Stanford Center on China’s Economy and Institutions is a joint effort of the Freeman Spogli Institute for International Studies and Stanford Institute for Economic Policy Research.
In a randomized trial conducted with primary school students in China, we find that pairing high and low achieving classmates as benchmates and offering them group incentives for learning improved low achiever test scores by approximately 0.265 standard deviations without harming the high achievers. Offering only low achievers incentives for learning in a separate trial had no effect. Pure peer effects at the benchmate level are not sufficiently powerful to explain the differences between these two results. We interpret our evidence as suggesting that group incentives can increase the effectiveness of peer effects.
Objectives: To determine whether China's New Rural Cooperative Medical Scheme (NCMS), which aims to provide health insurance to 800 million rural citizens and to correct distortions in rural primary care, and the individual policy attributes have affected the operation and use of village health clinics.
Design: We performed a difference-in-difference analysis using multivariate linear regressions, controlling for clinic and individual attributes as well as village and year effects.
Setting: 100 villages within 25 rural counties across five Chinese provinces in 2004 and 2007.
Participants: 160 village primary care clinics and 8339 individuals.
Main outcome measures: Clinic outcomes were log average weekly patient flow, log average monthly gross income, log total annual net income, and the proportion of monthly gross income from medicine sales. Individual outcomes were probability of seeking medical care, log annual "out of pocket" health expenditure, and two measures of exposure to financial risk (probability of incurring out of pocket health expenditure above the 90th percentile of spending among the uninsured and probability of financing medical care by borrowing or selling assets).
Results: For village clinics, we found that NCMS was associated with a 26% increase in weekly patient flow and a 29% increase in monthly gross income, but no change in annual net revenue or the proportion of monthly income from drug revenue. For individuals, participation in NCMS was associated with a 5% increase in village clinic use, but no change in overall medical care use. Also, out of pocket medical spending fell by 19% and the two measures of exposure to financial risk declined by 24-63%. These changes occurred across heterogeneous county programmes, even in those with minimal benefit packages.
Conclusions: NCMS provides some financial risk protection for individuals in rural China and has partly corrected distortions in Chinese rural healthcare (reducing the oversupply of specialty services and prescription drugs). However, the scheme may have also shifted uncompensated new responsibilities to village clinics. Given renewed interest among Chinese policy makers in strengthening primary care, the effect of NCMS deserves greater attention.
Background. Despite growing wealth and the growing commitment of China’s government to providing quality education, a significant share of children across rural China still have no access to regular sources of iron-rich foods, vitamins and other micronutrients. Such poor diets may not only result in high incidences of nutritional problems, including anemia, good nutrition has been shown to be an effective input into the creation of human capital.
Objective. To increase our understanding of the extent of anemia in poor Shaanxi Province’s primary schools, and identify structural correlates of anemia in this region. Methods. A cross-section survey was conducted. Data were collected from 4000 grade fourth grand students (ages 9 to 11) in 70 primary schools in poor rural areas of Shaanxi province. Structured questionnaires and standard test were used to gather data. Trained nurses carried out the hemoglobin tests (using Hemocue finger prick kits) and anthropomorphic measurements using high quality equipment.
Results. The paper shows that the overall anemia rate is 21.5% (39%) when using a blood hemoglobin cutoff of 115 g/L (120 g/L). We find that those students that are boarding at school and those students that eat lunch away from home are more likely to be anemic. Children with anemia are found to have lower height for age (HAZ) scores and have higher incidences of stunting.
Conclusions. If this part of Shaanxi province is representative of the rest of Shaanxi’s poor rural areas (or all national designed poor counties in China), this means that tens of thousands (or millions) of children in rural Shaanxi (all national designed poor counties in China) may be anemic. Although we were not able to pinpoint the exact determinates and causal effects of anemia, the main implication of this work is that anemia remains a serious health problem for educators and health officials in rural China.
Despite the rise in grade retention in poor areas in rural China recently, little work has been done to understand the impact of grade retention on the educational performance of students in these areas in rural China. This paper seeks to redress this shortcoming and examines the effect of grade retention on educational performance on 1649 students in 36 elementary schools in Shaanxi province. With a dataset that was collected from a survey designed specifically to capture school performance of students before and after they were retained, we use Differences-in-Differences, Propensity Score Matching and Differences-in-Differences Matching approaches to analyze the effect of grade retention on school performance. Although the descriptive analysis shows that grade retention helps to improve the scores of the students that were retained, somewhat surprisingly, the results from the multivariate analysis consistently show that there is no significant positive effect of grade retention on school performance of the students. In fact, in some cases (e.g., for the students who repeat grade 2), grade retention is shown to hurt school performance.