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

In the last 30 years, China experienced high economic growth accompanied by a transition to a more marketoriented economy. The health system of China is also converting from a centrally planned health system to one that is more market oriented. 1 These transitions have resulted in an expanded supply of high-quality hospital services, especially to the people in large cities. Unfortunately, the majority of people in rural and poor areas are still having difficulties accessing good-quality and affordable health care. 2 Health inequality has become a major issue in the health system of China, which raises concerns among the general public and the government. 3 In China, health inequality at the individual level is reflected in health disparities between rural and urban areas and variation among provinces. The health disparity between urban and rural areas has been decreasing, but still exists. 4 Geographic health variation is also dramatic, but less studied. In 2005, Shanghai, the most affluent city in China, enjoyed 78 years' life expectancy at birth, which was the highest in China. However, the life expectancy at birth in the poorest province in Western China was only 65 years. 5 The extent of diffusion of the advantages of growth throughout the economy has not been rigorously studied. Our hypothesis is that over the 30 years' economic growth, geographic variation in health system resources and performance at the provincial level has decreased and is achieving convergence. The alternative hypothesis is that over the 30 years' economic growth, health resources and performance at the provincial level have increased, resulting in divergence.