Over the past decade, China has implemented reforms designed to expand access to health care in rural areas. Little objective evidence exists, however, on the quality of that care. This paper reports results from a standardized patient study designed to assess the quality of care delivered by village clinicians in rural China. To measure quality, we recruited individuals from the local community to serve as undercover patients and trained them to present consistent symptoms of two common illnesses (dysentery and angina). Based on 82 covert interactions between the standardized patients and local clinicians, we find that the quality of care is low as measured by adherence to clinical checklists and the rates of correct diagnoses and treatments. Further analysis suggests that quality is most strongly correlated with provider qualifications. Our results highlight the need for policy action to address the low quality of care delivered by grassroots providers. 

Despite their recent deterioration, village clinics have historically been an important source of health care for the poor and elderly in rural China. In this paper, we examine the current role of village clinics, the patients who use them and some of the services they provide. We focus specifically on the role of village clinics in meeting the health-care needs of the rural poor and elderly. We find that although clinics are continuing to decline financially, they remain a source of care for the rural elderly and poor. We estimate that the elderly are 10–15 percent more likely than young individuals to seek care at a clinic. We show that clinics provide many unique services to support the rural elderly (and the elderly poor), such asin-home patient care, the option for patients to pay on credit, and free and discounted services.

Despite growing wealth and a strengthening commitment from the government to provide quality education, a significant share of students across rural China still have inadequate access to micronutrient-rich regular diets. Such poor diets can lead to nutritional problems, such as iron-deficiency anemia, that can adversely affect health, attention and cognitive ability. The overall goal of this paper is to assess the impact of multiple micronutrient supplementation on anemia and anxiety among students in poor areas of rural China. We report on the results of a randomized control trial (RCT) involving over 2700 fourth grade students, mostly aged 9 to 12, from 54 randomly-chosen elementary schools in 8 of the poorest counties in Shaanxi Province in China’s poor northwest region. The design called for random assignment of schools to one of two groups. One group received a daily multivitamin with mineral supplements, including 5 milligrams of iron, for 5 months while the other group was a non-intervention, control group. Anemia was defined as < 120 g/L. We found that 42.4 percent of students were anemic at baseline In the schools that received the multivitamins with mineral supplements, Hb levels rose by more than 1.7 g/L over the control schools. The test for anxiety showed that students that received the multivitamin with mineral supplements also improved significantly. Overall, these results should encourage further research on the interaction between nutrition and mental health in a development context.