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Health Policy and Planning Advance Access originally published online on May 8, 2009
Health Policy and Planning 2009 24(5):324-334; doi:10.1093/heapol/czp016
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Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2009; all rights reserved.

Determinants of health care demand in poor, rural China: the case of Gansu Province

Dongfu Qian1,*, Raymond W Pong2, Aitian Yin3, K V Nagarajan4 and Qingyue Meng3

1School of Health Policy and Management, Nanjing Medical University, Hanzhong Road 140, Nanjing 210029, Jiangsu Province, China.
2Centre for Rural and Northern Health Research, Laurentian University, Ramsey Lake Road, Sudbury, ON, Canada P3E 2C6.
3Center for Health Management and Policy, Shandong University, Wen Hua Xi Rd. 44, Jinan 250012, Shandong, P.R. China.
4Department of Economics and the Centre for Rural and Northern Health Research, Laurentian University, Ramsey Lake Road, Sudbury, ON, Canada P3E 2C6.

* Corresponding author. School of Health Policy and Management, Nanjing Medical University, Hanzhong Road 140, Nanjing 210029, jiangsu Province, China. Tel: +86-25–86862948. Fax: +86-25–86862949. E-mail: qiandf006{at}hotmail.com

This paper examines the determinants that influence health care demand decisions in rural areas of Gansu province, China. This represents the first effort to identify and quantify the effect of price of care on choice of provider in China, and is the first quantitative examination of this topic focusing on poor rural areas in China. In the three-tier health care system in rural China, we further distinguish the public village clinics and private village clinics using a mixed multinomial logit model. The results show that price and distance play significant roles in choice of health care provider. The price elasticity of demand for outpatients is higher for low-income groups than for high-income groups. When outpatients have particular concerns about provider quality or reputation, or when their health status is poor, distance tends to matter less, i.e. they are willing to travel further in order to obtain better treatment for their illness. Insurance status has a significant impact on the choice of public village clinics relative to self-treatment. Furthermore, age and the attributes of illness are also statistically significant factors. We discuss the policy implications of the results for meeting the health care needs of the poor in rural China.

Key Words: Health care seeking behaviour, rural health, insurance, health policy, health economics, China

Accepted for publication 3 December 2008.


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