ISSN (Print) - 0012-9976 | ISSN (Online) - 2349-8846

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Financing Health Care in China-Implications of Some Recent Developments

Implications of Some Recent Developments PGK Panikar After Liberation the Chinese leadership showed an astute understanding of the nature of health problems and evolved ways of resolving them within the constraints imposed by limited resources. Some of those innovations, the reliance on non-pecuniary incentives to motivate the masses to get involved in preventive health programmes, a multi-tiered network of medical care facilities, appropriate skill and training for medical personnel at different points, all have financial implications which are equally relevant to other developing countries.

Fertility Decline in Kerala-Social Justice Hypothesis

Fertility Decline in Kerala Social Justice Hypothesis PGK Panikar RATCLIFFE's formulation of the social justice (equity-fertility) hypothesis in his attempt to explain Kerala's fertility decline had a weak empirical basis, as brought out by Moni Nag in his recent paper (EPW, January 7, 1981). Nag has chosen to test the equity-fertility hypothesis by comparing Kerala with West Bengal, the State which is pretty similar with respect to the factors governing fertility according to this hypothesis. It is found that while the distribution of income and assets in Kerala is more skewed than in West Bengal the opposite is the case with respect to social service like education and health. Nag, therefore, concludes: "A comparative study of Kerala and West Bengal suggests that the higher decline of fertility in Kerala is associated more with greater equity in education and health facilities than with greater equity in income and assets." (p 40) Thus, the main difference between Ratcliffe and Nag seems to be in the choice of the parameters for the empirical verification of the equity-fertility hypothesis; according to Nag, equity in the distribution of income should also include the access to social services such as education and health. However, even this modified version does not capture all the factors which moti- vate parents in opting for fewer children. Ratcliffe refers, in passing though, to the alternative hypothesis suggested by Libenstein (1957). and Schultz (1981) according to which fertility declies in response to the decrease in the benefits and increase in the costs of children, thanks to economic development and the associated changes. Nag himself (1980), in his extensive review of the literature on fertility response to modernisation under Easterlies 'synthesis' framework, has highlighted this aspect. Thus, the demand for children is governed by (i) labour value of children, (ii) children's value as old age support and risk insurance, (3) economic costs of children, and (4) infant and child mortality. The process of modernisation in this context comprehends economic growth and its concomitant changes, including shifts in the sectoral shares of output and labour force, participation of women in work out side their homes, urbanisation, progress in educaton and health, emergence of social security system, regulation of child labour, compulsory education, etc. These changes get reflected in the progressive erosion of the value ol children as sources of current income and old age support and security. On the other hand, with modern- isatioiu the costs of bearing and rear- ing children tend to increase. The fall in infant and child mortality rates ensures the survival of the desired number of children. (The decrease in the benefits and increase in the costs of children motivate parents to adopt family planning leading to fall in fertility. It is these changes affecting the motivations of parents that set in motion the last phase of the demographic transition in today's low-fertility countries. We shall argue in this note that in the case of Kerala also, it is the change in parental attitudes and motivations, thanks to the altered benefit- cost ratio of children, which stimulated increasing acceptance of birth control resulting in the rather sharp and rapid fall in fertility.
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