Disparities in Health and Health Care Access in China: An Ecological Perspective

Objective. To examine how community contexts including medical care resources impact health and health care access in China, independent from the effect of individual-level factors.

Data. The data used in this study come from the 2010 Chinese Family Panel Studies consisting of a nationally representative sample of 21,572 adults. The two dependent variables in the analysis include self-rated health and another variable denoting whether respondents would see doctor immediately when getting sick.

Methods. Multivariate logit models were estimated to assess the effect of community contexts on self-rated health and the likelihood to see a doctor immediately when getting sick after controlling for selected variables at the individual level.

Results. Southern Chinese were less likely to report poor SRH compared to their northern counterparts (OR=0.78, p=0.001). Communities lacking of medical care facilities were associated with worse SRH. Negative perception of local government at the community level was also associated with worse SRH. Coming from communities lacking of medical care facilities, having negative perception of local government, and living close to polluting factories were all associated with a lower chance of seeing a doctor when getting sick.

Policy Implications. 1) The health care reform in China should invest more in developing medical infrastructure in the north, middle, and west as well as communities lacking basic medical resources; 2) Improving legitimacy of local governments can potentially improve health and health care access; 3) Pollution needs to be addressed as a significant barrier to health care access in China.