We describe the degree to which household income is negatively associated with the prevalence of different types of disability (i.e. medical impairments) in China using data from the 2006 China National Sample Survey of Disabled Persons. We then calculate the extra costs of disability across different types of households and show how these costs differ by the type and severity of disability in both urban and rural areas. We finally use nationally-representative panel data on persons with disabilities from 2007 to 2009 to examine the degree to which social security measures are reaching persons with different types and severity of disabilities in both urban and rural areas. We conclude that while social assistance and insurance for households with disabilities is increasing rapidly over time, it is still not enough to offset the income differential between households with and without disabled persons, especially when accounting for the extra costs of living associated with disability.

Background: To study how misaligned supply-side incentives impede health programs in developing countries, we tested the impact of performance pay for anemia reduction in rural China. To the best of our knowledge, our study is the first to evaluate performance pay for actual health improvement.

Methods: We conducted a cluster randomised trial of information, subsidies, and incentives for school principals to reduce anemia among fourth and fifth grade students in 72 randomly-selected rural primary schools across northwest China. Our experiment included a control and three treatment arms: (1) an information arm in which principals received education about anemia; (2) a subsidy arm in which principals received information and unconditional subsidies; and (3) an incentive arm in which principals received information, subsidies, and financial incentives for reducing anemia among students. Students, parents, nursing teams, and survey enumerators were blind to arm assignment. Primary outcomes were student hemoglobin concentrations; secondary outcomes were behavioral responses to the interventions.

Findings: Mean student haemoglobin concentration rose by 1.5 g/L (95% CI –1.1 to 4.1) in information schools, 0.8 g/L (–1.8 to 3.3) in subsidy schools, and 2.4 g/L (0 to 4.9) in incentive schools compared with the control group. This increase in haemoglobin corresponded to a reduction in prevalence of anaemia (Hb <115 g/L) of 24% in incentive schools. Interactions with pre-existing incentives for principals to achieve good academic performance led to substantially larger gains in the information and incentive arms: when combined with incentives for good academic performance, associated effects on student haemoglobin concentration were 9.8 g/L (4.1 to 15.5) larger in information schools and 8.6 g/L (2.1 to 15.1) larger in incentive schools.

Interpretation: Financial incentives for health improvement were modestly effective. Understanding interactions with other motives and pre-existing incentives is critical.

China’s New Cooperative Medical Scheme, launched in 2003, was designed to protect rural households from the financial risk posed by health care costs and to increase the use of health care services. This article reports on findings from a longitudinal study of how the program affected the use of health care services, out-of-pocket spending on medical care, and the operations and financial viability of China’s township health centers, which constitute a middle tier of care in between village clinics and county hospitals. We found that between 2005 and 2008 the program provided some risk protection and increased the intensity of inpatient care at township health centers. Importantly, the program appears to have improved the centers’ financial status. At the same time, the program did not increase the overall number of patients served or the likelihood that a sick person would seek care at a township center. These findings serve as a benchmark of the program’s early impact. The results also suggest that the composition of health care use in China has changed, with people increasingly seeking outpatient care at village clinics and inpatient care at township health centers.

Despite rapid growth in China, it is unclear whether the poor have benefited in terms of nutrition. This paper’s goal is to understand the prevalence of anemia among school children in western China.We report on results from seven cross-sectional surveys involving 12,768 age 8-12 students. Sample students were selected randomly from 283 primary schools in 41 poor counties of Ningxia, Qinghai, Shaanxi and Sichuan provinces. Data were collected through questionnaires and hemoglobin tests. The dataset represents 7 million age 8-12 children in poor western counties. The anemia prevalence was 34% using the WHO’s hemoglobin cutoff of < 120g/L. Students who boarded at school and girls were more likely to be anemic. Assuming the sample population is representative of poorregions in western China, nearly2.5 million 8-12 year old school children in the region may be anemic and many more iron deficient. Given China’s growth, such high prevalence of anemia is surprising and illustrative of the large health disparities in the country. Iron deficiency remains a significant nutrition issue, though there appears to be no effort to address this issue.

Although the past few decades have seen incomes rise and increased government commitment to helping the poor, there is concern that a large fraction of children in rural China still lack regular access to micronutrient-rich regular diets. Insufficient diets and poor knowledge of nutrition among low income populations can result in nutritional problems, including iron deficiency anemia, which adversely affect attention and learning in school. Surprisingly, there has been little research in China trying to document the prevalence of nutritional problems among certain vulnerable populations, such as school-aged children in rural areas. The absence of programs to combat iron deficiency anemia among students might be interpreted as a sign that the government does not recognize the severity of this problem. The goal of this paper is to increase our understanding of the extent of anemia among school-aged children in poor regions of Qinghai and Ningxia, and to identify structural correlates of anemia in this region. We report on the results of a cross-sectional survey involving over 4000 fourth grade students, from 76 randomly selected elementary schools in 10 poor counties in Qinghai Province and Ningxia Hui Autonomous Region, in China’s poor northwest region. Data were collected through structured questionnaires and standardized tests. Trained professional nurses administered hemoglobin (Hb) tests (using Hemocue finger prick kits) and anthropomorphic measurements using high quality equipment. Our baseline data shows that the overall anemia rate is 34.5% (23.0%) using the World Health Organization’s blood Hb cutoff of 120g/L (115g/L). We find that students who live and eat at school have higher rates of anemia. Children with less-educated parents are more likely to be anemic. Higher anemia rates are associated with students with parents working on farms and away from home. Anemia rates are correlated with adverse physical (lower body mass index (BMI) z-scores and higher incidences of stunting), cognitive and psychological impacts among students. Such findings are consistent with recent findings of other studies in other poor areas in China’s Northwest.

The overall goal of the paper is to understand the progress of the design and implementation of China’s New Cooperative Medical System (NCMS) program between 2004 (the second year of the program) and 2007. In the paper we seek to assess some of the strengths and weaknesses of the program using a panel of national- representative, household survey data that were collected in 2005 and early 2008. According to our data, we confirm the recent reports by the Ministry of Health that there have been substantial improvements to the NCMS program in terms of coverage and participation. We also show that rural individuals also perceive an improvement in service by 2007. While the progress of the NCMS program is clear, there are still weaknesses. Most importantly, the program clearly does not meet one of its key goals of providing insurance against catastrophic illnesses. On average, individuals that required inpatient treatment in 2007 were reimbursed for 15% of their expenditures. Although this is higher than in 2004, on average, as the severity of the illness (in terms of expenditures on health care) rose, the real reimbursement rate (reimbursement amount/total expenditure on medical care) fell. The real reimbursement rate for illnesses that required expenditures between 4000 and 10000 yuan (over 10000 yuan) was only 11% (8%). Our analysis shows that one of the limiting factors is constrained funding.