Regional health-care inequity in children's survival in Zhejiang Province, China.

BACKGROUND: China is now under a period of social transition, and inequity is evident in the field of health care. We aimed to investigate regional health-care inequalities in children's survival in Zhejiang Province, China. METHODS: In our study, monitoring data of Zhejiang Province from 2005 to 2014 was collected. The flow of data collection of community-district-city for urban areas or village-township-county rural areas was followed. The factors affecting equity was analyzed including regional economical level and household registry. We adopted standard measures of concentration curve and concentration index to evaluate degree of income-related inequity and the trend of mortality changes. RESULTS: From 2005 to 2014, overall mortality rate in children under five decreased, and regional disparity reduced markedly, and with a reduced disparity of mortality rate among children from urban and rural areas. In 2014, the mortality rate in children from urban and rural areas was similar. In contrast, the mortality rate in the children from migrant population was more than two folds of that in the children from native residency (7.82 ‰ vs. 3.89 ‰). The mortality rates of newborns (rs = -0.396, P < 0.001), infants (rs = -0.553, P < 0.001) and children under five (rs = -0.568, P < 0.001) were all negatively correlated with per capita GDP in different regions. CI in the newborns, infants and children under 5 years was -0.105, -0.107 and -0.118, respectively. The concentration curve was near to equity curve. The concentration curve was near to equity curve. The mortality rate of children was negatively related with economical level in this study. CONCLUSIONS: The survival status was near to equity. Regional economical development can improve children's survival but it was not the only social determinant. Migrant population will be the future monitor focus for reducing disparity on healthcare and increase equity in children's survival.

Uncompensated care for children without insurance or from low-income families in a Chinese children's hospital.

BACKGROUND: In China, children from low-income families, particularly those of rural to urban migrant families, have become one of the most vulnerable populations in terms of healthcare access. Without support, these families will finally give up treatment for their children. Our hospital has sought several ways to fund the uncompensated care for children without insurance or from low-income families. MATERIAL AND METHODS: The annual hospital financial report and donated patients' medical records from 2005 to 2011 were reviewed for extracting data, including disease type, and sources and amounts of donations. Files with information on uncompensated care were also reviewed. Uncompensated care was defined as the sum of a hospital's "bad debt" and the charity care it provides. RESULTS: The total expense of uncompensated care increased from 813 597 RMB in 2005 to 4 415 967 RMB in 2011, with a percentage of total budget ranging from 0.24% to 1.6% from 2005 to 2011. The hospital's bad debt accounts for 17.6% of the uncompensated care charge on average per year. The charity care was from: 1) donations from common warm-hearted persons, companies, and institutions after media reporting; 2) governmental charity organizations; 3) non-governmental charity organizations; and 4) special funding from contributions solicited by hospital, media, and governmental charity organizations' collaboration. Leukemia and congenital heart disease were the 2 leading types of diseases benefitted from the uncompensated care from 2005 to 2011. CONCLUSIONS: Uncompensated care is still an indispensable complementary supporting measure for pediatric care access in China. Children from rural-to-urban migrant families should be considered as a target population for the government to focus on.