Social Protection for Children

China

Hana Brixi & UNICEF China Social Policy Team

ADB – UNICEF Social Protection Conference
Manila, April 2010
Disclaimer: The views expressed in this paper/presentation are the views of the author and do not necessarily reflect the
views or policies of the Asian Development Bank (ADB), or its Board of Governors, or the governments they represent.
ADB does not guarantee the accuracy of the data included in this paper and accepts no responsibility for any
consequence of their use. Terminology used may not necessarily be consistent with ADB official terms.
 Child-sensitive social protection highlights

ƒ Massive expansion of social protection coverage in

the past five years… benefitting children in China’s
rural and urban areas!
ƒ Yet, challenges remain… benefits tend to be low,
inequities across and within China’s localities
persistent
ƒ UNICEF’s contribution sought at the upstream policy
level… to support the move beyond the individual
schemes to a cohesive system of social welfare for
children in China
Economic development and poverty 1978-2009
Rapid Economic Development
ƒ GDP real annual growth rate over
the past 30 years was about 10
percent
ƒ GDP per capita from $175 per
capita income in 1978 to around
US$3,700 in 2009
ƒ Income Disparities
ƒ Economic growth uneven across
China
ƒ Growing income disparities,
particularly rural-urban within
provinces
ƒ Disparities in HD outcomes, only
partly addressed by vertical
programs and earmarked transfers
Poverty Reduction Performance
ƒ Extreme poverty eliminated
ƒ The share of the poor declined from
90% to less than 20%
ƒ Vulnerability to poverty still concerning
about 30% of population
ƒ Social Assistance
ƒ China’s social safety net established,
Dibao cash transfers targeting both
rural and urban poor
ƒ Coverage and benefit levels to rise and
address the needs of children
ƒ Comprehensive social welfare system
for children under consideration
 Social protection schemes to promote the
rights and well-being of children
ƒ Social Assistance
ƒ Dibao cash transfer Scheme (*2002 for urban and *2007 for rural) covering
71.7m in 2/2010, 1/4 recipients are children
ƒ Medical finance assistance (*2005)
ƒ Social Insurance
ƒ New Rural Cooperative Medical Scheme (*2004) covering 94% of rural
residents in 12/2009
ƒ Urban Residents Basic Medical Insurance Scheme (*2007) covering over
200m previously uninsured urban population at the end of 2008
ƒ Rural pension scheme (*2009) piloted in 10% counties of China
ƒ Other social insurance - employment based
ƒ Pension, Work Injury, Maternal Insurance, and Unemployment
ƒ Fee Waiver
ƒ Free compulsory 9-year education (2006 law revision): Nation-wide tuition
and miscellaneous fees waiver; free textbooks and boarding subsistence for
the poor in rural areas
 Social protection after the 2008 earthquake

ƒ Disaster relief cash subsidy at $1.5/person/day for 3 months

ƒ Disaster relief in-kind to children and women including food,
clothing and shelter
ƒ Psychosocial intervention for children and women including CFS
ƒ Free MCH service to children and women in relief & recovery
ƒ Priority reconstruction on schools and hospitals
ƒ Solid orphan assistance policy framework including cash
subsidy at $88/month per orphan
ƒ Cash subsidy to 1.5 million rural families at $2940/family & free
land reassignment for housing reconstruction
ƒ Financial support and capacity building to support women
seeking employment
Social protection to tackle the impact of recent
food price increases
Social protection in the current fiscal stimulus
package responding to the global financial crisis and
economic slowdown ($586 billion)

…allowing for a huge increase in central government

spending in 2009 – on health (by 50%), education (by 24%),
housing for the poor (by 203%) and social protection (by 20%)
Government spending on health, education and
social assistance increasing (% of GDP)
Rural-urban disparities in maternal and child mortality
declining since the 1990s
Population coverage of the RCMS and Dibao
schemes rising

(millions)
 Utilization of outpatient care improving

Two‐week clinical visit ratio (‰)
20
2003
15
2008
10
5
0
poorest  middle  richest  poorest  middle  richest 
quintile quintile quintile quintile quintile quintile

urban  rural

Source: 2003 & 2008 National Health Services Survey

 Utilization of inpatient care improving

Hospitalization ratio (‰)
10
2003
8
2008
6
4
2
0
poorest  middle  richest  poorest  middle  richest 
quintile quintile quintile quintile quintile quintile

urban rural

Source: 2003 & 2008 National Health Services Survey

 Dibao cash transfer recipients include an increasing
share of the poor
(millions)

Source: Ministry of Civil Affairs, China Civil Affairs’ Statistical Yearbook, 2009
 Average dibao cash benefit received rising
RMB/ capita/ month

220

200

180

160

140

120

100

80

60

40

20

0
Urban Rural Urban Rural Urban Rural
2006 2007 2008
Average Income
Average dibao received by eligible
Source: Ministry of Civil Affairs, China Civil Affairs’ Statistical Yearbook, 2009 households
 Social assistance proven to work for children

ƒ Good targeting – Surveys confirm that the most needy

children and families are generally covered
• Dibao recipients use the cash benefit to improve child nutrition,
education and health care utilization
ƒ Nearly universal access to basic education
• Surveys confirm that almost every child has access to the compulsory 9-
year education
ƒ Rapidly improving access to basic public health services
• Surveys confirm that an increasing majority of mothers and children able
to obtain hospital delivery service and core public health services (vertical
public health programs)

Source: 2007 - 2009 UNICEF-supported studies

 Challenges remain
ƒ Funding still insufficient, hence
benefit levels low (albeit rising)
ƒ Fragmentation of social
protection schemes
geographically and by
population groups
ƒ Allocation of public resources
yet to adequately promote
equity and efficiency,
particularly at the local levels
ƒ Health insurance service benefit
package not cost-effective
(inpatient vs. outpatient care)
ƒ Utilization and quality of
essential social services
inequitable
ƒ Migrant and the poorest
children and women only
gradually benefit from social
protection / services
ƒ Social workers profession and
role in social protection only
emerging
ƒ Children's needs and rights only
gradually being recognized and
reflected in social protection
design & implementation
 Minimum living standards and consumption
RMB
expenditures unequal (by province, 2009)
18,000

16,000

14,000

12,000

10,000

8,000

6,000

4,000

2,000

ao ia
on ng
N ing

Ji ong
H ng

G Fu g

ai
ua n

B su
Q ang

A xi

an g
G ou

e g
ng ai

H xia

nn i
H an

an jin
H ui
ch i
Sh nan

lin

Ti an

ng an
ne ng i
su

Sh an
nj t

Ji ei
gx
Yu nx

Si nx

Li gol
In ilo ube

n
Xi be

G ua

Sh jian
Zh jin

gh
ng
ho h

r M jia
nh
eb

ni

do

g
Sh an
zh

Ji

u a ji
un
an

en
g

an
C ing

aa

d
Ti

an
i

ei
ai
in

H H
ui
G

Urban consumption expenditure Rural consumption expenditure

Sources: Ministry of Civil Affairs, China Civil Affairs’ Urban minimum living standard Rural minimum living standard
Statistical Yearbook, 2009 (urban dibao standard);
National Bureau of Statistics, China Statistical Rural poverty line
Yearbook, 2009 (consumption); Ministry of Civil Affairs
(rural dibao standard)
 Out-of-pocket expenditure on health still significant
Percentage of GDP

5.00

4.50

4.00

3.50

3.00

2.50

2.00

1.50

1.00

0.50

0.00
87

90

93

96

04

07
79
80
81
82
83
84
85
86

88
89

91
92

94
95

97
98
99
00
01
02
03

05
06

08
19

19

19

19

20

20
19
19
19
19
19
19
19
19

19
19

19
19

19
19

19
19
19
20
20
20
20

20
20

20
Government health expenditure
Social health expenditure
Source: Ministry of Health, China Health Statistical Yearbook, 2009 Out-of-pocket health expenditure
Can the poor, even if insured, afford co-payment?

RCMS reimbursement rate

(eligible inpatient, % of medical bills)

2005 2006 2007 2008

Eastern Region 22.5 26.1 29.2 34.1

Central Region 24.5 29.5 31.3 40.6

Western Region 28.8 31.1 33.8 40.6

National Average 23.4 27.8 30.9 38.1

Source: China Health Economics Institute, 2009

 Although government contribution increases,
RCMS still underfunded

2009
2004 2005 2006 2007 2008 (est.)
Total funding
(100m yuan) 40 75 214 428 785 1275

Per capita
funding (yuan)
50 42 52 59 96 120

Source: MOH

In 2009, about 80% of the total funded by government

The poor less likely to benefit from the most
advantageous schemes (2006)
Social Government Commercial no insurance
100%

90% 17%
25%
31%
80% 46% 7%
56% 7% 7%
70%
7% 4%
60% 3%

50% 6%
2%
40% 5%
3%
69%
64%
30% 59%
46%
20% 36%
10%

0%
Poorest Quintile 2nd 3rd 4th Richest Quintile
 The poor are served less by higher-level facilities
Choice of provider by income group, 2006

50%
Provincial City District Community Private Clinic
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
Poorest quintile 2nd,3rd,4th Richest quintile
 Poor children are less likely to enroll in better schools
(which benefit from higher government financing)
Type of school attended by income group, 2006
(% of children enrolled in a given type of school)
50%
45% Richest Quintile Poorest Quintile

40%
35%
30%
25%
20%
15%
10%
5%
0%
Provincial key City key school District key school Ordinary school
school
UNICEF’s contribution in social protection at the
upstream level
ƒ Strategic partnerships
ƒ NDRC, MOF, LGOP, MCA, NWCCW – policy dialog, analytic
and advisory activities at the highest upstream level
ƒ Data analysis for policy
ƒ Confidential analyses for policy options and decisions
ƒ Evidence-based advocacy –
ƒ Closed-door policy seminars as well as contribution to the
public debate
ƒ Sharing and adapting international & local practice
ƒ UNICEF as knowledge broker and connector
 UNICEF’s contribution in social protection at the
upstream level
ƒ Assisting to develop the national strategic policy frameworks,
laws and plans to:
ƒ Establish a comprehensive child poverty reduction program as part of
China’s poverty reduction strategy
ƒ Develop a comprehensive social welfare system for children across
sectors and beyond the individual vertical programs and schemes
ƒ Promote fairness, quality and cost-effectiveness in the delivery of
essential social services
ƒ Improving policy implementation mechanisms
Namely government financing allocations & mechanisms, and local
governance system (including accountability relationships and women
empowerment) to:
ƒ Ensure proper implementation of child-sensitive social protection and
policies at the local level
ƒ Align incentives, responsibilities and capacities across government levels
and agencies with the national priorities toward realizing child rights
 Thank you!

UNICEF China Social Policy Team

Hana Brixi (hbrixi@unicef.org), Shi Weilin,
Mu Yan, Huang Jun, and Bai Xiaojing