Abstract
BackgroundMonitoring the equity of government healthcare subsidies (GHS) is critical for evaluating the performance of health policy decisions. China’s low-income population encounters barriers in accessing benefits from GHS. This paper focuses on the distribution of China’s healthcare subsidies among different socio-economic populations and the factors that affect their equitable distribution. It examines the characteristics of equitable access to benefits in a province of northeastern China, comparing the equity performance between urban and rural areas.MethodsBenefit incidence analysis was applied to GHS data from two rounds of China’s National Health Services Survey (2003 and 2008, N = 27,239) in Heilongjiang province, reflecting the information in 2002 and 2007 respectively. Concentration index (CI) was used to evaluate the absolute equity of GHSs in outpatient and inpatient healthcare services. A negative CI indicates disproportionate concentration of GHSs among the poor, while a positive CI indicates the GHS is pro-rich, a CI of zero indicates perfect equity. In addition, Kakwani index (KI) was used to evaluate the progressivity of GHSs. A positive KI denotes the GHS is regressive, while a negative value denotes the GHS is progressive.ResultsCIs for inpatient care in urban and rural residents were 0.2036 and 0.4497 respectively in 2002, and those in 2007 were 0.4433 and 0.5375. Likewise, CIs for outpatient care are positive in both regions in 2002 and 2007, indicating that both inpatient and outpatient GHSs were pro-rich in both survey periods irrespective of region. In addition, KIs for inpatient services were −0.3769 (urban) and 0.0576 (rural) in 2002 and those in 2007 were 0.0280 and 0.1868. KIs for outpatient service were -0.4278 (urban) and -0.1257 (rural) in 2002, those in 2007 were −0.2572 and −0.1501, indicating that equity was improved in GHS in outpatient care in both regions but not in inpatient services.ConclusionsThe benefit distribution of government healthcare subsidies has been strongly influenced by China’s health insurance schemes. Their compensation policies and benefit packages need reform to improve the benefit equity between outpatient and inpatient care both in urban and rural areas.
Highlights
Monitoring the equity of government healthcare subsidies (GHS) is critical for evaluating the performance of health policy decisions
In Chinese cities in 2007, a new type of urban insurance, the Urban Resident Basic Medical Insurance (URBMI), was piloted to expand the coverage of the Urban Workers Basic Medical Insurance (UWBMI), which only covers the workers in formal sectors such as stateowned and collective enterprises
It was found that the insurance coverage in rural areas was lower than that in cities in 2002, while the coverage had become much higher than in the urban areas by 2007
Summary
Monitoring the equity of government healthcare subsidies (GHS) is critical for evaluating the performance of health policy decisions. This paper focuses on the distribution of China’s healthcare subsidies among different socio-economic populations and the factors that affect their equitable distribution. It examines the characteristics of equitable access to benefits in a province of northeastern China, comparing the equity performance between urban and rural areas. Citizens who did not have a job, such as children, the aged or students, were allowed to be covered in the URBMI This basket of policies made a significant change to the GHS, with government spending as a proportion of health expenditure increasing from 15.69% in 2002 to 22.31% in 2007 [6]
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