IMPACT OF PUBLIC MEDICAL INSURANCE ON HEALTH CARE EQUITY BETWEEN URBAN AND RURAL CHILDREN IN MAINLAND CHINA

Equity, as a major social work principle, refers to social justice or fairness. Health care equity, therefore, has widely been defined as the absence of systematically unjust or unfair health disparities (Peter, 2001). Since the collapse of China’s old public medical insurance system in mid-1970s due to an expansion of the market economy and a focus on private industry, China initiated several health reforms. Those reforms have been successful in increasing medical insurance coverage for Chinese citizens, but have not successfully reduced the inequalities in affordability and accessibility, nor decreased disparities between urban and rural populations, especially children. This dissertation provides an examination of the health inequities faced by rural and urban children in China, the policies enacted to address them, and their impact on the health equity of Chinese children. Two articles highlight the continued need for policy change to increase health care equity for Chinese children. One article evaluates the impact of China’s public medical insurance policies on urban and rural children’s physical health outcomes and financial risk between 2004 and 2009, through applying Structural Equation Models. The second employs a content analysis to assess whether China’s most recent public medical insurance policy, as written, would support the goals of increasing health care equity for Chinese children. Overall, results indicate that China’s past and current health care policies serve to maintain the systematic health inequalities between urban and rural children. Recommendations such as performance measurement and stakeholder analysis for policy to improve China’s public medical insurance systems are also provided.