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  • The China Quarterly, Volume 181
  • March 2005, pp. 100-121

Children's Social Welfare in China, 1989–1997: Access to Health Insurance and Education


Fundamental changes in China's finance system for social services have decentralized responsibilities for provision to lower levels of government and increased costs to individuals. The more localized, market-oriented approaches to social service provision, together with rising economic inequalities, raise questions about access to social services among China's children. With a multivariate analysis of three waves of the China Health and Nutrition Survey (1989, 1993 and 1997), this article investigates two dimensions of children's social welfare: health care, operationalized as access to health insurance, and education, operationalized as enrolment in and progress through school. Three main results emerge. First, analyses do not suggest an across-the-board decline in access to these child welfare services during the period under consideration. Overall, insurance rates, enrolment rates and grade-for-age attainment improved. Secondly, while results underscore the considerable disadvantages in insurance and education experienced by poorer children in each wave of the survey, there is no evidence that household socio-economic disparities systematically widened. Finally, findings suggest that community resources conditioned the provision of social services, and that dimensions of community level of development and capacity to finance public welfare increasingly mattered for some social services.

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The authors were supported while conducting this research by a Spencer Research Training Grant awarded to Jennifer Adams and a National Academy of Education Fellowship awarded to Emily Hannum. Additional support came from a Faculty Research Innovation Fund grant from Harvard University Graduate School of Education. An earlier version of this paper was presented at the Columbia University Conference on Education Reform in China (New York, 7 February 2003).
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