2008年-世界发展银行全球_Health_Reform_Population_Policy_and_Child_Nutritional_Status_in_China_23页_177kb

Summary of "Health Reform, Population Policy and Child Nutritional Status in China"

Core Content

This working paper investigates the impact of two major public policies on child nutritional status in China during the 1990s: the one-child family policy and health sector reform. The analysis uses data from four waves of the China Health and Nutrition Survey (CHNS) across seven provinces, focusing on the relationship between income, access to quality healthcare, and being an only-child on child nutritional status.

Main Points

• National Trends in Child Undernutrition: There was a significant decline in child undernutrition in China during the 1990s, with stunting among children under five decreasing by 42% between 1992 and 2002.

• Policy Context:

  • One-child Policy: Introduced in 1979, it aimed to reduce fertility through a combination of incentives and penalties. Over time, it became more stringent, with second births being largely forbidden, leading to a sharp increase in the number of only-children, especially among rural populations.
  • Health Sector Reform: This reform led to increased costs and reduced access to healthcare services, with a significant rise in the real cost of medical visits and travel. However, there were some improvements in waiting times and medicine availability, suggesting mixed effects on healthcare quality.

• Theoretical Model: The paper uses a modified version of Becker's household production model and Grossman's health demand model. It assumes that child nutritional status depends on both endogenous and exogenous factors, including income, access to healthcare, and being an only-child.

• Data and Methodology:

  • Data is drawn from the CHNS, covering 1991–2000.
  • The study employs OLS, random effects (RE), fixed effects (FE), and instrumental variables (IV) models to analyze the relationships.
  • The FE model is preferred due to its ability to control for unobserved community-level factors that may be correlated with explanatory variables.

• Key Variables:

  • Nutritional Status: Measured using height-for-age z-scores (and length-for-age z-scores for children under 36 months).
  • Income: Measured as the logarithm of real per adult income, adjusted for price variations.
  • Only-child Status: Defined as a child under 18 with no siblings under 18.
  • Healthcare Access: Includes travel time, travel cost, cost of treating a cold, and waiting time. A measure of medicine availability is also included.

• Empirical Findings:

  • Only-child Effect: Being an only-child is found to increase height-for-age z-scores by 0.119 standard deviations, and this effect is largely gender and income neutral.
  • Income Effect: The effect of income on child nutritional status is significant in the basic OLS model, but diminishes when policy variables are included.
  • Healthcare Access: While the study finds no significant association between access to quality healthcare and improved nutritional status in the preferred model, the data suggests that healthcare access has deteriorated in terms of cost and time, though some improvements in waiting times and medicine availability are noted.

Key Information

• Policy Impact: The one-child policy is shown to have a measurable positive impact on child nutritional status, likely due to increased resource allocation per child and changes in maternal behavior and health-seeking patterns.

• Model Results:

  • In the basic OLS model, the income coefficient is 0.1.
  • When only-child status is controlled for, the income coefficient drops to 0.08.
  • When healthcare variables are introduced, the coefficient further decreases to 0.06.
  • In the fixed effects model, the only-child coefficient is 0.10, indicating that the effect is partially captured by income and other variables.

• Robustness Checks: The study uses cluster-robust standard errors to account for potential correlation in errors within communities. The Hausman test confirms the superiority of the fixed effects model over the random effects model.

Conclusion

The paper highlights that while income is a significant determinant of child nutritional status, its effect is mediated by policy changes, particularly the one-child policy. The findings suggest that the one-child policy has a substantial and positive impact on child nutrition, independent of income, and that health sector reforms may have had limited or no effect on nutritional status in the preferred model. The study underscores the importance of considering policy interactions when analyzing health and nutrition outcomes.