where variation among counties and among provinces is large. These differences in public spending translate into differences in social outcomes. Up through 1990, there were only modest differences across provinces in infant survival rate, but by 2000 there had emerged a very sharp difference, closely related to the province's per capita GDP. So too with the high-school enrollment rate: there used to be small differences across provinces. By 2003, high-school enrollment was nearing 100% in the wealthier provinces while still less than 40% in poor provinces. There is some redistribution within China's fiscal system, but arguments abound whether it is enough. Poor areas have very little tax collection and hence cannot fund education and health care. Some of their population will relocate over time. But for reasons of both national efficiency and opportunity, some theoretical economists argue for the communist state to ensure everyone has some basic education and basic health care. China's highly decentralized fiscal system results in: local government in many locations not having adequate resources to fund basic social services. As a consequence, households are left to pay for their own needs to a remarkable extent. The average hospital visit in China in 2018 is paid 35% out-of-pocket by the patient, compared to 25% in Mexico, 17% in Australia, 10% in Turkey and the United States, and lower amounts in most developed countries. Poor households either forego treatment, or travel to other cities for treatment, which can be expensive if the condition is severe. In the 2003 National Health Survey, 30% of poor households identified a large health care expenditure as the reason that they were having financial difficulties. The situation in education is similar. In a survey of 3037 villages in 2004, average primary school fees were 260 yuan and average middle-school fees, 442 yuan. A family living right at the dollar-a-day poverty line would have about 900 yuan total resources for a child for a year; sending a child to middle-school would take half of that. Not surprisingly, then, enrollment rates are relatively low in poor areas and for poor families. Women In Poverty Lead Women In Poverty In China, women are more vulnerable to suffer from severe poverty than men. More women experience multidimensional poverty (38.9% compared to 25.2%). Many individual and social characteristics shape women's experiences on poverty, such as age, education, employment, family structure, family size, urban or rural areas, etc. Article