Trends in health services utilization in eight provinces in China, 1989-1993.

Continued pursuit of market-oriented reforms in China seems to have resulted in increasing income disparities. This has raised concerns about possible declines in the use of health services by the poor. Using data from three waves of the China Health and Nutrition Survey (1989, 1991, 1993), we examine whether people age 20-45 in eight provinces became less likely to seek care when ill. We carried out three probit estimations of seeking care when ill; the predictor variables include individual and workplace characteristics, a measure of the severity of illness and community level factors. Health care is broadly defined to include basic level clinics as well as urban hospitals. We find no evidence that health care utilization is decreasing. Rather, for people in a community survey reporting mainly mild or moderate illness, health care continues to be accessible. We consider possible limits of our study and discuss extensively the implications of the use of illness reports from the three cross-sectional surveys as health status indicators.

Heatlh care in the People's Republic of China: a view from inside the system.

During a three-month period, all admissions to an infectious disease ward at a tertiary care hospital in the People's Republic of China were studied. The hospital's catchment area covered a population of almost eight million, 10 per cent urban and 90 per cent rural. Seventy-two per cent of the patients admitted to this facility were city dwellers with illnesses which were significantly less serious in degree than the illnesses encountered among patients transferred from rural facilities. Ease of travel, nature of the disease process, availability of beds, ability to manipulate the referral ladder, and cost of health care may account for these results. Charges for health care in China proved very expensive relative to per capita income. This may be of major consequence to rural persons who are personally liable for some portion of this cost. These results suggest that although referral to tertiary care in China occurs more commonly among rural patients than is the case in other developing nations, access to this care and its cost are significant problems of the present system. During the drive for modernization, a multifactorial approach (including health policy, administrative controls, and patient and physician education) will be essential to avoid deterioration of the rural health system, and the increase financial burden to be expected with the introduction of advanced medical technology.