IDEAS home Printed from https://ideas.repec.org/a/eee/jhecon/v32y2013i6p1214-1229.html
   My bibliography  Save this article

Rising inequalities in income and health in China: Who is left behind?

Author

Listed:
  • Baeten, Steef
  • Van Ourti, Tom
  • van Doorslaer, Eddy

Abstract

In recent decades, China has experienced double-digit economic growth rates and rising inequality. This paper implements a new decomposition approach using the China Health and Nutrition Survey (1991–2006) to examine the extent to which changes in level and distribution of incomes and in income mobility are related to health disparities between rich and poor. We find that health disparities in China relate to rising income inequality and in particular to the adverse health and income experience of older (wo)men, but not to the growth rate of average incomes over the last decades. These findings suggest that replacement incomes and pensions at older ages may be one of the most important policy levers for reducing health disparities between rich and poor Chinese.

Suggested Citation

  • Baeten, Steef & Van Ourti, Tom & van Doorslaer, Eddy, 2013. "Rising inequalities in income and health in China: Who is left behind?," Journal of Health Economics, Elsevier, vol. 32(6), pages 1214-1229.
  • Handle: RePEc:eee:jhecon:v:32:y:2013:i:6:p:1214-1229
    DOI: 10.1016/j.jhealeco.2013.10.002
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0167629613001343
    Download Restriction: Full text for ScienceDirect subscribers only
    ---><---

    As the access to this document is restricted, you may want to look for a different version below or search for a different version of it.

    Other versions of this item:

    References listed on IDEAS

    as
    1. Dennis Tao Yang, 1999. "Urban-Biased Policies and Rising Income Inequality in China," American Economic Review, American Economic Association, vol. 89(2), pages 306-310, May.
    2. Zhang, Xiaobo & Kanbur, Ravi, 2005. "Spatial inequality in education and health care in China," China Economic Review, Elsevier, vol. 16(2), pages 189-204.
    3. Wagstaff, Adam & Paci, Pierella & van Doorslaer, Eddy, 1991. "On the measurement of inequalities in health," Social Science & Medicine, Elsevier, vol. 33(5), pages 545-557, January.
    4. Chen, Jian & Fleisher, Belton M., 1996. "Regional Income Inequality and Economic Growth in China," Journal of Comparative Economics, Elsevier, vol. 22(2), pages 141-164, April.
    5. Adam Wagstaff, 2011. "The concentration index of a binary outcome revisited," Health Economics, John Wiley & Sons, Ltd., vol. 20(10), pages 1155-1160, October.
    6. Petrie, Dennis & Allanson, Paul & Gerdtham, Ulf-G., 2011. "Accounting for the dead in the longitudinal analysis of income-related health inequalities," Journal of Health Economics, Elsevier, vol. 30(5), pages 1113-1123.
    7. Allanson, Paul & Gerdtham, Ulf-G. & Petrie, Dennis, 2010. "Longitudinal analysis of income-related health inequality," Journal of Health Economics, Elsevier, vol. 29(1), pages 78-86, January.
    8. Van Ourti, Tom & van Doorslaer, Eddy & Koolman, Xander, 2009. "The effect of income growth and inequality on health inequality: Theory and empirical evidence from the European Panel," Journal of Health Economics, Elsevier, vol. 28(3), pages 525-539, May.
    9. Zheng Song & Kjetil Storesletten & Yikai Wang & Fabrizio Zilibotti, 2015. "Sharing High Growth across Generations: Pensions and Demographic Transition in China," American Economic Journal: Macroeconomics, American Economic Association, vol. 7(2), pages 1-39, April.
    10. Feldstein, Martin, 1999. "Social security pension reform in China," China Economic Review, Elsevier, vol. 10(2), pages 99-107.
    11. Wagstaff, Adam, 2009. "Correcting the concentration index: A comment," Journal of Health Economics, Elsevier, vol. 28(2), pages 516-520, March.
    12. Ravi Kanbur & Xiaobo Zhang, 2005. "Fifty Years of Regional Inequality in China: a Journey Through Central Planning, Reform, and Openness," Review of Development Economics, Wiley Blackwell, vol. 9(1), pages 87-106, February.
    13. Andrew M. Jones & Angel López Nicolás, 2004. "Measurement and explanation of socioeconomic inequality in health with longitudinal data," Health Economics, John Wiley & Sons, Ltd., vol. 13(10), pages 1015-1030, October.
    14. Erreygers, Guido, 2009. "Correcting the Concentration Index: A reply to Wagstaff," Journal of Health Economics, Elsevier, vol. 28(2), pages 521-524, March.
    15. Lambert, Peter & Zheng, Buhong, 2011. "On the consistent measurement of attainment and shortfall inequality," Journal of Health Economics, Elsevier, vol. 30(1), pages 214-219, January.
    16. Chen, Zhuo & Meltzer, David, 2008. "Beefing up with the Chans: Evidence for the effects of relative income and income inequality on health from the China Health and Nutrition Survey," Social Science & Medicine, Elsevier, vol. 66(11), pages 2206-2217, June.
    17. Chen, Zhuo & Eastwood, David B. & Yen, Steven T., 2007. "A decade's story of childhood malnutrition inequality in China: Where you live does matter," China Economic Review, Elsevier, vol. 18(2), pages 139-154.
    18. E. Van de Poel & O. O'Donnell & E. Van Doorslaer, 2012. "Is there a health penalty of China's rapid urbanization?," Health Economics, John Wiley & Sons, Ltd., vol. 21(4), pages 367-385, April.
    19. Xin Meng & Robert Gregory & Guanhua Wan, 2007. "Urban Poverty In China And Its Contributing Factors, 1986–2000," Review of Income and Wealth, International Association for Research in Income and Wealth, vol. 53(1), pages 167-189, March.
    20. Adam Wagstaff, 2011. "Reply to Guido Erreygers and Tom Van Ourti's comment on ‘The concentration index of a binary outcome revisited’," Health Economics, John Wiley & Sons, Ltd., vol. 20(10), pages 1166-1168, October.
    21. Terry Sicular & Yue Ximing & Björn Gustafsson & Li Shi, 2007. "The Urban–Rural Income Gap And Inequality In China," Review of Income and Wealth, International Association for Research in Income and Wealth, vol. 53(1), pages 93-126, March.
    22. Fortin, Nicole & Lemieux, Thomas & Firpo, Sergio, 2011. "Decomposition Methods in Economics," Handbook of Labor Economics, in: O. Ashenfelter & D. Card (ed.), Handbook of Labor Economics, edition 1, volume 4, chapter 1, pages 1-102, Elsevier.
    23. Erreygers, Guido & Van Ourti, Tom, 2011. "Measuring socioeconomic inequality in health, health care and health financing by means of rank-dependent indices: A recipe for good practice," Journal of Health Economics, Elsevier, vol. 30(4), pages 685-694, July.
    24. Cai, Fang & Giles, John & Meng, Xin, 2006. "How well do children insure parents against low retirement income? An analysis using survey data from urban China," Journal of Public Economics, Elsevier, vol. 90(12), pages 2229-2255, December.
    25. Wagstaff, Adam & van Doorslaer, Eddy & Watanabe, Naoko, 2003. "On decomposing the causes of health sector inequalities with an application to malnutrition inequalities in Vietnam," Journal of Econometrics, Elsevier, vol. 112(1), pages 207-223, January.
    26. Adam Wagstaff & Magnus Lindelow & Shiyong Wang & Shuo Zhang, 2009. "Reforming China's Rural Health System," World Bank Publications, The World Bank, number 2646, June.
    27. Contoyannis, Paul & Forster, Martin, 1999. "The distribution of health and income: a theoretical framework," Journal of Health Economics, Elsevier, vol. 18(5), pages 603-620, October.
    28. Teresa Bago d'Uva & Eddy Van Doorslaer & Maarten Lindeboom & Owen O'Donnell, 2008. "Does reporting heterogeneity bias the measurement of health disparities?," Health Economics, John Wiley & Sons, Ltd., vol. 17(3), pages 351-375, March.
    29. Doorslaer, Eddy van & Jones, Andrew M., 2003. "Inequalities in self-reported health: validation of a new approach to measurement," Journal of Health Economics, Elsevier, vol. 22(1), pages 61-87, January.
    30. Lerman, Robert I. & Yitzhaki, Shlomo, 1989. "Improving the accuracy of estimates of Gini coefficients," Journal of Econometrics, Elsevier, vol. 42(1), pages 43-47, September.
    31. Shen, Yan & Yao, Yang, 2008. "Does grassroots democracy reduce income inequality in China?," Journal of Public Economics, Elsevier, vol. 92(10-11), pages 2182-2198, October.
    32. Erreygers, Guido, 2009. "Correcting the Concentration Index," Journal of Health Economics, Elsevier, vol. 28(2), pages 504-515, March.
    33. Guido Erreygers & Tom Van Ourti, 2011. "Putting the cart before the horse. A comment on Wagstaff on inequality measurement in the presence of binary variables," Health Economics, John Wiley & Sons, Ltd., vol. 20(10), pages 1161-1165, October.
    34. Albert Keidel, 2009. "Chinese Regional Inequalities In Income And Well‐Being," Review of Income and Wealth, International Association for Research in Income and Wealth, vol. 55(s1), pages 538-561, July.
    35. Giles, John & Wang, Dewen & Zhao, Changbao, 2010. "Can China's rural elderly count on support from adult children ? implications of rural-to-urban migration," Policy Research Working Paper Series 5510, The World Bank.
    36. Mills, Jeffrey A & Zandvakili, Sourushe, 1997. "Statistical Inference via Bootstrapping for Measures of Inequality," Journal of Applied Econometrics, John Wiley & Sons, Ltd., vol. 12(2), pages 133-150, March-Apr.
    37. Xiaobing Wang & Jenifer Piesse, 2010. "Inequality and the Urban–rural Divide in China: Effects of Regressive Taxation," China & World Economy, Institute of World Economics and Politics, Chinese Academy of Social Sciences, vol. 18(6), pages 36-55, November.
    38. Liu, Gordon G. & Dow, William H. & Fu, Alex Z. & Akin, John & Lance, Peter, 2008. "Income productivity in China: On the role of health," Journal of Health Economics, Elsevier, vol. 27(1), pages 27-44, January.
    39. Brun, J. F. & Combes, J. L. & Renard, M. F., 2002. "Are there spillover effects between coastal and noncoastal regions in China?," China Economic Review, Elsevier, vol. 13(2-3), pages 161-169.
    40. Zhong, Hai, 2011. "The impact of population aging on income inequality in developing countries: Evidence from rural China," China Economic Review, Elsevier, vol. 22(1), pages 98-107, March.
    41. Tafreschi, Darjusch, 2015. "The income body weight gradients in the developing economy of China," Economics & Human Biology, Elsevier, vol. 16(C), pages 115-134.
    42. Chang, Gene H., 2002. "The cause and cure of China's widening income disparity," China Economic Review, Elsevier, vol. 13(4), pages 335-340, December.
    43. Adam Wagstaff & Winnie Yip & Magnus Lindelow & William C. Hsiao, 2009. "China's health system and its reform: a review of recent studies," Health Economics, John Wiley & Sons, Ltd., vol. 18(S2), pages 7-23, July.
    44. Björn Gustafsson & Li Shi & Wei Zhong, 2006. "The Distribution Of Wealth In Urban China And In China As A Whole In 1995," Review of Income and Wealth, International Association for Research in Income and Wealth, vol. 52(2), pages 173-188, June.
    45. Andrew M. Jones & Xander Koolman & Nigel Rice, 2006. "Health‐related non‐response in the British Household Panel Survey and European Community Household Panel: using inverse‐probability‐weighted estimators in non‐linear models," Journal of the Royal Statistical Society Series A, Royal Statistical Society, vol. 169(3), pages 543-569, July.
    46. John Knight & Shi Li & Renwei Zhao, 2004. "Divergent Means and Convergent Inequality of Incomes among the Provinces and Cities of Urban China," WIDER Working Paper Series RP2004-52, World Institute for Development Economic Research (UNU-WIDER).
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Hongliang Wang & Yiwen Yu, 2016. "Increasing health inequality in China: An empirical study with ordinal data," The Journal of Economic Inequality, Springer;Society for the Study of Economic Inequality, vol. 14(1), pages 41-61, March.
    2. Nie, P. & Ding, L. & Jones, A.M., 2020. "Inequality of opportunity in bodyweight among middle-aged and older Chinese: a distributional approach," Health, Econometrics and Data Group (HEDG) Working Papers 20/14, HEDG, c/o Department of Economics, University of York.
    3. Akansha Batra & Indrani Gupta & Abhiroop Mukhopadhyay, 2018. "Gender Differences in Health Expenditure of Rural Cancer Patients: Evidence from a Public Tertiary Care Facility in India," Journal of Quantitative Economics, Springer;The Indian Econometric Society (TIES), vol. 16(3), pages 615-629, September.
    4. Joan Costa-i-Font & Frank Cowell & Belén Saénz de Miera Juárez, 2017. "Does Insurance Expansion Alter Health Inequality and Mobility? Evidence from the Mexican Seguro Popular," CESifo Working Paper Series 6788, CESifo.
    5. Qin, Xuezheng & Hsieh, Chee-Ruey, 2014. "Economic growth and the geographic maldistribution of health care resources: Evidence from China, 1949-2010," China Economic Review, Elsevier, vol. 31(C), pages 228-246.
    6. Gustav Kjellsson & Dennis Petrie & Tom (T.G.M.) van Ourti, 2018. "Measuring income-related inequalities in risky health prospects," Tinbergen Institute Discussion Papers 18-007/V, Tinbergen Institute.
    7. Peng Nie & Andrew E. Clarck & Conchita D'Ambrosio & Lanlin Ding, 2020. "Income-related health inequality in urban China (1991-2015): The role of homeownership and housing conditions," Working Papers 524, ECINEQ, Society for the Study of Economic Inequality.
    8. Zhang, Hao & Bago d’Uva, Teresa & van Doorslaer, Eddy, 2015. "The gender health gap in China: A decomposition analysis," Economics & Human Biology, Elsevier, vol. 18(C), pages 13-26.
    9. Paul Makdissi & Myra Yazbeck, 2017. "Robust rankings of socioeconomic health inequality using a categorical variable," Health Economics, John Wiley & Sons, Ltd., vol. 26(9), pages 1132-1145, September.
    10. Tao Zhang, 2016. "Socioeconomic determinants of obesity and hypertension at the county level in China," Mathematical Population Studies, Taylor & Francis Journals, vol. 23(4), pages 239-252, October.
    11. Wu, Yichao & Guo, Zhenli, 2020. "An analysis of the nutritional status of left-behind children in rural China and the impact mechanisms of child malnutrition," Children and Youth Services Review, Elsevier, vol. 119(C).
    12. Coveney, Max & García-Gómez, Pilar & van Doorslaer, Eddy & Van Ourti, Tom, 2020. "Thank goodness for stickiness: Unravelling the evolution of income-related health inequalities before and after the Great Recession in Europe," Journal of Health Economics, Elsevier, vol. 70(C).
    13. Hongliang Wang & Yiwen Yu, 2016. "Increasing health inequality in China: An empirical study with ordinal data," The Journal of Economic Inequality, Springer;Society for the Study of Economic Inequality, vol. 14(1), pages 41-61, March.
    14. Ding, L. & Jones, A.M. & Nie, P., 2020. "Ex ante Inequality of Opportunity in Health among the Elderly in China: A Distributional Decomposition Analysis of Biomarkers," Health, Econometrics and Data Group (HEDG) Working Papers 20/10, HEDG, c/o Department of Economics, University of York.
    15. Max Coveney & Pilar (P.) Garcia-Gomez & Eddy (E.K.A.) van Doorslaer & Tom (T.G.M.) van Ourti, 2018. "Every crisis has a silver lining? Unravelling the pro-cyclical pattern of health inequalities by income," Tinbergen Institute Discussion Papers 18-066/V, Tinbergen Institute.
    16. Martyna Kobus & Marcin Jakubek, 2015. "Youth unemployment and mental health: dominance approach. Evidence from Poland," IBS Working Papers 4/2015, Instytut Badan Strukturalnych.
    17. Brekke, Kjell Arne & Kverndokk, Snorre, 2014. "Health contingent income transfers. Are they relevant?," HERO Online Working Paper Series 2014:5, University of Oslo, Health Economics Research Programme.
    18. Max Coveney & Pilar García‐Gómez & Eddy Van Doorslaer & Tom Van Ourti, 2016. "Health Disparities by Income in Spain Before and After the Economic Crisis," Health Economics, John Wiley & Sons, Ltd., vol. 25(S2), pages 141-158, November.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Gustav Kjellsson & Dennis Petrie & Tom (T.G.M.) van Ourti, 2018. "Measuring income-related inequalities in risky health prospects," Tinbergen Institute Discussion Papers 18-007/V, Tinbergen Institute.
    2. Costa-Font, Joan & Hernández-Quevedo, Cristina, 2012. "Measuring inequalities in health: What do we know? What do we need to know?," Health Policy, Elsevier, vol. 106(2), pages 195-206.
    3. Erreygers, Guido & Clarke, Philip & Van Ourti, Tom, 2012. "“Mirror, mirror, on the wall, who in this land is fairest of all?”—Distributional sensitivity in the measurement of socioeconomic inequality of health," Journal of Health Economics, Elsevier, vol. 31(1), pages 257-270.
    4. Erreygers, Guido & Van Ourti, Tom, 2011. "Measuring socioeconomic inequality in health, health care and health financing by means of rank-dependent indices: A recipe for good practice," Journal of Health Economics, Elsevier, vol. 30(4), pages 685-694, July.
    5. FLEURBAEY, Marc & SCHOKKAERT, Erik, 2011. "Equity in health and health care," LIDAM Discussion Papers CORE 2011026, Université catholique de Louvain, Center for Operations Research and Econometrics (CORE).
    6. Mohammad Habibullah Pulok & Kees Gool & Mohammad Hajizadeh & Sara Allin & Jane Hall, 2020. "Measuring horizontal inequity in healthcare utilisation: a review of methodological developments and debates," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 21(2), pages 171-180, March.
    7. Quinn C, 2009. "Measuring income-related inequalities in health using a parametric dependence function," Health, Econometrics and Data Group (HEDG) Working Papers 09/24, HEDG, c/o Department of Economics, University of York.
    8. Aristides dos Santos, Anderson Moreira & Perelman, Julian & Jacinto, Paulo de Andrade & Tejada, Cesar Augusto Oviedo & Barros, Aluísio J.D. & Bertoldi, Andréa D. & Matijasevich, Alicia & Santos, Iná S, 2019. "Income-related inequality and inequity in children’s health care: A longitudinal analysis using data from Brazil," Social Science & Medicine, Elsevier, vol. 224(C), pages 127-137.
    9. Laia Maynou & Marc Saez & Jordi Bacaria & Guillem Lopez-Casasnovas, 2015. "Health inequalities in the European Union: an empirical analysis of the dynamics of regional differences," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 16(5), pages 543-559, June.
    10. Kristof Bosmans, 2016. "Consistent Comparisons of Attainment and Shortfall Inequality: A Critical Examination," Health Economics, John Wiley & Sons, Ltd., vol. 25(11), pages 1425-1432, November.
    11. Allanson, Paul, 2010. "Longitudinal analysis of income-related health inequality: welfare foundations and alternative measures," SIRE Discussion Papers 2010-71, Scottish Institute for Research in Economics (SIRE).
    12. Max Coveney & Pilar García‐Gómez & Eddy Van Doorslaer & Tom Van Ourti, 2016. "Health Disparities by Income in Spain Before and After the Economic Crisis," Health Economics, John Wiley & Sons, Ltd., vol. 25(S2), pages 141-158, November.
    13. Coveney, Max & García-Gómez, Pilar & van Doorslaer, Eddy & Van Ourti, Tom, 2020. "Thank goodness for stickiness: Unravelling the evolution of income-related health inequalities before and after the Great Recession in Europe," Journal of Health Economics, Elsevier, vol. 70(C).
    14. Paul Allanson & Dennis Petrie, 2013. "On The Choice Of Health Inequality Measure For The Longitudinal Analysis Of Income‐Related Health Inequalities," Health Economics, John Wiley & Sons, Ltd., vol. 22(3), pages 353-365, March.
    15. Merino Ventosa, María & Urbanos-Garrido, Rosa M.maria.merino.ven@gmail.com, 2016. "Disentangling effects of socioeconomic status on obesity: A cross-sectional study of the Spanish adult population," Economics & Human Biology, Elsevier, vol. 22(C), pages 216-224.
    16. Heckley, Gawain & Gerdtham, Ulf-G. & Kjellsson, Gustav, 2016. "A general method for decomposing the causes of socioeconomic inequality in health," Journal of Health Economics, Elsevier, vol. 48(C), pages 89-106.
    17. Hai Zhong, 2010. "On decomposing the inequality and inequity change in health care utilization: change in means, or change in the distributions?," International Journal of Health Economics and Management, Springer, vol. 10(4), pages 369-386, December.
    18. Joachim Frick & Nicolas Ziebarth, 2013. "Welfare-related health inequality: does the choice of measure matter?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(3), pages 431-442, June.
    19. Peng Nie & Andrew E. Clarck & Conchita D'Ambrosio & Lanlin Ding, 2020. "Income-related health inequality in urban China (1991-2015): The role of homeownership and housing conditions," Working Papers 524, ECINEQ, Society for the Study of Economic Inequality.
    20. Paul Allanson & Dennis Petrie, 2014. "Understanding The Vertical Equity Judgements Underpinning Health Inequality Measures," Health Economics, John Wiley & Sons, Ltd., vol. 23(11), pages 1390-1396, November.

    More about this item

    Keywords

    China; Income growth; Income inequality; Income mobility; Health inequality;
    All these keywords.

    JEL classification:

    • C00 - Mathematical and Quantitative Methods - - General - - - General
    • D30 - Microeconomics - - Distribution - - - General
    • D63 - Microeconomics - - Welfare Economics - - - Equity, Justice, Inequality, and Other Normative Criteria and Measurement
    • I14 - Health, Education, and Welfare - - Health - - - Health and Inequality
    • I15 - Health, Education, and Welfare - - Health - - - Health and Economic Development

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:jhecon:v:32:y:2013:i:6:p:1214-1229. See general information about how to correct material in RePEc.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Nithya Sathishkumar). General contact details of provider: http://www.elsevier.com/locate/inca/505560 .

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service hosted by the Research Division of the Federal Reserve Bank of St. Louis . RePEc uses bibliographic data supplied by the respective publishers.