Health Care Access and Regional Disparities in China

Abstract

Access to health care, as a determinant of health, became unequally distributed in China as a result of continued pursuit of the market-oriented reforms introduced the late 1970s. Increasing urban-rural socio-economic disparities jeopardized the equity in social welfare and particularly the equity of access to health care, which has been widely considered a key objective of health care policies, in turn putting the disadvantaged communities in especially vulnerable position by increasing their health risks. Using the household survey data from the China Health and Nutrition Survey (CHNS), changes in the accessibility of health care are herein examined at the household level across socioeconomic groups in nine provinces of China over the 1989-2004 period. First, we describe the access to health care over the 15 years of survey, and then using a multivariate regression we analyze the determinants of access in 2004. We find that the geographic accessibility gap between hospitals and clinics has decreased from 1989 to 2004, while the gap in financial accessibility has increased, making urban hospitals the least accessible facilities. This study concludes a strong correlation between the geographic factors (method of travel, region, and availability of infrastructure in the province of residence) and the quality of access received. Overall, patients who are able to reach the facilities on foot enjoy better access than those who can not. Similarly, residents of the West along with the provinces with higher availability of health care facilities also tend to have a better potential access than their counterparts. Understanding of health care utilization patterns and access issues is essential for informing public decision- and policy-making aimed at improving living conditions and building a harmonious society.