The positive impact of access to healthcare on health and survival among older adults is well-documented in Western societies. However, whether the pattern still holds in developing countries where healthcare coverage is more limited is largely unknown. China, a developing country with the largest population in the world, has been transforming its antiquated healthcare system during the past few decades in response to rapid population aging. Yet, in recent years the lack of access to healthcare has been identified as the top concern by most citizens in China. We used the Chinese Longitudinal Healthy Longevity Survey and the community-level data sources from the National Bureau of Statistics of China to examine the impact of current as well as childhood access to healthcare services on subsequent three-year survival and healthy survival at old ages from 2002 to 2005 under a multilevel context. Healthy survival was measured by a cumulative deficit index calculated from thirty-nine variables pertaining to various dimensions of health. Our analyses showed that access to healthcare at present and during childhood improved the odds of subsequent three-year survivorship by 13–19% and 10%, respectively, controlling for various confounders. But the effect of access to healthcare at present was no longer statistically significant once baseline health status in 2002 was controlled for. Access to healthcare at present increased odds of healthy survival by 22–68%, while access to healthcare in childhood increased odds of healthy survival by 18%. All patterns held true for both men and women, for urban and rural areas, across ages, as well as across socioeconomic statuses. Our findings suggested that positive inputs such as access to healthcare services over the life course make a substantial difference in healthy longevity, which has implications for the establishment of the universal healthcare system.
With the transformation of China's healthcare system from a government-managed system that provided affordable basic healthcare to all citizens to a market-oriented system, Chinese people have witnessed a universal and substantial decline in access to healthcare in spite of China's rapid economic growth since the late 1970s (Bloom and Gu, 1997, Blumenthal and Hsiao, 2005 and Yip and Hsiao, 2008). In addition, according to the Chinese government, there is severe inequality in healthcare services between cities and rural areas, with 80 percent of health resources (e.g., hospitals and healthcare practitioners) allocated to the cities. Coastal regions have also enjoyed more health resources than inland regions (Lee, 2004). Due to lack of adequate public funding, many rural clinics have become privatized for-profit institutions, and rural residents have witnessed a greater decline in access to healthcare than urban people (Lee, 2004 and Yip and Hsiao, 2008). In short, skyrocketing medical costs are prohibiting people with low socioeconomic status and older people from getting basic healthcare services in both rural and urban areas (Gu and Vlosky, 2008, Liu et al., 2002 and Liu et al., 2007). For the first time since the economic reform, healthcare replaced employment as the most important concern in 2002 among urban residents (Dong, 2003).
The steady decline in access to healthcare could have a negative impact on the health and well-being of Chinese people. The purpose of this study is to provide solid empirical evidence on whether access to healthcare can enhance healthy longevity at old ages. Before the second half of this century, China will have the largest number of the elderly in the world, at a time when its healthcare system will undergo major transformation. The investigation of the relationship between access to healthcare and health outcomes helps us better understand the role of access to healthcare as a positive input on the stock of health capital at old ages (Grossman, 1972), and provides important information to policy makers as they try to revamp the country's healthcare system.
