Abstract
BackgroundHealthcare financing should be equitable. Fairness in financial contribution and protection against financial risk is based on the notion that every household should pay a fair share. Health policy makers have long been concerned with protecting people from the possibility that ill health will lead to catastrophic financial payments and subsequent impoverishment. A number of studies on health care financing equity have been conducted in some provinces of China, but in Guangxi, we found such observation is not enough. What is the situation in Guagnxi? A research on rural areas of Guangxi can add knowledge in this field and help improve the equity and efficiency of health financing, particularly in low-income citizens in rural countries, is a major concern in China’s medical sector reform.MethodsSocio-economic characteristics and healthcare payment data were obtained from two rounds of household surveys conducted in 2009 (4634 respondents) and 2013 (3951 respondents). The contributions of funding sources were determined and a progressivity analysis of government healthcare subsidies was performed. Household consumption expenditure and total healthcare payments were calculated and incidence and intensity of catastrophic health payments were measured. Summary indices (concentration index, Kakwani index and Gini coefficient) were obtained for the sources of healthcare financing: indirect taxes, out of pocket payments, and social insurance contributions.ResultsThe overall health-care financing system was regressive. In 2013, the Kakwani index was 0.0013, the vertical effect of all the three funding sources was 0.0001, and some values exceeded 100%, indicating that vertical inequity had a large influence on causing total health financing inequity. The headcount of catastrophic health payment declined sharply between 2009 and 2013, using total expenditure (from 7.3% to 1.2%) or non-food expenditure (from 26.1% to 7.5%) as the indicator of household capacity to pay.ConclusionOur study demonstrates an inequitable distribution of government healthcare subsidies in China from 2009 to 2013, and the inequity was reduced, especially in rural areas. Future healthcare reforms in China should not only focus on expanding the coverage, but also on improving the equity of distribution of healthcare benefits.
Highlights
The concentration indices of tax decreased from 0.4247 to 0.3559 and for out-ofpocket payments decreased from 0.3360 to 0.1822 but there was an increase in social insurance
Compared with Thailand, another developing country in Asia well known for its success in health financing equity, our study showed a similar trend after universal health insurance coverage
The concentration indexes for out-of-pocket payments in 2003 and 2008 were 0.43 and 0.50, and the Kakwani indexes were 0.04 and 0.12, respectively. All these results indicate that the health finance by tax changed little relative to a person’s ability to pay, and the New Cooperative Medical Scheme (NCMS) improved the equity of social health security expenditure in rural areas, commercial health insurance increased for poor families, and out-of-pocket payments among wealthy families increased
Summary
A number of studies on health care financing equity have been conducted in some provinces of China, but in Guangxi, we found such observation is not enough. The fairness of health financing has become a major concern for both governments and its citizens. What constitutes a fair share depends on people’s expectations as to how health systems are financed [2, 3]. Vertical equity means that people with dissimilar abilities should make dissimilar levels of contribution to the health-care financing system [5, 6]. The means of financing health care has been identified as a barrier to access to healthcare and increases the likelihood of impoverishment of households [9, 10]
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