State extractive capacity, policy orientation, and inequity in the financing and delivery of health care in urban China

This paper explores how the Chinese government's reluctance/inability to invest in health has influenced the performance of its health system in the context of urban China. It focuses on two related issues. To what extent is the financing of the health care system progressive? To what extent is the utilization of health care services equitable? Section I explains why the Chinese government has become less willing and able to bear the burden of health care during the era of economic reform and inspects the impacts of these changes on the structure of overall health expenditure. The following two sections empirically examine the extent to which the shift toward out-of-pocket spending has made health care less accessible and less affordable for the poor and vulnerable. Section IV explores how inequity in health care and health services has put groups of people who are already socially disadvantaged at more disadvantaged positions. The study finds that the market-oriented health reform in urban China has exacerbated the cost problem that it intended to solve, reduced access to health services for the most vulnerable, and increased the instances of illness-induced poverty.