A gendered view of reforming health care access for farmers in China

Purpose - The social safety net of health care insurance is rapidly expanding in rural China. New Rural Cooperative Medical System (NRCMS) programs proliferated between the national decree of 2002 and 2008, moving from a situation where less than 10 per cent of the rural population had access to health insurance to one where over 80 per cent had the opportunity to participate in these programs. The purpose of this paper is to investigate how NRCMS affects equity goals in access to health care and explore the gender‐specific determinants for farmers to participate in NRCMS and use health care services. Design/methodology/approach - Empirical analysis, by using the national rural socio‐economic survey data collected by the Centre for Chinese Agricultural Policy, Chinese Academy of Sciences in 2005. Based on Andersen's access to medical care model, the probit model for regression was used. All analyses are conducted with Stata 9.0 software. Findings - Gender was found to have significant effects on both NRCMS participation and health care use. Age, education, deductible level and ceiling limits of reimbursement had positive effects on both NRCMS participation and health care use. The narrow coverage with high co‐payment compensation system asserted significant deterrence effects on equity access to health care. This is only a first step toward building an adequate health safety net for all rural residents, there is still a long way to go. Originality/value - Using the national household survey data, this study is one of few studies focusing on the interplay between gender and the distinct determinants of access to health care under the ongoing NRCMS. The relevant findings have important implications for further policy design.