Does Rapid and Sustained Economic Growth Lead to Convergence in Health Resources: The Case of China From 1980 to 2010

Liang, Di; Zhang, Donglan; Huang, Jiayan; Schweitzer, Stuart

Geographic variation in health system resources and performance can be analyzed with several methods. Small area variation studies have been widely used, especially with comparisons of health care expenditures (HCEs) in different regions; for example, the Dartmouth Atlas points out variations of expenditures as possible explanations of high health costs. The Dartmouth researchers have also presented simulations that suggest that the cost savings would be huge if high-cost regions could, somehow, reduce their costs to those of low-cost regions. 6 Convergence analysis is another method to study geographic variation. Convergence analysis does not focus on the difference between specific areas, but looks at the time trend of variation reduction in HCEs, or other health indicators. Triggered by the seminal articles by Barro and Sala-i-Martin and Mankiw et al, a huge amount of convergence literature emerged in various contexts, mainly to study patterns of economic growth across different regional economies. [7] [8] [9] Health economists have also adopted convergence analysis to measure health variation within and between regions. The convergence of HCEs has been studied in the European Union and the United States. [10] [11] [12] [13] [14] Limited publications have explored geographical variation in China at the provincial level or small-area level. Chou and Wang examined regional health expenditure inequality by testing 2 hypotheses on HCE convergence from 1978 to 2004. 15 According to their research, no single nationwide convergence was observed, but convergence in regional clusters was found. However, very few studies to date have looked at the geographic health variation longitudinally. We suspected that it may be related to the accessibility of geographic health data either at the provincial or small-area level.