China’s economic reforms have improved average income and living standards. But how has the health system fared? Universal access to healthcare is enshrined in the country’s constitution. But do services really meet people's healthcare needs regardless of their ability to pay?

Policy analysts from the Centre for Health Statistics and Information of the Ministry of Health, China, in collaboration with researchers from the Liverpool School of Tropical Medicine ask whether healthcare financing reforms have created inequalities in access to services related to ability to pay. It focuses on the changing use of healthcare among urban Chinese and discusses the implications of these changes for equity of access.

Analysis of data from national household health surveys in 1993 and 1998 highlights a number of trends. The income gap between the highest and lowest income groups is increasing. Meanwhile, changes to government and labour insurance schemes have reduced coverage and the poorer groups have suffered the largest decreases. The proportion of the population who have to pay for services increased from 28 percent in 1993 to 44 percent in 1998.

Other key findings are:

• Self-reported illness has changed little but ill people across all income groups are now more likely to seek treatment of some kind.
• People are now less likely to visit a health facility. The proportion seeing a doctor dropped from 59 to 50 percent between 1993 and 1998 while the percentage of ill people who treat themselves increased from 77 to 88 percent.
• People with lower incomes are more likely to claim financial difficulty as a major obstacle to seeking treatment from a doctor.
• The use of in-patient services has fallen from 4.5 percent in 1993 to 3 percent in 1998. The decline is greater among lower income groups than wealthier groups.
• Low income is also a factor in the failure of referred patients to be hospitalised.

Access to formal health services for the urban population, particularly the poor, has worsened and become more inequitable since the early 1990s. Possible reasons for this trend are the rapid rise of per capita expenditure on health services and the decline in insurance coverage. The situation is unlikely to improve unless the government can develop appropriate policies and take effective action to protect the poor in the near future.

Recommendations to policy-makers include:

• developing a variety of health insurance or medical financial assistance schemes to provide urban poor and other vulnerable groups with basic healthcare
• introducing adequate mechanisms to reduce over-prescription and the misallocation of resources towards expensive drugs and diagnostic technologies by service providers.

Source(s):
‘Changing access to health services in urban China: implications for equity’, Health Policy and Planning, 16 (3): 302-312, by J. Gao et al., 2001

Funded by: Ministry of Health of China; UK Department for International Development

id21 Research Highlight: 08 May 2002

Further Information:
Dr Shenglan Tang
Liverpool School of Tropical Medicine
Pembroke Place
Liverpool
L3 5QA

Tel: +44 (0)151 708 9393
Fax: +44 (0)151 708 8733
Contact the contributor: stang@liv.ac.uk

Liverpool School of Tropical Medicine (LSTM), UK

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