Urban-Rural Inequality of Opportunity in Health Care: Evidence from China.

Chao Ma,Ze Song,Qingqing Zong

doi:10.3390/ijerph18157792

Abstract

(1) Background: We aim to measure the urban-rural inequality of opportunity in healthcare in China based on the theory of Equality of Opportunity (EOp). (2) Methods: Following the compensation principle, we establish a decomposition strategy for the fairness gap, which we use for the measurement of the inequality of opportunity in urban-rural healthcare utilization. We then use China Health and Nutrition Survey (CHNS) data from 1997 to 2006 to calculate the fairness gap. (3) Results: Empirical analysis using CHNS data shows that the ratio of the fairness gap to the directly observed average urban-rural difference in healthcare was 1.167 for 1997–2000 and 1.744 for 2004–2006. The average urban-rural difference observed directly from original statistical data may have underestimated the degree of this essential inequity. (4) Conclusions: Our findings suggest that upgrading urban-rural reimbursement ratios may not be sufficient in eliminating the inequality of opportunity in healthcare utilization between urban and rural residents. Within the context of an urban-rural dualistic social structure and widening of the urban-rural income gap, a shift to a pro-disadvantaged policy will be a more effective approach in promoting equality of opportunity in healthcare.

Highlights

Chinese medical insurance systems are urban-rural dualistic—the Urban ResidentsBasic Medical Insurance (URBMI) is only for urban residents, and the New CooperativeMedical System (NCMS) is only for rural residents
Due to a large gap in individual and circumstance characteristics between urban and rural residents, it may lead to an inefficiency. (We have provided several examples in the Appendix A as a simple explanation.) Equality of Opportunity (EOp) means that primary goods (according to Rawls (1971), primary goods mainly include rights, liberties and opportunities, income and wealth, and the social bases of self-respect) should be accessible to all individuals, regardless of their race, religion, or other factors that represent their identity [4]
In the second principle of justice, Rawls [4] points out that public opportunities should be open to all individuals regardless of race, religion or other identity

Summary

Introduction

Chinese medical insurance systems are urban-rural dualistic—the Urban ResidentsBasic Medical Insurance (URBMI) is only for urban residents, and the New CooperativeMedical System (NCMS) is only for rural residents. Chinese medical insurance systems are urban-rural dualistic—the Urban Residents. Owing to deficiency in urban-rural dualistic medical insurance systems, there are large health and healthcare inequalities between urban and rural in China. In order to reduce inequalities in the healthcare system, China recently initiated the Urban-Rural Integrated Medical Insurance System (URIMIS). The URIMIS is still in the exploration stage It aims to realize equality by unifying the two medical insurance systems. This divide is evident in two areas: outcome equality and Equality of Opportunity (EOp). Outcome equality means the same reimbursement policy or the same healthcare utilization between urban and rural residents. Due to a large gap in individual and circumstance characteristics between urban and rural residents, it may lead to an inefficiency. EOp is of vital importance for both academic research and policy making [8]

Objectives

Methods

Discussion

Conclusion