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.

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.

In this paper we report the results of a randomized controlled trial designed to measure the impact of a parental training program on the nutritional status of primary school students in rural Shaanxi Province, in Northwest China. Using hemoglobin (Hb) levels as the outcome variable, we first measure the overall impact of a nutritional training program, then measure the impact separately by gender. We use both descriptive and multivariate analyses.

The results for the descriptive and econometric results were robust and consistent with the literature. Overall, we find no impact on students’ Hb levels when we trained their parents about undernutrition and anemia. In both the descriptive and multivariate results, there was no difference in the change of Hb levels between control and treatment students. Parents in the treatment group did learn more about anemia than parents in the control group, but this increased knowledge did not lead to sharp changes in behavior, in general. We did find, however, that there was a measurable impact of parental training on the Hb levels of female students. In both the descriptive and econometric results we found that the Hb levels of female students rose more than that of male students, and that this difference was statistically significant. We conjecture that the parents of female students may have recognized from the training that they were not providing their daughters with sufficient nutrition. Our data show that parents in the treatment group responded by increasing the daily provision of meat, fish, eggs and beans, relative to parents of girls in the control group.

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.

Background. 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 attention and learning in school.

Objective. The overall goal of this paper is to test whether simple nutritional interventions lower rates of anemia and to assess whether this leads to improved educational performance among students in poor areas of rural China.

Approach: We report on the results of a randomized control trial (RCT) involving over 3600 fourth grade students, mostly aged 9 to 12, from 66 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 three groups: two different types of treatment/intervention schools; a non-intervention, control group. The two interventions were designed to improve hemoglobin (Hb) levels, which is a measure of iron deficiency. One intervention provided a daily multivitamin with mineral supplements, including 5 milligrams of iron, for 5 months. The other informed the parents of their child’s anemia status and suggested several courses of action (henceforth, the information treatment).

Findings: Some 38.3 percent of the students had Hb levels of below 120 g/L, the World Health Organization’s cutoff for anemia for children 9 to 12 years old. In the schools that received the multivitamins with mineral supplements, Hb levels rose by more than 2 g/L (about 0.2 standard deviations). The standardized math test scores of the students in the schools that received the multivitamin with mineral supplements also improved significantly. In schools that received the information treatment, only students that lived at home (and not the students that lived in boarding schools and took most of their meals at schools) registered positive improvements in their Hb levels. The reductions in anemia rates and improvements in test scores were greater for students that were anemic at the beginning of the study period. Overall, these results should encourage China’s Ministry of Education (MOE) to begin to widen its view of education (beyond teachers, facilities and curriculum) and provide better nutrition and health care for students.

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.

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.