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Improving equity in health care financing in China during the progression towards Universal Health Coverage

Citation

Chen, M and Palmer, AJ and Si, L, Improving equity in health care financing in China during the progression towards Universal Health Coverage, BMC Health Services Research, 17, (1) Article 852. ISSN 1472-6963 (2017) [Refereed Article]


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Copyright 2017 The Authors. Licensed under Creative Commons Attribution 4.0 International (CC BY 4.0) https://creativecommons.org/licenses/by/4.0/

DOI: doi:10.1186/s12913-017-2798-7

Abstract

Background: 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. Improving financing equity is a major policy goal of health care system during the progression towards universal coverage.

Methods: We 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.

Results: The 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.

Conclusion: China'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.

Item Details

Item Type:Refereed Article
Keywords:financing equity, progressivity, kakwani index, universal health coverage
Research Division:Economics
Research Group:Applied economics
Research Field:Health economics
Objective Division:Health
Objective Group:Evaluation of health and support services
Objective Field:Evaluation of health and support services not elsewhere classified
UTAS Author:Palmer, AJ (Professor Andrew Palmer)
UTAS Author:Si, L (Mr Lei Si)
ID Code:123358
Year Published:2017
Web of Science® Times Cited:8
Deposited By:Menzies Institute for Medical Research
Deposited On:2018-01-03
Last Modified:2018-07-23
Downloads:137 View Download Statistics

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