News Release

China faces daunting challeges to heatlh equity

But it has the means to turn these problems around

Peer-Reviewed Publication

The Lancet_DELETED

China's economic boom of recent decades has also seen its reputation for health slipping and the health gap between the rich and the poor widening. Yet this economic boom means it is in a much better position than other nations to overcome health inequities, as it should be able to afford major health reforms. These are among the conclusions of authors of the first paper in The Lancet's Health System Reform in China Series, authored by Dr Lincoln Chen, China Medical Board, Cambridge, MA, USA, and Professor Margaret Whitehead, University of Liverpool, UK, and colleagues.

China has a number of health related disparities. Eg, rural infant mortality rates are nearly five times higher in the poorest compared with the wealthiest communities – 123 versus 26 deaths per livebirths, respectively. And while life expectancy in the rich city of Shanghai has increased 5.2 years in the years 1981-2000 (from 72.9 to 78.1 years), in Gansu, one of the poorest provinces, the increase was just 1.4 years from 66.1 to 67.5 years.

The authors say China is facing daunting equity challenges: a vicious cycle of three reinforcing forces which aggravate each other. Firstly, market failures and insufficient government stewardship – such as doctors using their knowledge to prescribe inappropriate yet profitable procedures and drugs; inadequate government investment, and, tied to that, increased out-of-pocket healthcare costs that hit the poorest hardest; and failure of government health insurance schemes. Secondly, the massive inequity in distribution of social determinants of health. The wealthiest counties in China have public spending 48 times higher than the poorest. Safe drinking water is available to 96% of the population in large cities but to less than 30% in poor areas. And migrants from rural to city areas have grossly inadequate healthcare, with massive differences in maternal mortality in migrant women in large cities compared with women resident in them. Finally, the Chinese government needs to tackle public perceptions of fairness and trust. As the economy has boomed, so has public dissatisfaction with unfair distribution of wealth and health services, especially concerning increasing out-of-pocket expenses.

The authors say the Chinese Government is establishing one rural and two urban health insurance schemes, and has pledged stronger public financing; and add that public facilities must be deincentivised from profit-seeking to remain viable. They conclude: "Most important, China's economic capacity is growing rapidly so that it should be able to afford major reforms."

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Professor Margaret Whitehead, University of Liverpool, UK T) +44 (0) 151-794-5280 or +44 (0) 7528 286169 E) mmw@liverpool.ac.uk

Full paper: http://press.thelancet.com/china1.pdf


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