Edited by Yingjie Guo
Chapter 11: Class, stratification and health inequities in contemporary China
In China’s unprecedented and remarkable socio-economic transformation since the late 1970s, health presents a more checkered trajectory. At the turn of the twenty-first century, as China consolidated its rise as a global economic power, the growing number of people in both urban and rural areas who could not afford medical treatment had become one of the first warning signs of the negative externalities of its high income inequalities. Changing funding mechanisms and the consequent move towards fee-for-service in the public health care system had made access to health services and medicines dependent on capacity to pay. In 2003 the third National Health Services Survey found that close to 50 percent of respondents did not seek outpatient treatment when ill, and that 30 percent of those referred to a hospital refused inpatient care; the main reason given for forgoing treatment was cost (WHO 2005). In rural China the situation was particularly dire, with earlier studies showing that close to half of those needing inpatient care would refuse hospitalization because they could not cover the related cost (Liu, Y. et al. 1996: 160). Health care expenses had by then become one of the main causes of poverty in rural China (Liu, Y. et al. 2003; Wagstaff 2005). These inequalities in access to health care services not only highlighted the income inequalities underpinning them, but also made evident other aspects of social stratification that affected the health outcomes of specific social groups.
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