Abstract
Geographic accessibility plays a key role in health care inequality but remains insufficiently investigated in China, primarily due to the lack of accurate, broad-coverage data on supply and demand. In this paper, we employ an innovative approach to local supply-and-demand conditions to (1) reveal the status quo of the distribution of health care provision and (2) examine whether individual households from communities with different housing prices can acquire equal and adequate quality health care services within and across 361 cities in China. Our findings support previous conclusions that quality hospitals are concentrated in cities with high administrative rankings and developmental levels. However, after accounting for the population size an “accessible” hospital serves, we discern “pro-poor” inequality in accessibility to care (denoted as GAPSD) and that GAPSD decreases along with increases in administrative rankings of cities and in community ratings. This paper is significant for both research and policy-making. Our approach successfully reveals an “unexpected” pattern of health care inequality that has not been reported before, and our findings provide a nationwide, detailed benchmark that facilitates the assessment of health and urban policies, as well as associated policy-making.
Highlights
The problem of health care inequalities in China became noticeable after the turn of the new millennium, i.e., 20 years after the country established economic liberalization in the 1980s
The above results further indicate that after 80 years of urbanization and development, the Hu Line might be endowed with a wider connotation that points out a serious problem facing an economically vulnerable population, a less densely inhabited Northwestern area where quality health care services are remarkably lacking
There are indications that the health care distribution has been continuously uneven and that evidence of pro-rich inequities. Such inconsistencies have been voiced in parallel with another policy issued in 2012, which implicitly invites private provision of health care services and is deemed to be weakening the effects of the 2009 reform
Summary
The problem of health care inequalities in China became noticeable after the turn of the new millennium, i.e., 20 years after the country established economic liberalization in the 1980s. Public discontent with limited access to care and soaring expenditures (called Kan-bing-nan and Kan-bing-gui by the Chinese press) grew and prompted a major health care reform in 2009 [2]. The new health care system emanating from the complex 2009 reform was ambitiously pitted against the previous one; it put great emphasis on redefining the role of the state through ‘flagship’ moves such as promoting primary health care, expanding the coverage of social health insurance, working off price markups of drug sales, innovating public hospitals and promoting diversified channels of health. The statistics yearbooks of cities in China have provided the ToU or guidelines in their corresponding websites (e.g., Beijing can be found at tjj.beijing.gov.cn/syqtlmu/ gywm/202003/t20200321_1723585.html, Shanxi can be found at http://tjj.shanxi.gov.cn/wzxg/yssm/ 201508/t20150818_705458.shtml)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
