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. 

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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.

This article explores the problem of cognitive delays among toddlers in rural China and the role of their caregivers in producing low levels of cognition (i.e., low IQ). According to the results of a well-tested international scale of child development, the Bayley Scales of Infant Development (BSID), cognitive delays are alarmingly common, and nearly half the toddlers in our sample score an IQ of less than 84 on the BSID test (more than one standard deviation below the mean). In analyzing the source of this, we find that poor parenting—for example, not reading to, singing with, or engaging in stimulating play with one’s children—is closely associated with these delays. Even though mothers (as opposed to grandmother caregivers), and especially more educated mothers, are more likely to follow good parenting practices, quality parenting is rare overall. We seek to find out why so many young children appear to be neglected when it comes to modern parenting practices. We empirically rule out the hypotheses that caregivers discriminate according to their child’s gender; that the number of children in a given household is associated with the quality of parenting; or that caregivers living in relative poverty parent differently than their wealthier counterparts. According to the qualitative component of our study, we also find that inadequate parenting does not stem from parental indifference. Parents and grandparents obviously love their children and want them to succeed in life. Instead, the barriers appear to be primarily a lack of time and an absence of knowledge about the importance of good parenting practices. As a result, when they grow up, these children may not possess the levels of cognition needed to thrive in China’s increasingly high-skill-based economy. Overall, our findings suggest that China may be facing a national crisis due to inadequate rural early childhood development.

Policymakers in many developing countries regard upper-secondary technical and vocational education and training (TVET) as a key element in economic growth and poverty reduction. Unfortunately, there is evidence that upper-secondary TVET programs in developing countries experience high rates of dropout. The overall goal of this study is to examine the dropout rates and reasons for dropout among uppersecondary TVET students in China. To meet this goal, we have three specific objectives. First, we seek to produce high-quality estimates of dropout rates among students in upper-secondary TVET schools in one coastal and one inland province of China. Second, we seek to identify which students drop out from upper-secondary TVET. Third, we test whether financial constraints, math and computer achievement, and parental education and migration status correlate with TVET dropout. Drawing on data from a survey of 7414 upper-secondary TVET students in two provinces of China, we find dropout rates of 10.7% across both provinces and as high as 22% in poorer inland areas, suggesting major gaps and disparities in Chinese TVET dropout rates. Furthermore, we find that baseline academic performance and maternal education and migration status are strong correlates for student dropout.

A number of developing countries are currently promoting vocational education and training (VET) as a way to build human capital and strengthen economic growth. The primary aim of this study is to understand whether VET at the high school level contributes to human capital development in one of those countries—China. To fulfill this aim, we draw on longitudinal data on more than 10,000 students in vocational high school (in the most popular major, computing) and academic high school from two provinces of China. First, estimates from instrumental variables and matching analyses show that attending vocational high school (relative to academic high school) substantially reduces math skills and does not improve computing skills. Second, heterogeneous effect estimates also show that attending vocational high school increases dropout, especially among disadvantaged (low-income or low-ability) students. Third, we use vertically scaled (equated) baseline and follow-up test scores to measure gains in math and computing skills among the students. We find that students who attend vocational high school experience absolute reductions in math skills. Taken together, our findings suggest that the rapid expansion of vocational schooling as a substitute for academic schooling can have detrimental consequences for building human capital in developing countries such as China. 

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.

Can a county-based vision center increase eyeglasses use and improve school performance among primary schoolchildren in rural China? This cluster randomized clinical trial of 31 schools and 2613 participants showed that children who received eyeglasses earlier in the school year performed significantly better on an end-of-year mathematics test than children who received eyeglasses later in the year, equivalent to half a semester. Provision of free eyeglasses also improved children's use of spectacles.