Children's Social Welfare in China, 1989–1997: Access to Health Insurance and Education

Jennifer Adams, Emily Hannum
2005 The China Quarterly  
Fundamental changes in China's finance system for social services have decentralized responsibilities for provision to lower levels of government and increased costs to individuals. The more localized, market-oriented approaches to social service provision, together with rising economic inequalities, raise questions about access to social services among China's children. With a multivariate analysis of three waves of the China Health and Nutrition Survey (1989, 1993 and 1997), this article
more » ... tigates two dimensions of children's social welfare: health care, operationalized as access to health insurance, and education, operationalized as enrolment in and progress through school. Three main results emerge. First, analyses do not suggest an across-the-board decline in access to these child welfare services during the period under consideration. Overall, insurance rates, enrolment rates and gradefor-age attainment improved. Secondly, while results underscore the considerable disadvantages in insurance and education experienced by poorer children in each wave of the survey, there is no evidence that household socio-economic disparities systematically widened. Finally, findings suggest that community resources conditioned the provision of social services, and that dimensions of community level of development and capacity to finance public welfare increasingly mattered for some social services. 2. Elisabeth Croll, "Social welfare reform: trends and tensions," The China Quarterly, 123-153. 4. Insurance is a narrow indicator that does not provide information about service utilization or quality. Nevertheless, access differences associated with insurance are one significant element of health stratification in China. Furthermore, identifying the determinants of insurance coverage is increasingly important as health care costs continue to rise.
doi:10.1017/s0305741005000068 fatcat:ksm2tqgvqrawxbcjrqgwsuyw6y