| Health and medical services show enormous differences between urban and rural areas in many ways, such as the difference between possession of medical resources, health financing, health consuming, medical insurance and so on. The disparities of the health care services in urban and rural areas not only affect the health condition of citizens but also cause a series of social problems. In showing the characteristics and causes of the equalization of the health and medical services in urban and rural areas, the existing researches at home and abroad have made some good attempts; however, on the whole they are still not comprehensive or in-depth. The researches have ignored a number of important issues, which are, for example, what's the scope of the equalization of the health and medical services in urban and rural areas? How to set standard of this equalization? What's the essence of this equalization? Are there any negative effect of the equalization, and if there are any, what are they? What roles do health system and other institutional arrangements play in causing the inequality of the hearth and medical services in rural and urban areas? The answers to these crucial questions are obviously of great importance in deeper understanding of the equalization of the health and medical services in urban and rural areas in our country. To this end, this paper is working at the equalization in China based on the result of the existing study, using the more advanced methods. This paper is aiming at perfect the basic theory in the equalization of public services in urban and rural areas, and provides scientific policy recommendations in the practice of the reform in medical system.There are eight chapters in this paper. Chapter 1 is the preface. And Chapter2-4 is the basis and premise of the analysis: Chapter 2 is about the review. Chapter3 is the mechanism analysis of the equalization of the health and medical services in urban and rural areas. Chapter4 is the international experience of this equalization. What Chapter5 to Chapter8 study in include the equity of the health care in Chinese urban and rural areas, the effects of inequality in health and medical services in urban and rural areas, the reason why there is inequality in these areas and propose suggestions. Chapter5 makes the disintegration analysis of the equality of health and medical services in the view of medical financing, health consuming, the usage of medical service and health equity. Chapter6 analyzes the economic and social effects caused by the inequality of the health and medical services in urban and rural areas. Chapter7 explore the inequality of these services in urban and rural areas from the side of government, the side of demand and the side of supply in medical services. Chapter8 is the part of the policy recommendations in this paper.Chapter2 is a part of review. Firstly, this part sort out the western theory of equitable health care services, that is, public goods theory, welfare economics theory, super-welfare theory, mini-max theory and egalitarian theory, which are the basis of researching in the health and medical equalization in urban and rural areas. Secondly, this part reviews the empirical literature for the equalization of medical and health services. Chapter3 makes the mechanism analysis of the equalization of health and medical services in urban and rural areas. This chapter firstly analyses the association and the operation mechanism in this equalization by the four of the government, the supply and demand sides and the third-party by making the connotation and essence of the equalization of health and medical in urban and rural areas clear. And then designs an index system of this kind of equalization. Chapter4 is a part of the experience drawing, from study the system arrangements of equalization of health and medical services in urban and rural areas in Japan, Korea and Taiwan in Asia and some countries in Europe and America, summarize the general law and enlightenment.Chapter5 makes the decomposition analysis in the equalization of the urban and rural health care. The method used in analyzing the health financing is similar to that used in the redistribution of tax revenue; in analyzing the utilization of medical service and equity of health, this paper uses a concentration factor decomposition method; and in analyzing the consumption inequality of civil health consumer, this paper utilizes the Thiele index, the Ginny coefficient and Atkinson index. Chapter6 analyses the non-equal effects of the health and medical services in urban and rural areas. This chapter firstly analyzes the effects in widening income gap of the non-equal health and medical services in urban and rural areas, by using panel data models. It is analyzed with respect to the two aspects which are consumption of public health and consumption of individual health. Secondly, it analyzes the economic and social effects caused by the development of medical insurance for urban and rural areas. It studies the welfare effects of the medical insurance reform in urban and rural areas by the use of method of difference in difference; and describes the relationship between the medical insurance reform and anti-poverty with the use of TIP poverty curves and PEN queue. Moreover, this chapter also calculates the balance of efficiency of health and equity of the health by using the health performance coefficient. Chapter7 analyzes the reasons for non-equal of health and medical services in the urban and rural areas. Firstly, it analyzes the effects of the equalization in health and medical services in urban and rural areas which are caused by governmental actions, using space econometric methods and panel data. Then, it analyzes the effects in the use of health service and the health funding caused by the urban-rural income gap.Through the above-mentioned studies, this paper has drawn the main conclusions as follows.1 .The equalization of health and medical services in urban and rural areas refers to a process, which makes the urban and rural residents enjoy the same public health service, basic medical services and medical insurance services with the Government's participation. The essence of the equalization of urban and rural health and medical services is fairness, and what's more, it's the unification of fairness and efficiency. The goal of this equalization is to ensure the equality of starting point in the survival and development of urban and rural residents, to ensure the equality of the right to get the basic medical treatment of urban and rural residents, and to make equalization of the public health and basic medical services. The index system of equalization of urban and rural health and medical services is composed by three systems, which is the fair system, the efficient system and the system of government responsibility. The enlightenment of developed countries (regions) of the equalization of urban and rural health and medical services are that medical support model should be based on community-based health insurance, and we must emphasize the responsibility of the Government.2. The gap between urban and rural residents constitutes the main body of the health consumption gap between urban and rural residents. And the differences among the eastern, central and western regions have their own characteristics. Population changes play a minor role in reducing the widening the health consumption gap. In recent years, the internal non-equality of health consumption in rural areas is gradually shrinking, however, the internal non-equality in urban areas is gradually expanding.The health financing of China makes an increase of income inequality, shows a redistribution of pro-rich. The main reason of this is because of the horizontal inequality and the re-order effect, for example, if the same income groups make the same hygiene payments, the redistribution effect will be reduced by 64%. Another reason is because that health financing system is regressive. In the same redistribution between the poor and the rich, the extent of pro-rich is higher in rural areas than that in urban, the regression in rural health financing is greater than that in urban, and the level of inequality in rural health financing is lower than that of urban areas. The inequality of health and medical services in our country is pro-rich, and the high-income groups are in better health conditions and consume more medical services. Income factors make the contribution of 0.13-0.2 in the inequality of the usage of medical services, and other factors, just like medical insurance, also expand this inequality. The degree of this inequality is deeper in rural than that in urban in total, and in both areas, the degree of inequality is expanding. In the year 1991-2006, the average contribution rates in the inequality of health in urban and rural made by the income changes are separately 7.08% and 13.38%.3. The gap between urban and rural private health investment and the gap of that in public health investment have played an enhanced role on the urban-rural income gap. There is a higher proportion of urban and rural households in catastrophic health expenditure, and the percentage of the poorest groups of medical expenses in excess of their income is increasing. The medical insurance has only play a weak role in reducing income inequality. After the medical insurance compensation, the number of home in poverty in urban and rural areas has not decreased, and medical insurance has a very small fluctuation in reducing poverty. The multivariate regression model about the poverty characteristics shows that more family members, lower levels of education, higher dependency ratio and lower rate of insurance number are incentives of poverty, conditional multivariate regression model shows that health insurance for the poor does not affect the changes. As most vulnerable groups were not covered by medical insurance, the saving rates of medical insurance fund remained high, state investment duty was not in place and other reasons, the medical insurance system played a weak role in anti-poverty in urban and rural in the past years of our country. With the declining average level of health and increasing health inequality, the performance of the health in our country has shown a downward trend.New rural cooperative medical system increased the accessibility of medical services, but it only made little effect on the net medical expenses. The reform of urban health insurance didn't have crowding-out effect on the precautionary savings, and the risk of medical expenses did not reduce as the reforms going. That is an important reason that why China's urban health insurance reform does not affect the savings.4. The fundamental reason of the unequal situation in health and medical services in urban and rural areas is the strategies that government value the city but neglect the rural areas and the deviation of health and finance. Medical and health expenditures are an integral part of consumer spending, which is based on income (productivity). With the lower productivity and less income, peasant can spend little on medical and health expenditure. The urban-rural income gap has seriously restrained the demand of the rural residents for medical and health services, resulting in inequality between urban and rural health care expenditures. Further more, the serious division of medical insurance is also the cause of inequality of medical and health in urban and rural areas.5. The implementation of the equalization of urban and rural health and medical services requires the government coordinates the development in urban and rural areas, and also gives peasant back the civil right. Changing the evaluation standards of performance, building a sound health financial system, and narrowing the income gap between urban and rural areas are ways to achieve equality of health and medical services in urban and rural areas. It should be carried out in three steps to integrate urban and rural medical insurance.
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