Health care access and regional disparities in China

This thesis examines the access of health care facilities in nine provinces of China between the years 1989 and 2004, evaluating the effect of demographic, financial and geographic factors. Equity in social welfare has long played a major role in shaping China's national policies. However, continued pursuit of the GDP-led development orientation in China since the late 1970s has resulted in increasing urban-rural and intra- and inter-regional socio-economic disparities, raising multiple causes for concern from an equity perspective and suggesting the trends that should be closely monitored. While there is a consensus about the need and importance of access equity, little geographic research has been conducted in this area. In light of these issues, using China Health and Nutrition Survey this study addressed the following two objectives: (1) to describe the geographic and financial disparities in access to clinics and hospitals in nine provinces of China during the 1989-2004 period, and (2) to explore the demographic, socio-economic and geographic factors affecting access to health care. Results of the analysis show that between 1989 and 2004 the accessibility gap between hospitals and clinics in terms of geographic indicators has decreased, while the gap in financial accessibility has increased, making urban hospitals the least accessible facilities. Access to both hospitals and clinics in urban and rural areas is mostly conditioned by geographic factors, namely the travel method, region of residence and the availability of health care facilities. Patients who were able to reach the facilities on foot were more likely to enjoy better access than those who were not able to do so. Similarly, residents of western China (Guangxi and Guizhou) along with the provinces with higher availability of health care facilities also tended to have better potential access than their counterparts. Several important contributions essential for informing public decision- and policymaking stem from this thesis, leading to a better understanding of issues related to the accessibility of health care in nine provinces of China. While, typically, the determinants of accessibility have been attributed to the financial or demographic characteristics of patients, this research has identified geographic factors as being of the foremost importance in the accessibility of health care. This important finding provides grounds for further geographic research on accessibility issues in China. While our conceptual framework was designed for studying the accessibility of health care in China, it can be potentially applied to any country with regional, provincial or neighborhood disparities in access