Inequality of Opportunity in Health Care in China: Suggestion on the Construction of the Urban-Rural Integrated Medical Insurance System

This paper investigates the urban-rural inequality of opportunity in health care in China based on the theory of equality of opportunity of Roemer (1998). Following the compensation principle proposed by Fleurbaey and Schokkaert (2011), this paper establishes a decomposition strategy of the fairness gap, which we use for the measurement of the inequality of opportunity in the urban-rural health care use. Empirical analysis using the CHNS data shows that the ratios of the fairness gap to the directly observed average urban-rural difference in health care are 1.167 during 1997-2000 and 1.744 during 2004-2006, indicating that the average urban-rural difference observed directly from original statistical data may underestimate the degree of the essential inequity. Meanwhile, the increasing fairness gap and the decomposition results imply that generally leveling the urban-rural reimbursement ratios is probably not sufficient, and pro-disadvantage policies should be put in place in order to mitigate or even eliminate the inequality of opportunity in health care use between urban and rural residents. The results are also illuminating for the experiments and establishment of the urban-rural integrated medical insurance system (URIMIS) in China. The pro-disadvantage policies will be more appreciated and effective in the promotion of the equality of opportunity in health care, within the background of urban-rural dualistic social structure and widening urban-rural income gap. This suggestion is supported by data from the URIMIS pilot regions in Jiangsu province. The results show that the fairness gap can be narrowed significantly via pro-disadvantage policies.