Using individual data collected in rural China and adopting Heckman’s two-step function, we examined the impact of childcare and eldercare on laborers’ off-farm activities. Our study finds that having school-aged children has a negative impact on rural laborers’ migration decisions and a positive impact on their decision to work in the local off-farm employment market. As grandparents can help to take care of young children, the impact of preschoolers is insignificant. Having elderly family to care for decreases the income earned by female members of the family. Although both men and women are actively engaged in off-farm employment today in rural China, this study shows that women are still the primary care providers for both children and the elderly. Therefore, reforming public school enrollment and high school/college entrance examination systems so that migrant children can stay with their parents, this will help rural laborers to migrate to cities. The present study also calls for more public services for preschoolers and the elderly in rural China.

In this paper we have two objectives - one empirical; one methodological. Although China's leaders are beginning to pay attention to health care in rural China, there are still concerns about access to health services. To examine this issue, we use measure of travel distances to health services to examine the nature of coverage in Shaanxi Province, our case study. The mean distance by road to the nearest health center is more than 6 km. When we use thresholds for access of 5 and 10 km we find that more than 40 (15) percent of the population lives outside of these 5 (10) kilometer service areas for health centers. The nature of the access differs by geographical region and demographic composition of the household.. The methodological contribution of our paper originates from a key feature of our analysis in which we use Geographic Information System (GIS) network analysis methods to measure traveling distance along the road network. We compare these measures to straight-line distance measures. Road distances (produced by network analysis) produce measures (using means) that are nearly twice as great as straight-line distances. Moreover, the errors in the measures (that is, the difference between road distances and straight-line distances) are not random. Therefore, traditional econometric methodsof ameliorating the effects of measurements errors, such as instrument variables regression, will not produce consistent results when used with straight-line distances.

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Since economic liberalization in the late 1970s, China's health care providers have grown heavily reliant on revenue from drugs, which they both prescribe and sell. To curb abuse and to promote the availability, safety, and appropriate use of essential drugs, China introduced its national essential drug list in 2009 and implemented a zero markup policy designed to decouple provider compensation from drug prescription and sales. The authors collected and analyzed representative data from China's township health centers and their catchment-area populations both before and after the reform. They found large reductions in drug revenue, as intended by policy makers. However, they also found a doubling of inpatient care that appeared to be driven by supply, instead of demand. Thus, the reform had an important unintended consequence: China's health care providers have sought new, potentially inappropriate, forms of revenue. 

Background: Empty-nest elderly refers to those elderly with no children or whose children have already left home. Few studies have focused on healthcare service use among empty-nest seniors, and no studies have identified the prevalence and profiles of non-use of healthcare services among empty-nest elderly. The purpose of this study is to compare the prevalence of non-use of healthcare services between empty-nest and non-empty-nest elderly and identify risk factors for the non-use of healthcare services among empty-nest seniors.

Methods: Four thousand four hundred sixty nine seniors (60 years and above) were draw from a cross-sectional study conducted in three urban districts and three rural counties of Shandong Province in China. Non-visiting within the past 2 weeks and non-hospitalization in previous year are used to measure non-use of healthcare services. Chi-square test is used to compare the prevalence of non-use between empty-nesters and non-empty-nesters. Multivariate logistic regression analysis is employed to identify the risk factors of non-use among empty-nest seniors.

Results: Of 4469 respondents, 2667(59.7 %) are empty-nesters. Overall, 35.5 % of the participants had non-visiting and 34.5 % had non-hospitalization. Non-visiting rate among empty-nest elderly (37.7 %) is significantly higher than that among non-empty-nest ones (32.7 %) (P = 0.008). Non-hospitalization rate among empty-nesters (36.1 %) is slightly higher than that among non-empty-nesters (31.6 %) (P = 0.166). Financial difficulty is the leading cause for both non-visiting and non-hospitalization of the participants, and it exerts a larger negative effect on access to healthcare for empty-nest elderly than non-empty-nest ones. Both non-visiting and non-hospitalization among empty-nest seniors are independently associated with low-income households, health insurance status and non-communicable chronic diseases. The nonvisiting rate is also found to be higher among the empty-nesters with lower education and those from rural areas.

Conclusions: Our findings indicate that empty-nest seniors have higher non-use rate of healthcare services than non-empty-nest ones. Financial difficulty is the leading cause of non-use of health services. Healthcare policies should be developed or modified to make them more pro-poor and also pro-empty-nested.

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Abstract: The overall goal of this article is to understand the progress in implementing the New Cooperative Medical Scheme, while seeking to assess the strengths and weaknesses of the programme and, in particular, to understand its effects on the incidence of catastrophic medical payment. The study is based on two rounds of nationally representative household survey data collected in 2005 and 2008. The study found that the programme has a very high level of participation, and has increased farmers’ use of medical services. However, despite efforts by both central and local governments and high household participation, the programme is only partially achieving its policy objectives. In particular, it has been able to extend to almost all of the rural population, but has failed to cover expenses for catastrophic illness, due to insufficient funds.

Abstract The overall goal of this article is to understand the progress in implementing the New Cooperative

Medical Scheme, while seeking to assess the strengths and weaknesses of the programme and, in particular,

to understand its effects on the incidence of catastrophic medical payment. The study is based on two

rounds of nationally representative household survey data collected in 2005 and 2008. The study found that

the programme has a very high level of participation, and has increased farmers’ use of medical services.

However, despite efforts by both central and local governments and high household participation, the

programme is only partially achieving its policy objectives. In particular, it has been able to extend to almost

all of the rural population, but has failed to cover expenses for catastrophic illness, due to insufficient funds.

Background: Anemia early in life has been associated with delayed cognitive and motor development. The WHO recommends home fortification using multiple micronutrient powders (MNPs) containing iron as a strategy to address anemia in children under two. We evaluated the effects of a program freely distributing MNP sachets to caregivers of infants in rural China.

Methods: We conducted a cluster-randomized controlled trial in Shaanxi province, enrolling all children aged 6–11 months in target villages. Following a baseline survey, investigators randomly assigned each village/ cluster to a control or treatment group. In the treatment group, caregivers were instructed to give MNPs daily. Follow-up was after 6, 12, and 18 months of intervention. Primary outcomes were hemoglobin concentrations and scores on the Bayley Scales of Infant Development.

Results: One thousand, eight hundred and-two eligible children and their caregivers were enrolled. At baseline 48% (870) of children were anemic and 29% (529) were developmentally delayed. Six hundred and-ten children (117 villages) were assigned to the control group and 1192 children (234 villages) were assigned to the treatment group. Assignment to the treatment group was associated with an improvement in hemoglobin levels (marginal effect 1.77 g/L, 95% CI 0.017–3.520, p-value = 0.048) and cognitive development (marginal effect 2.23 points, 95% CI 0.061–4.399, p-value = 0.044) after 6 months but not thereafter. There were no significant effects on motor development. Zero effects after the first 6 months were not due to low compliance, low statistical power, or changes in feeding behavior. Hemoglobin concentrations improved in both the treatment and control groups over the course of the study; however, 22% (325) of children remained anemic at endline, and 48% (721) were cognitively delayed.

Conclusions: Providing caregivers with MNP sachets modestly hastened improvement in hemoglobin levels that was occurring absent intervention; however, this improvement did not translate into improved developmental outcomes at endline.

Trial registration: ISRCTN44149146; prospectively registered on 15th April 2013.

Keywords: Micronutrient supplementation, Anemia, Cognition, Early childhood

Taenia solium cysticercosis affects millions of impoverished people worldwide and can cause neurocysticercosis, an infection of the central nervous system which is potentially fatal. Children may represent an especially vulnerable population to neurocysticercosis, due to the risk of cognitive impairment during formative school years. While previous epidemiologic studies have suggested high prevalence in rural China, the prevalence in children as well as risk factors and impact of disease in low-resource areas remain poorly characterized.

Economic growth and socioeconomic changes have transformed nearly every aspect of childhood in China, and many are worried by the increasing prevalence of mental health issues among children, particularly depression. To provide insight into the distribution of depressive symptoms among children in China and identify vulnerable groups, we use data from the 2012 China Family Panel Survey (CFPS), a survey that collected data from a large, nationally representative sample of the Chinese population. Using the CFPS data, we construct a sample of 2679 children aged 10–15 years old from 25 provinces in China. According to our results, the incidence of depression varies by geographic area. Specifically, we find that rates of depressive symptoms are significantly lower in urban areas (14% of sample children) than in rural areas (23% of sample children). Our results also show that children from ethnic minorities, from poorer families, and whose parents are depressed are more likely to be depressed than other children. In contrast, we find that depressive symptoms do not vary by gender.

Keywords: childhood depression; China; depressive symptoms; left-behind children; migrant children

Affecting more than one billion people around the world, neglected tropical diseases are a group of diseases which mainly occur in poor populations living in tropical and subtropical environments. Although considered a middle-income country, neglected diseases persist in many rural areas of China. Neurocysticercosis (NCC), an infection caused when the larvae of the tapeworm Taenia solium (T. solium) enters the human brain, is a prime example of this. Infection can lead to seizures, severe headaches, decreased cognitive abilities and other debilitating neurologic symptoms. The overall goal of our study is to understand the nature of NCC in China as well as to identify possible interventions that might be useful for helping to control or eradicate the disease. To meet this goal, we use a mixed methods approach, combining quantitative survey data with observational and interview-based qualitative data. We find a significant prevalence of neurocysticercosis in Tibetan school age children in western Sichuan. We identify three interventions with high potential for stopping the spread of the disease: regular composting of human feces, installing sanitation stations outside of school bathrooms to encourage hand washing, and working through the local veterinary networks to administer the newly developed porcine T. solium vaccine.

Keywords: Neurocysticercosis (NCC), tapeworms, cognitive ability, parasites