The Relationship Between The Access To Health Care And The Health Inequality In Rural China

Health is one of the most basic needs for the survival, reproduction and development of human being, the basic premise of various social activities and creative activities that human beings are engaged in, and also a common development goal of human society. In the beginning of the establishment of the New China, China has made remarkable achievements in the health field. However, since the reform and opening-up, although the average health level of the Chinese population continued to improve, the growth rate was obviously slow and the advantages in the international comparison also decreased significantly. Excessive pursuits for economic benefits led to the neglect of equality, which resulted in the expansion of social inequality. Compared to urban residents, the health of rural residents was still in a weak position. Since the rapid economic development, the spectrum of diseases and health demand of rural residents have undergone great changes. Village clinics as the basis of three-tier health system in rural areas, should undertake the responsibilities of treatment, prevention and healthcare. The running of village clinics reflects the access to health care and directly affects the health level of rural residents.After summarizing the home and abroad studies on health inequality, the paper investigates the relationship between access to health care and health inequality in China during1997-2006by means of China Health and Nutrition Survey (CHNS) data. The paper analyzes health from subjective and objective points of view, and investigates the access to health care from the aspects of supply and demand. On basis of reviewing the changing trends of health, health inequality and access to health care, the paper adopts Grossman model to build the theoretical framework, and analyzes the affecting approaches and degree of the variables of access to health care on health by using random-intercept logistic regression model, compares the affecting degree of access to demander, and supplier, and analyzes the similarities and differences of the results of subjective and objective models. The illness behavior of sick rural residents can reflect their health service needs, show the equality degree of access to health care, and illuminate the situation of health inequality. Therefore, under the theoretical guidance of equity in health care, the paper makes deep analysis of the hospitalizing behavior of sick rural residents, further discusses the development process and reformation difficulty of rural clinics, introduces the international experiences of primary health service construction in rural area, and by vertical and horizontal comparisons makes the flowing conclusions:Firstly, by analyzing four-week morbidity rate, self-rated ill health rate, the diseases composition, the morbidity of common diseases and the severity of illness, the results show that for the rural residents the health level decreases, and the severity of illness increases. The rural residents are facing the double burden of infectious diseases and chronic diseases. The aging of population, the changing lifestyle and the decreasing of the public health service ability are the main reasons for the deceasing of rural health level.Secondly, the degree of health inequality of rural residents in China during1997-2006is measured and calculated by the range analysis, the dissimilarity index, the slope index of inequality (SII) and the concentration index to reflect the status of health inequality from different aspects. The studies show that, along with the substantial growth of income and the expansion of income gap for rural residents, their health inequality has widening trend in general. Moreover, higher-income groups have higher health level, compared with the lower-income groups, which means that pro-rich inequalities exist in health. However, the concentration curve is not far from the fair line, which indicates the extent of health inequality is not so serious.Thirdly, the paper studies the access to health care in rural area in China during1997-2006, and the results are as follows:Per capita household income increases, the time in clinic decreases, the clinic waiting time decreases, and the ability of village clinics to provide necessary drugs increases. But people who have health insurance are less and the medical services price is higher and increasing faster. Under the framework of Penchansky and Thomas, the access to health care has less barriers in organization, more barriers in economy, but whether it has personal barriers needs to consider the effect of health care on health.Fourthly, by random-intercept logistic regression model, the paper analyzes the impact of access to health care on the health of rural residents during1997-2006. The study shows that:under the control of individual factors, the access variables of the demander in the four-week morbidity model have a significant effect on the health. For example, the higher the per capita household income, the better the health. The health of the individual who owns medical insurance is worse than the individual who doesn’t. The access variables of the supplier only have a significant effect on the price of medical service.The higher the price, the higher the morbidity rate. The other variables such as the medicine provision, the time in clinic and the clinic waiting time have not played significant roles. In the subjective model, among the access variables of demander only the per capita household income affects significantly, while the access variables of supplier do not affect the health. The rho has been decreasing which shows that the family’s effect on health turns weaker.The affecting degree of the demander is larger than that of the supplier. The clinic waiting time in the four-week morbidity model becomes less significant, and the medicine provision and the time in clinic in the subjective model become less significant, which indicates that the supplier has improved to some extent, but the demander has personal barriers.Fifthly, through the analysis of illness behavior of sick rural residents, it can be found that clinical rate and hospitalization rates rise during1997-2006. Per capita outpatient costs, per capita cost of hospitalization, per capita costs, and per capita self-payment generally show an upward trend, which creates the obstacles to turn the need to the demand of health service for the low-income people. Meanwhile, the issue of the health service inequity of rural residents is prominent, and the medical assistance system cannot really play the role of poverty alleviation. Moreover, the township hospitals and village clinics are lagging behind the socio-economic development, and also cannot meet the diversified health service demand of major rural residents.Sixthly, through the vertical comparison of glorious period and decline period of village health services in China and the horizontal comparison of primary health services status in India, Cuba and Brazil and other countries, the paper draws the following conclusions:the government should take the main funding responsibility on basis of the construction of primary health services and take account of both efficiency and just.Finally, concerning the problems existing in current health inequalities and access to health care, the paper draws the conclusions and puts forward some suggestions for correlative policy.