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October 24/31, 2007

Factors Contributing to High Costs and Inequality in China's Health Care System

Author Affiliations

Author Affiliations: Department of Emergency Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, PR China.

JAMA. 2007;298(16):1928-1930. doi:10.1001/jama.298.16.1928

China, the largest developing country in the world, has experienced great economic development in recent years. Since reform and the opening-up policy were implemented in 1978, the national economy has grown at an average rate of 9.6% each year, and in 2005 China's gross domestic product (GDP) per capita reached US $1698.1 Along with economic development have come social challenges. The gap between rich and poor has widened. In 2005, China's Gini coefficient, an indicator of income distribution difference, was estimated2 at more than 0.48 (for comparison, the US Gini coefficient was 0.45 in 2004).3 Although the proportion of the population with incomes below the poverty level has decreased dramatically over the past 3 decades, about 21.5 million individuals are absolutely poor (annual income <US $85) and another 35.5 million are underprivileged (annual income US $85-$115) in China.4 More than half of the poor reside in remote western counties.4 One result of economic inequality is wide disparity in access to many social programs, especially in the health care system.