ABSTRACT
This chapter examines how changing systems and practices of local governance and health financing in China have influenced patterns of inequality in access to health services.2 These patterns of inequality are important because they can be closely connected to the patterns of income inequality discussed in other chapters in this volume, as well as to experiences of poverty and social inequality, and to health inequalities.3 First, for example, in health financing systems like China’s today, where health insurance participation is low and most people have to pay directly for health services, patterns of inequality in access map onto patterns of income inequality. In turn, people – particularly those with low incomes – who do not have health insurance are vulnerable to impoverishment due to ill health, so that inequalities in access may contribute to rising poverty and income inequalities. Second, where access to care is dependent on ability to pay, those on low incomes may be unable to afford the medical treatment they need, meaning that in China as elsewhere “unequal legitimate claims upon a health system, and unequal experiences of seeking care are important elements of poverty and inequality in people’s experience” (Mackintosh 2001: 175). Third, inequalities in access to health services can interact with factors such as age, socio-economic differences or diet to contribute to increasing or reducing health inequalities (Peter and Evans 2001).
