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Høgskolen i Oslo og Akershus. Fakultet for samfunnsfag
Master in International Social Welfare and Health Policy
This thesis is the first systematic effort in Chinese scholarship in the social sciences to apply the concept, benchmarks of fairness, which was developed by Norman Daniels et al. (1996) as a tool for evaluating and discussing issues in health care equity and to identify factors that need improvement in order to improve the inequality in health care services between rural and urban communities. Since the economic reform started in 1978, China has experienced continuous economic development, which has contributed to the improved health status of the whole population. However, the benefits of this improvement have not been distributed equally, as the data on the infant mortality rate (IMR) indicate. Hence, the key questions in this thesis include the following: 1) How is the IMR distributed between urban and rural communities in China today compared with two decades ago? 2) How can this disparity be explained? 3) Does the health care system reinforce, reduce, or maintain these disparities? 4) Is the inequality between rural and urban communities justifiable? If not, why does it exist? The main methods employed are a literature review and secondary data analysis. Based on the analysis of the IMR data from 1991 to 2010, three objectives are realized by the thesis: 1) Describe the current distribution of child health in China as measured by IMR; 2) Analyze the main health determinants that affect the distribution; 3) Discuss the equity of child health distribution according to the benchmarks of fairness. Measured by the IMR, the results of the data analysis suggest that although the status of child health has improved tremendously in the last two decades, inequality between urban and rural areas remains a main challenge despite the fact that the decrease in IMR reduction in rural areas has been faster than that in urban areas. Over the last 20 years, the IMR has decreased by 73.9%, from 50.2 per 1000 live births in 1991 to 13.1 per 1000 live births in 2010. In 1991, in rural areas, the IMR was 3.35 times higher than in urban areas. In 2010, the IMR in rural areas was still 2.78 times higher than in urban areas. However, some health determinants, such as income disparity and unequal distribution of public facilities, can be used to explain the inequality. Nevertheless, as evaluated by the benchmarks of fairness, the unequally distributed IMR in China between 1991 and 2010 does not show a positive result. From a total of nine benchmarks, five were adopted: inter-sectoral public health, financial barriers to equitable access, nonfinancial barriers to access, comprehensiveness of benefits and tiering, equitable financing, which is related to equity of health. The score was 2.0 of 5.0, which indicates that more effort is needed to reduce social discrimination in health care, improve the distribution of equitable finance between urban and rural areas, and improve the involvement of both urban and rural communities in the design of the health system.
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