Challenges in China: Assessing health determinants and health care reforms

China has enjoyed remarkable economic growth in the past few decades. However, there have been increasing concerns about health inequalities, non-communicable diseases, and the rocketing cost of the health care system. Hao Zhang’s dissertation addresses the challenges faced by China around 2010 in both the population health domain and the health care system. She defends her thesis Thursday 5 October 2017 at Erasmus University.

Population health
The study on the female health disadvantage finds that the worse self-assessed health of women is not a reporting artifact. It can be explained by both biological differences, as reflected in gender differences in chronic conditions and health functioning, and the culturally embedded discrimination against females, as reflected in female education disadvantage. The second study assesses the effect of only children (as a result of the One Child Policy in China since 1980) on their elderly parents’ mental wellbeing. The findings suggest that having only one child did not negatively affect parents’ mental wellbeing in later life, as measured by depressive symptoms, cognitive skills and life satisfaction. Further analysis on potential mechanisms suggests that having only one child did not reduce parents’ chances of having a child around, or receiving transfers from a child. On the contrary, it increased their chances of seeing a child.

Health care system
The studies on health care system challenges evaluate two reforms in rural China. One examines whether local decentralization combined with a pre-specified evaluation framework would nurture successful reforms in the presence of substantial geographic and socioeconomic variation in project counties. Improvements are found in a number of indicators in three domains examined – medical care, public health services provision and people’s self-rated health. It appears that this approach holds promise for future reform projects in a context of substantial regional variation because it strikes a delicate balance between effective management and local adaptation.

The other study assesses a reform aimed at containing cost escalation while improving the quality of care by changing hospital payment for certain diseases from service-based to case-based and enforcing treatment guidelines for these diseases. Results suggest patient selection by health care providers, little intended effect on cost containment, and compliance with the treatment guidelines.


Publication date: 3 October 2017


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