Association for Public Policy Analysis & Management

Although health problems are often private concerns, healthcare should always be a public service. As a fast developing country, the development of the medical services in China did not match the development of China’s economy and society. Although China has significantly improved healthcare coverage in recent years, due to the huge population and relatively few facilities, low-income citizens still suffer, and even die, from lack of adequate medical care. The huge inequities that existed between the wealthy, who could afford to go to superior hospitals, receive the treatment and medicines they needed, and consult with highly qualified doctors, and the poor and residents of rural areas, who had no access to the major medical facilities in urban areas, or adequate medicines, was appalling.

This paper tries to study this phenomenon by analyzing the panel data of health insurance coverage and quality in all the 31 provinces in the past three decades. In addition, we conducted a case study in Qinghai Province (the Tibetan Plateau, China’s fourth largest province yet containing the third smallest population, a severely underdeveloped area with most of the residents living at the poverty level). We traveled throughout the province, visiting over twenty (largely pastoral) sparsely populated counties, and specifically through direct interviews with the farmers and herdsmen regarding their healthcare and health needs. These residents (all of whom were ethnic minorities) were economically and socially underdeveloped and due to the decentralized nature of their living conditions, basic medical services were not easily accessible nor affordable.

Based on the firsthand data we acquired and the statistical yearbook of the government, we did a qualitative and quantitative analysis of the medical services in Qinghai Province. We found that both within and between regions of China, there was still a large imbalance in the quality of healthcare available to residents. We also studied how destitute citizens could benefit from China’s economic growth and how public resources could be effectively allocated to disadvantaged groups, providing them with quality public services. We suggested that the local government to increase compensation for low-income famers or herdsmen who suffered in those poverty-stricken areas, and promoted public service equalization between regions.

The development of an equitable public healthcare system should be one of China’s priorities, unless the issues of unbalanced distribution of healthcare resources are addressed and the coordination mechanism of China’s national drug policy involving government sectors, pharmaceutical industries, hospitals, and the public is improved; and effective new policies implemented, the poor and the rich will never receive the same level of service.