China has undergone great economic and social change since 1978 with far reaching implications for the health care system and ultimately for the health status of the population. The Chinese Medical Reform of the 1980s made cost recovery a primary objective. The urban population is mostly protected by generous government health insurance. A high share government budget is allocated to urban health care. Rural cooperative health insurance reached a peak in the mid-1970s when 90% of the rural population were covered. In the 1980s rural cooperative health insurance collapsed and present coverage is less than 8%. The decline has been accompanied by reports of growing equity problems in the financing of and access to health care. This article is the first in a four-year study of the impact on equity of the changes in Chinese health care financing. The article examines the relationship between rural cooperative health insurance as the explanatory variable and health care expenditure, curative vs. preventive expenditure and tertiary curative care expenditure as dependent variables using a natural experimental design with a 'twin' county as a control. The findings support the hypothesis that cooperative health insurance will induce higher growth of health care expenditure. The findings also support the hypothesis that cooperative health insurance will lead to a shift from preventive medicine to curative medicine and to a higher level of tertiary curative care expenditure. The empirical evidence from the Chinese counties is contradicting World Bank health financing policies.

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Health sector reforms in China, instituted starting in 1985, have centred on cost recovery, with fee-for-service revenue replacing public budget funding. The share of public funding for maternal health services was reduced greatly, forcing an increasing proportion of pregnant women to pay for deliveries and treatment of pregnancy-related complications out of pocket, as most had no health insurance to cover these costs. This study aimed to identify socio-economic variables associated with utilisation of essential maternal health services and linked to health sector reforms in China, with a focus on cost recovery. A retrospective household survey (n = 5756) was carried out in six counties in three provinces of Central China in 1995. Antenatal service utilisation continued to improve in 1990-95, but only in relation to the number of visits, which were pre-paid if the woman was participating in a maternal pre-payment scheme or covered by another health insurance scheme. Significant decreases were found in the utilisation of skilled attendance at delivery and hospital delivery, as well as differences in adverse pregnancy outcomes (miscarriages and stillbirths) between women paying out of pocket and those covered by insurance. This study confirms a strong association between utilisation of delivery services and financing variables of amount of savings in the bank, maternal pre-payment schemes and health insurance. It also shows the critical importance of out-of-pocket, fee-for-service payments for maternity care as a barrier to the utilisation of these services.

The correlation between mean surface air temperature and altitude is analyzed in this paper based on the annual and monthly mean surface air temperature data from 106 weather stations over the period 1961-2003 across the Qinghai-Tibet Plateau. The results show that temperature variations not only depend on altitude but also latitude, and there is a gradual decrease in temperature with the increasing altitude and latitude. The overall trend for the vertical temperature lapse rate for the whole plateau is approximately linear. Three methods, namely multivariate composite analysis, simple correlation and traditional stepwise regression, were applied to analyze these three correlations. The results assessed with the first method are well matched to those with the latter two methods. The apparent mean annual near-surface lapse rate is -4.8 °C /km and the latitudinal effect is -0.87 °C /˚latitude. In summer, the altitude influences the temperature variations more significantly with a July lapse rate of -4.3°C /km and the effect of latitude is only -0.28°C /˚latitude. In winter, the reverse happens. The temperature decrease is mainly due to the increase in latitude. The mean January lapse rate is -5.0°C /km, while the effect of latitude is -1.51°C /˚latitude. Comparative analysis for pairs of adjacent stations shows that at a small spatial scale the difference in altitude is the dominant factor affecting differences in mean annual near-surface air temperature, aided to some extent by differences of latitude. In contrast, the lapse rate in a small area is greater than the overall mean value for the Qinghai-Tibet Plateau (5 to 13°C /km). An increasing trend has been detected for the surface lapse rate with increases in altitude. The temperature difference has obvious seasonal variations, and the trends for the southern group of stations (south of 33˚ latitude) and for the more northerly group are opposite, mainly because of the differences in seasonal variation at low altitudes. For yearly changes, the temperature for high-altitude stations occurs earlier clearly. Temperature datasets at high altitude stations are well-correlated, and those in Nanjing were lagged for 1 year but less for contemporaneous correlations. The slope of linear trendline of temperature change for available years is clearly related to altitude, and the amplitude of temperature variation is enlarged by high altitude. The change effect in near-surface lapse rate at the varying altitude is approximately 1.0°C /km on the rate of warming over a hundred-year period.