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Did the distribution of health insurance in China continue to grow less equitable in the nineties? Results from a longitudinal survey


  • Akin, John S.
  • Dow, William H.
  • Lance, Peter M.


This paper examines changes in the distribution of health insurance across socioeconomic groups in China over the 1989-1997 period. The analysis is based on the China Health and Nutrition Survey (CHNS), a unique micro-level longitudinal survey of households in eight Chinese provinces. Findings indicate that while aggregate insurance coverage rates in the sample changed little over this period, certain previously noted differences in coverage rates across socioeconomic groups narrowed significantly. These findings bring into question the presumption that continued market-oriented reform would lead to increased differences in coverage across those groups. The results, in fact, suggest exactly the opposite, that as the market oriented changes have occurred important disparities in health insurance coverage have been reduced. If these reductions are occurring there are important implications for policy. The groups normally targeted for equity reasons seem to be making progress over time but continued improvements are needed for these groups to reach the levels of coverage enjoyed by more fortunate subgroups.

Suggested Citation

  • Akin, John S. & Dow, William H. & Lance, Peter M., 2004. "Did the distribution of health insurance in China continue to grow less equitable in the nineties? Results from a longitudinal survey," Social Science & Medicine, Elsevier, vol. 58(2), pages 293-304, January.
  • Handle: RePEc:eee:socmed:v:58:y:2004:i:2:p:293-304

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    References listed on IDEAS

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    Cited by:

    1. Lindelow, Magnus & Wagstaff, Adam, 2005. "Health shocks in China : are the poor and uninsured less protected ?," Policy Research Working Paper Series 3740, The World Bank.
    2. Eddy van Doorslaer & Owen O'Donnell & Ravindra P. Rannan-Eliya & Aparnaa Somanathan & Shiva Raj Adhikari & Charu C. Garg & Deni Harbianto & Alejandro N. Herrin & Mohammed Nazmul Huq & Shamsia Ibragimo, 2007. "Catastrophic payments for health care in Asia," Health Economics, John Wiley & Sons, Ltd., vol. 16(11), pages 1159-1184.
    3. Deber, Raisa B. & Forget, Evelyn L. & Roos, Leslie L., 2004. "Medical savings accounts in a universal system: wishful thinking meets evidence," Health Policy, Elsevier, vol. 70(1), pages 49-66, October.
    4. Linping Xiong & Xiuqiang Ma, 2007. "Forecasting China's Medical Insurance Policy for Urban Employees Using a Microsimulation Model," Journal of Artificial Societies and Social Simulation, Journal of Artificial Societies and Social Simulation, vol. 10(1), pages 1-8.
    5. Bredenkamp, Caryn, 2008. "Health reform, population policy and child nutritional status in China," Policy Research Working Paper Series 4587, The World Bank.
    6. Juergen Jung & Jialu Liu Streeter, 2015. "Does health insurance decrease health expenditure risk in developing countries? The case of China," Southern Economic Journal, Southern Economic Association, vol. 82(2), pages 361-384, October.
    7. Du, Juan, 2009. "Economic reforms and health insurance in China," Social Science & Medicine, Elsevier, vol. 69(3), pages 387-395, August.
    8. Bredenkamp, Caryn, 2009. "Policy-related determinants of child nutritional status in China: The effect of only-child status and access to healthcare," Social Science & Medicine, Elsevier, vol. 69(10), pages 1531-1538, November.
    9. Linda Yueh, 2010. "The Economy of China," Books, Edward Elgar Publishing, number 3705.
    10. repec:spr:soinre:v:132:y:2017:i:1:d:10.1007_s11205-016-1244-2 is not listed on IDEAS
    11. Hendrik P. van Dalen, 2006. "When Health Care Insurance does not make a Difference – The Case of Health Care ‘Made in China’," Tinbergen Institute Discussion Papers 06-091/1, Tinbergen Institute.
    12. Eddy van Doorslaer, 2007. "Paying Out-of-Pocket for Health Care in Asia: Catastrophic and Poverty Impact," Working Papers id:823, eSocialSciences.


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