0RUDOLW\·+HDOWK1HZV$SULO +XDQJ 4LQIX HW DO ¶$QKXL +HQDQ DQG -LDQJ[L (QKDQFH WKH &RQVWUXFWLRQ RI 0HGLFDO 3URIHVVLRQDO 0RUDOLW\·+HDOWK1HZV-XO\ -LQJ:HLHWDO¶$FWXDOO\5HGXFH)DUPHUV·%XUGHQ7KH5HTXLUHPHQWRI-LDQJ[L+HDOWK'HSDUWPHQWV· +HDOWK1HZV-DQXDU\ /DPSWRQ'7KH3ROLWLFVRI0HGLFLQHLQ&KLQDWKH3ROLF\3URFHVV'DZVRQ)RONHVWRQH8. /HH +< )URP 5HYROXWLRQDU\ &DGUHV WR 3DUW\ 7HFKQRFUDWV LQ 6RFLDOLVW &KLQD 8QLYHUVLW\ &DOLIRUQLD 3UHVV 2[IRUG /HRQDUG'$IULFD·V&KDQJLQJ0DUNHWVIRU+HDOWKDQG9HWHULQDU\6HUYLFHV0DFPLOODQ%DVLQJVWRNH /L&KDQJVKHQJDQG/LX'DRDQ¶6RPH+RVSLWDOV6WLOO6WRS5HG3DFNDJH3KHQRPHQRQ·+HDOWK1HZV 'HFHPEHU /L'H\XDQDQG:DQJ&KXQVKHQJ¶7KH &RQVWUXFWLRQ RI +HDOWK 6HFWRU·V 3URIHVVLRQDO 0RUDOLW\ *RHV 8S·+HDOWK1HZV-DQXDU\ /L+XDDQG+XDQJ<L\L¶:K\'RHV+HDOWK:RUNHU5HFHLYH5HG3DFNDJH<HW$IWHU6WRSSHG$JDLQDQG $JDLQ·&KLQHVH-RXUQDO2I+RVSLWDO0DQDJHPHQW /LFKWHQVWHLQ1¶(QWHUSULVHUHIRUPLQ&KLQDWKHHYROYLQJOHJDOIUDPHZRUN·:RUNLQJ3DSHU1R :RUOG%DQN:DVKLQJWRQ /LX * /LX ; DQG 0HQJ 4 3ULYDWL]DWLRQ RI WKH PHGLFDO PDUNHW LQ VRFLDOLVW &KLQD D KLVWRULFDO DSSURDFK+HDOWK3ROLF\ /LX-LDQURQJHWDO¶$Q$QDO\VLVRQ¶5HG3DFNDJH·3KHQRPHQRQDQG5HVROXWLRQ 6HDUFKLQJ·&KLQHVH -RXUQDORI+RVSLWDO0DQDJHPHQW /LX-LDTLQJD¶7KH&ULWLFDO9RWLQJ+HDY\$ZDUGDQG6HULRXV3XQLVKPHQW·+HDOWK1HZV-XQH /LX;LDRUHQE¶7KH3XEOLF$JUHHPHQW,V*RRG·+HDOWK1HZV$SULO /LX < +X 6 )X : DQG +VLDR : ¶,V FRPPXQLW\ ILQDQFLQJ QHFHVVDU\ DQG IHDVLEOH IRU UXUDO &KLQD"·+HDOWK3ROLF\ /X%DR¶6KRXOG'DUHWR'R$JDLQVW+DUGQHVV·+HDOWK1HZV0DUFK /XR%DRJXRDQG=KDQJ6KHQ\DQJ¶:KRUHFHLYLQJ¶5HG3DFNDJH·0XVW&KDUJHIRUWKH3DWLHQW·+HDOWK1HZV -XQH 0HFKDQLF ' ¶&KDQJLQJ 0HGLFDO 2UJDQLVDWLRQ DQG WKH (URVLRQ RI 7UXVW· 0LOOEDQN 4XDUWHUO\ 023+¶023+·V1HZ5HJXODWLRQRI¶5HG3DFNDJH··+HDOWK1HZV-XQH 023+$Q$QQRXQFHPHQW$ERXW6WULFWO\WR)RUELG.LFNEDFN%HKDYLRUVLQ0HGLFDO$FWLYLW\+HDOWK1HZV 6HSWHPEHU 0RRUH0¶&RPSHWLWLRQDQGSOXUDOLVPLQSXEOLFEXUHDXFUDFLHV·,'6%XOOHWLQ 1XQEHUJ%DQG /LQGDXHU ' 5HKDELOLWDWLQJ *RYHUQPHQW :RUOG %DQN 5HJLRQDO DQG 6HFWRUDO 6WXGLHV 7KH:RUOG%DQN:DVKLQJWRQ 2·%ULHQ.,PSOHPHQWLQJ3ROLWLFDO5HIRUPLQ&KLQD·V9LOODJHV7KH$XVWUDOLDQ-RXUQDORI&KLQHVH$IIDLUV 1R 3HQJ %LQ 'HQJ 0HL\XQ ¶'LVFXVVLRQ RQ .LFNEDFN DQG 'LVFRXQW DQG 6WUDWHJLHV RI 6WRSSLQJ 7KHP· &KLQHVH-RXUQDORI+RVSLWDO$GPLQLVWUDWLRQ 7KH3HRSOH'DLO\$JHQF\¶7KH0LOLWDU\+RVSLWDOV·3URIHVVLRQDO0RUDO,V9HU\*RRG·7KH3HRSOH'DLO\ -XQH 4X6DQMLDQHWDO¶7R7DNH$JDLQVW¶7KH6HFRQG5HG3DFNDJH·'UXJ.LFNEDFNLQ3UHVFULSWLRQ·&KLQHVH +HDOWK3ROLF\ 5LVNLQ&&KLQD·V3ROLWLFDO(FRQRP\2[IRUG8QLYHUVLW\3UHVV2[IRUG 6KL 'RQJIHL DQG &KX :HLKXD ¶023+ $QQRXQFHV $JDLQ 6WULFWO\ WR )RUELG 9DULRXV .LFNEDFN %HKDYLRUVLQ0HGLFDO3URFHGXUH·+HDOWK1HZV6HSWHPEHU 6KX%DQG<DR-¶3UHYHQWLYH+HDOWK&DUH6HUYLFHVLQ3RRU5XUDO$UHDVRI&KLQD7ZR&DVH6WXGLHV·,'6 %XOOHWLQ 6LGHO9DQG6LGHO56HUYHWKH3HRSOH2EVHUYDWLRQVRQ0HGLFLQHLQWKH3HRSOH·V5HSXEOLFRI&KLQD-RVLDK0DF\ -U)RXQGDWLRQ1HZ<RUN 6RQJ/LVKHQJ¶$FFHSWDQFH:KHQ$GPLWWLQJDQG6HHNLQJ6XJJHVWLRQV:KHQ&KHFN2XW·+HDOWK1HZV $XJXVW 6RQJ-LXUX¶7KH&RQVWUXFWLRQRI3URIHVVLRQDO0RUDOLW\LQ=KHMLDQJ+HDOWK6HFWRU,V(YDOXDWHG:HOO· +HDOWK1HZV0DUFK 6WDWH &RXQFLO RI WKH 3HRSOH·V 5HSXEOLF RI &KLQD ¶7KH 6WDWH &RXQFLO·V 8UJHQW $QQRXQFHPHQW RQ 0HDVXUHVWR6WUHQJWKHQ'UXJ$GPLQLVWUDWLRQ· 6WDWH &RXQFLO RI WKH 3HRSOH·V 5HSXEOLF RI &KLQD ¶7R &RQWLQXH 6WUHQJWKHQLQJ WKH 2UGHU RI 3KDUPDFHXWLFDO%XVLQHVV· 6WDWH 6WDWLVWLFDO %XUHDX RI WKH 3HRSOH·V 5HSXEOLF RI &KLQD &KLQD 6WDWLVWLFDO <HDUERRN &KLQD 6WDWLVWLFDO,QIRUPDWLRQ&RQVXOWDQF\&HQWUH%HLMLQJ 7DQJ 6 %ORRP * )HQJ ; /XFDV + *X ; DQG 6HJDOO 0 ¶)LQDQFLQJ 5XUDO +HDOWK 6HUYLFHV LQ &KLQD$GDSWLQJWR(FRQRPLF5HIRUP·,'65HVHDUFK5HSRUW%ULJKWRQ 7DQJ 6 7KH FKDQJLQJ UROH RI WKH WRZQVKLS KHDOWK FHQWUHV LQ WKH FRQWH[W RI HFRQRPLF UHIRUP LQ &KLQD,'6%XOOHWLQ 7DR ;L ¶$FWXDOO\ ,PSOHPHQW $QWLFRUUXSWLRQ 7KH 'LVFLSOLQH 6XSHUYLVLRQ 0HHWLQJ RQ WKH :KROH +HDOWK6HFWRU·+HDOWK1HZV$SULO 7VRX 7 WKH &XOWXUDO 5HYROXWLRQ DQG 3RVW0DR 5HIRUPV D +LVWRULFDO 3HUVSHFWLYH 8QLYHULVW\ RI &KLFDJR 3UHVV&KLFDJR :DQJ$LJXR¶$Q$QDO\VLVRQWKH3URIRXQG5HDVRQVRI'UXJ.LFNEDFN%HLQJ1RW$EOHWR%H)RUEDGH DQG5HVROXWLRQV·&KLQHVH-RXUQDORI+HDOWK6HUYLFH0DQDJHPHQW :DQJ&KXQVKHQJ¶:KR5HFHLYLQJ5HG3DFNDJH,V&HUWDLQO\3XQLVKHG·+HDOWK1HZV0D\ :DQJ-LQJ]KX¶,QYDOXDEOH0HGLFDO3URIHVVLRQDO0RUDOLW\7KH0HPEHUVRIWKH3HRSOH·V5HSUHVHQWDWLYH &RQIHUHQFHLQ+HDOWK6HFWRU7DONDERXWWKH&RQVWUXFWLRQRI0HGLFDO3URIHVVLRQDO0RUDO·+HDOWK1HZV 0DUFK :DQJ6XSLQJ¶3KDUPDFHXWLFDO6HFWRUDQG+HDOWK6HFWRU7RJHWKHUWR*RYHUQ¶.LFNEDFN··+HDOWK1HZV 6HSWHPEHU :DQJ6XSLQJ¶5HYLHZRQ6WRSSLQJ'UXJ.LFNEDFN3KHQRPHQRQ·+HDOWK1HZV6HSWHPEHU :DQJ=KLKXD¶.LFNEDFN5HVROYLQJ2XJKWWR&ORVH6RXUFHV·+HDOWK1HZV'HFHPEHU :DQJ 4LOLQJ DQG 0D :HLKDQJ ¶7KH 1XPEHU 2QH LQ 7KH +RVSLWDOV RI =KHMLDQJ +HDOWK 1HZV· -DQXDU\ :DQJ6XSLQJDQG<X0LQJGH¶6HULRXV2YHUVXSSO\LQ3URGXFLQJRI0HGLFLQHLQ&KLQD·+HDOWK1HZV -DQXDU\ :HLW]PDQ0DQG;X&¶&KLQHVH7RZQVKLRS9LOODJH(QWHUSULVHVDV9DJXHO\'HILQHG&RRSHUDWLYHV· 5HVHDUFKSURJUDPPHRQWKH&KLQHVH(FRQRP\'LVFXVVLRQ3DSHU&3/RQGRQ6FKRRORI(FRQRPLFV/RQGRQ :RQJ & +HDG\ & DQG :RR :7 )LVFDO 0DQDJHPHQW DQG (FRQRPLF 5HIRUP LQ WKH 3HRSOH·V 5HSXEOLF RI &KLQD2[IRUG8QLYHUVLW\3UHVV2[IRUG :RUOG %DQN D 7KH 6WDWH LQ D &KDQJLQJ :RUOG :RUOG 'HYHORSPHQW 5HSRUW 2[IRUG 8QLYHUVLW\ 3UHVV 2[IRUG :RUOG%DQNE)LQDQFLQJ+HDOWK&DUH,VVXHVDQG2SWLRQVIRU&KLQD:RUOG%DQN:DVKLQJWRQ ;LQJ<XDQ[LDQJ¶7KH&RQVWUXFWLRQRI3URIHVVLRQDO0RUDOLW\LQWKH+HDOWK6HFWRU(QWHULQJWKH6HFRQG &\FOH·+HDOWK1HZV0D\ <DQJ5RQJ*DQJ¶&KRQJTLQJ·V+HDOWK'HSDUWPHQWDQG&KLQHVH7UDGLWLRQDO0HGLFLQH%XUHDX5HTXLUH $JDLQ6WULFWO\WR)RUELG.LFNEDFN%HKDYLRUVLQ0HGLFDO$FWLYLW\·+HDOWK1HZV-XO\ <DR-LPLQJDQG5HQ$LODQ¶7KLQNLQJDERXW 'UXJ .LFNEDFN 3KHQRPHQRQ·&KLQHVH -RXUQDO RI +RVSLWDO $GPLQLVWUDWLRQ <X ' ¶&KDQJHV LQ KHDOWK FDUH ILQDQFLQJ DQG KHDOWK VWDWXV WKH FDVH RI &KLQD GXULQJ WKH V· ,QQRFHQWL2FFDVLRQDO3DSHUV(FRQRPLF3ROLF\6HULHV1R <XH=HQJZHQ¶+RZWR&OHDQWKH:DWHULQ&DQDO3URIRXQGO\7KLQNLQJ$ERXW5HG3DFNDJH·&KLQHVH +HDOWK(FRQRPLFV =KDQ67DQJ6*XR<%ORRP*¶'UXJSUHVFULELQJLQUXUDOKHDOWKIDFLOLWLHVLQ&KLQDLPSOLFDWLRQVIRU VHUYLFHTXDOLW\DQGFRVW·7URSLFDO'RFWRU =KDQJ +XDQWLDQ ¶6WUHQJWKHQ 5HJXODWLRQ DQG 6WULFWO\ 3XQLVK ,UUHJXODULW\ %HKDYLRUV· +HDOWK 1HZV )HEUXDU\ =KDQJ.:DQJ$'X.DQG-LDQJ7¶$6WXG\RIWKH0DWHUQDODQG&KLOG+HDOWK3UHSD\6FKHPH LQ 5XUDO <XQQDQ· LQ )LQDQFLQJ 3URYLVLRQ DQG 8WLOLVDWLRQ RI 5HSURGXFWLYH +HDOWK 6HUYLFHV LQ &KLQD D UHVHDUFK UHSRUWSUHSDUHGIRU)RUGIRXQGDWLRQ%HLMLQJ =KDQJ=HQURQJ¶2XJKWWR5HJXODWH6HOI%HIRUH*RYHUQLQJ2WKHUV·+HDOWK1HZV2FWREHU =KDQJ=KLMLDQJ¶3XW¶5HG3DFNDJH·DQG¶.LFNEDFN·RQWKH.H\VWRQHVRI$QWLFRUUXSWLRQ·+HDOWK1HZV -XQH =KRX+XDQ¶+HQDQ+XDLKH+RVSLWDO.LOOLQJ.LFNEDFN·+HDOWK1HZV)HEUXDU\ =KRX-LQJXDQJDQG=KDQJ;LDQKXDL¶7KH&DXVHVDQG6ROXWLRQVRI5HG3DFNDJHRI+RVSLWDO·&KLQHVH -RXUQDORI+RVSLWDO$GPLQLVWUDWLRQ =XR ; ¶5HIRUP RI &KLQD·V XUEDQ KHDOWK LQVXUDQFH V\VWHP HVWDEOLVKLQJ D FRVWFRQWDLQPHQW PHFKDQLVPDQGLQVWLWXWLRQDOLQQRYDWLRQ·XQSXEOLVKHGSDSHU =KRX<DRKXD¶6WRSSLQJ'UXJ.LFNEDFN$FKLHYHV(IIHFWLQ+XQDQ·+HDOWK1HZV-DQXDU\ =KRX =DLPLQJ ¶7KLQNLQJ DERXW 5HG 3DFNDJH 3KHQRPHQRQ LQ 0HGLFDO 6HUYLFHV· &KLQHVH -RXUQDO RI +RVSLWDO$GPLQLVWUDWLRQ =X=XRJRQJ¶7KH.H\VWRQHRI$QWLFRUUXSWLRQLV6WLOOWR¶5HG3DFNDJH·LQ+HDOWK6HFWRU7KLV<HDU WKH9LFH0LQLVWHU6XQ1RQJFKXQ·V/HFWXUHLQ'LVFLSOLQH6XSHUYLVLRQ0HHWLQJ+HDOWK 1HZV 0DUFK =X =XRJRQJ D ¶7KH $OOLDQFH RI 6L[ $JHQFLHV RI 7KH &HQWUDO *RYHUQPHQW 5HTXLUHV WR &RQWLQXH 6WRSSLQJ'UXJ.LFNEDFN·+HDOWK1HZV0DUFK =X=XRJRQJE¶6SHFLDO*RYHUQLQJ$FKLHYHV3OHQWLIXO(IIHFWDQG'UXJ.LFNEDFNKDVEHHQ2EYLRXVO\ 5HGXFHG·+HDOWK1HZV0DUFK
© Copyright 2025 Paperzz