Trends in health services utilization in eight provinces in China, 1989-1993

Continued pursuit of market-oriented reforms in China seems to have resulte d in increasing income disparities. This has raised concerns about possible declines in the use of health services by the poor. Using data from three waves of the China Health and Nutrition Survey (1989, 1991, 1993), we exami ne whether people age 20-45 in eight provinces became less likely to seek c are when ill. We carried out three probit estimations of seeking care when ill; the predictor variables include individual and workplace characteristi cs, a measure of the severity of illness and community level factors. Healt h care is broadly defined to include basic level clinics as well as urban h ospitals. We find no evidence that health care utilization is decreasing. R ather, for people in a community survey reporting mainly mild or moderate i llness, health care continues to be accessible. We consider possible limits of our study and discuss extensively the implications of the use of illnes s reports from the three cross-sectional surveys as health status indicator s. (C) 1998 Elsevier Science Ltd. All rights reserved.