Abstract
BackgroundChina is reforming the way it finances health care as it moves towards Universal Health Coverage (UHC) after the failure of market-oriented mechanisms for health care. Improving financing equity is a major policy goal of health care system during the progression towards universal coverage.MethodsWe used progressivity analysis and dominance test to evaluate the financing channels of general taxation, pubic health insurance, and out-of-pocket (OOP) payments. In 2012 a survey of 8854 individuals in 3008 households recorded the socioeconomic and demographic status, and health care payments of those households.ResultsThe overall Kakwani index (KI) of China’s health care financing system is 0.0444. For general tax KI was −0.0241 (95% confidence interval (CI): −0.0315 to −0.0166). The indices for public health schemes (Urban Employee Basic Medical Insurance, Urban Resident’s Basic Medical Insurance, New Rural Cooperative Medical Scheme) were respectively 0.1301 (95% CI: 0.1008 to 0.1594), −0.1737 (95% CI: –0.2166 to −0.1308), and −0.5598 (95% CI: –0.5830 to −0.5365); and for OOP payments KI was 0.0896 (95%CI: 0.0345 to 0.1447). OOP payments are still the dominant part of China’s health care finance system.ConclusionChina’s health care financing system is not really equitable. Reducing the proportion of indirect taxes would considerably improve health care financing equity. The flat-rate contribution mechanism is not recommended for use in public health insurance schemes, and more attention should be given to optimizing benefit packages during China’s progression towards UHC.
Highlights
China is reforming the way it finances health care as it moves towards Universal Health Coverage (UHC) after the failure of market-oriented mechanisms for health care
Various countries have designed and implemented health sector reforms to bring about Universal Health Coverage (UHC), and the World Health Organization (WHO) has called for health systems to move towards UHC, where there are ‘key promotive, preventive, curative and rehabilitative health interventions for all at an affordable cost, thereby achieving equity in access’ [1]
Government Welfare Insurance Scheme (GWIS) mainly covered civil servants, other government employees, veterans and college students, whereas Labor Insurance Scheme (LIS) was for workers and their dependents across all the formal sectors of the economy [6].Cooperative Medical Scheme (CMS) played a key role in guaranteeing access to basic health services for the vast majority of the rural population, especially the poor [7]
Summary
China is reforming the way it finances health care as it moves towards Universal Health Coverage (UHC) after the failure of market-oriented mechanisms for health care. China is reforming the way it finances its health care system as it moves towards UHC after the failure of the market-oriented approach to health care. During the period of the planned economy, China’s social health insurance consisted of the Government Welfare Insurance Scheme (GWIS), the Labor Insurance Scheme (LIS) for those in urban areas and the Cooperative Medical Scheme (CMS) for those in rural areas. GWIS mainly covered civil servants, other government employees, veterans and college students, whereas LIS was for workers and their dependents across all the formal sectors of the economy [6].CMS played a key role in guaranteeing access to basic health services for the vast majority of the rural population, especially the poor [7]. Taking the year 1980 as an example, OOP expenditure accounted for only 21.19% of all health care financing [8]
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