title: China's three-year health reform program and equity in sanitation improvement: a panel analysis.
abstract: BACKGROUND
  Accessible improved sanitation is critical to child health, and inequities in improved sanitation can be interpreted as health inequities across socio-economic groups. From 2009 to 2011, the Chinese government invested 4.448 billion yuan for rural sanitation improvement through a 3-year health reform program. This study assesses the inequity of sanitation improvement in rural China from 2003 to 2011 and examines whether the 3-year health reform program promoted equity in sanitation improvement.
  
  
  METHODS
  Data from the China Health Statistics Yearbooks of 2004 to 2012 and the National Bureau of Statistics of China were used to create the concentration curve (CC), concentration index (CI), and absolute concentration index (ACI) of improved sanitation. Data of central investment for sanitation improvement in each province of China for 2009, 2010, and 2011 was gained through correspondence and used to create the CC and CI for investment.
  
  
  RESULTS
  Although the CIs of improved sanitation are lower than the CIs of the net income of rural residents, the latter have an obvious downtrend. The CIs of improved sanitation increased from 2003 until 2008 and started to drop in 2009. As a result, by 2011, the CIs of improved sanitation had reached their 2003 levels. The ACI of improved sanitation decreased slightly from 2003 to 2008, but declined sharply from 2009 to 2011. The CIs of central investment for 2009, 2010, and 2011 are negative and the CCs of central investment are above the line of absolute equality, indicating that investments had been concentrated more on poorer provinces and regions.
  
  
  CONCLUSIONS
  The equality of rural residents' net income has been improving each year, whereas equity in sanitation improvement deteriorated from 2003 to 2008. However, equity in sanitation improvement has increased since 2009 due to central investment in sanitation improvement during the 3-year health reform program that benefits low-income areas more. It is clear that the 3-year health reform program played an important role in promoting the level and equity of sanitation improvement.
authors: School of Economics and Management, Beijing University of Posts and Telecommunications, Beijing, 100876, China. tell714@gmail.com.
authors: Xiaolong
authors: X
authors: Li
authors: China National Health Development Research Center, NHFPC, Beijing, 100083, China. miaohanxinyun@126.com.
authors: Yanqing
authors: Y
authors: Miao
authors: School of Economics and Management, Beijing University of Posts and Telecommunications, Beijing, 100876, China. cwjbupt@163.com.
authors: Wenjing
authors: W
authors: Chen
mesh_terms: D002681:China; D006293:Health Promotion / Q000458:organization & administration*; D006801:Humans; D007182:Income / Q000706:statistics & numerical data*; D011204:Poverty Areas; D012424:Rural Population / Q000706:statistics & numerical data*; D012499:Sanitation / Q000191:economics / Q000706:statistics & numerical data*
references: Int J Equity Health. 2013 Jul 18;12:53
references: 23866925
references: Bull World Health Organ. 2012 Aug 1;90(8):578-87
references: 22893741
references: Aust N Z J Public Health. 2013 Jun;37(3):211-7
references: 23731102
references: Annu Rev Public Health. 2000;21:543-67
references: 10884964
references: Soc Sci Med. 2002 Jun;54(11):1657-67
references: 12113447
references: BMC Health Serv Res. 2013 Mar 25;13:114
references: 23530658
references: Health Policy. 2010 Jan;94(1):14-25
references: 19735959
references: Aust N Z J Public Health. 2002 Apr;26(2):136-43
references: 12054332
references: Bull World Health Organ. 2008 Sep;86(9):710-7
references: 18797647
references: Lancet. 2010 Mar 27;375(9720):1110-9
references: 20346817
references: BMJ. 2001 Sep 22;323(7314):678-81
references: 11566834
references: PLoS Med. 2010 Nov 09;7(11):e1000367
references: 21085694
references: Soc Sci Med. 2007 Apr;64(7):1355-62
references: 17208343
references: Soc Sci Med. 2006 Sep;63(5):1246-61
references: 16650921
references: Iran J Public Health. 2014 Aug;43(8):1148-9
references: 25927046