Abstract
BackgroundImproving the equitable distribution of government healthcare subsidies (GHS), particularly among low-income citizens, is a major goal of China’s healthcare sector reform in China.ObjectivesThis study investigates the distribution of GHS in China between socioeconomic populations at two different points in time, examines the comparative distribution of healthcare benefits before and after healthcare reforms in Northwest China, compares the parity of distribution between urban and rural areas, and explores factors that influence equitable GHS distribution.MethodsBenefit incidence analysis of GHS progressivity was performed, and concentration and Kakwani indices for outpatient, inpatient, and total healthcare were calculated. Two rounds of household surveys that used multistage stratified samples were conducted in 2003 (13,564 respondents) and 2008 (12,973 respondents). Data on socioeconomics, healthcare payments, and healthcare utilization were collected using household interviews.ResultsHigh-income individuals generally reap larger benefits from GHS, as reflected by positive concentration indices, which indicates a regressive system. Concentration indices for inpatient care were 0.2199 (95% confidence interval [CI], 0.0829 to 0.3568) and 0.4445 (95% CI, 0.3000 to 0.5890) in 2002 (urban vs. rural, respectively), and 0.3925 (95% CI, 0.2528 to 0.5322) and 0.4084 (95% CI, 0.2977 to 0.5190) in 2007. Outpatient healthcare subsidies showed different distribution patterns in urban and rural areas following the redesign of rural healthcare insurance programs (urban vs. rural: 0.1433 [95% CI, 0.0263 to 0.2603] and 0.3662 [95% CI, 0.2703 to 0.4622] in 2002, respectively; 0.3063 [95% CI, 0.1657 to 0.4469] and −0.0273 [95% CI, −0.1702 to 0.1156] in 2007).ConclusionsOur study demonstrates an inequitable distribution of GHS in China from 2002 to 2007; however, the inequity was reduced, especially in rural outpatient services. 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 equity of the distribution of government healthcare subsidies (GHS) within developing countries has recently received considerable attention [1,2,3]
This study investigates the distribution of GHS in China between socioeconomic populations at two different points in time, examines the comparative distribution of healthcare benefits before and after healthcare reforms in Northwest China, compares the parity of distribution between urban and rural areas, and explores factors that influence equitable GHS distribution
Who Benefits from Government Subsidies on Healthcare in China?
Summary
The equity of the distribution of government healthcare subsidies (GHS) within developing countries has recently received considerable attention [1,2,3]. In 2003, a health care initiative was launched in China, and many more GHS have been appropriated to healthcare facilities [4]. China’s GHS comprise a budget appropriation to the healthcare sector that is intended to support the provision of widely accessible and relatively lowcost healthcare, especially to low-income persons. The provision of public benefits to the entire population requires that policymakers and researchers investigate and analyze how healthcare sector resources are targeted, delivered, and distributed in China; it is important to determine how well these subsidies and services benefit the intended recipients (i.e., people of lower socioeconomic status). Improving the equitable distribution of government healthcare subsidies (GHS), among low-income citizens, is a major goal of China’s healthcare sector reform in China
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