Study On Equity Of Health Care Financing In China

BackgroundWith the large economic development in China after reform and opening, the gap of individual income is growing. According to the estimation from experts of World Bank, The Gini index of China in 1995 was 0.39. In fact, the Gini index should be more larger than 0.45 if the disparity of allowance between urban and rural was considered. Furthermore, the gap of individual income was becoming larger and larger in recently years. Account for the lack of sustaining from collective economic units, the coverage ratio of RCMS(rural cooperative medicine scheme) decreased sharply in these years and most of farmers were out-of-pocket in the use of health care. The larger gap of individual income and the weakness of health insurance brought the inequity of health care finance more and more. Three types of equity were viewed in health care, which include equity of health care utilization, equity of health resource distribution and inequity of health care finance. Two axioms were concerned in inequity of health care finance: horizontal equity of health care finance and vertical equity of health care finance. Horizontal equity means health expenditure of household is same when the household has the same income, vertical equity means health expenditure of household should increase in both account and ratio to income with respect to household's income. It is very difficulty to decrease the vulnerable groups' economic burden of disease, which is the main obstacle in equity of health care finance in developed countries and developing countries. More and more proof were find that the poorer pay more for health care than the richer in China, and what enhance the burden of poorer. Government all over the countries expect to establish a perfect health care finance system with good risk pooling and risk sharing and decrease the poor people's economic burden of disease. In <>, health care finance was one of performances of health system, and a new method of health care finance was introduced. With the opinion of experts of WHO, health finance is considered perfectly fair if the ratio of total health contribution of household to their effective non-subsistence income is identical for all households. Many criticism to this method were arise, and most of them were focus on its suitable and reasonable. But the significance of this method is this is the new way of health finance calculation, and this way will be spreaded and will be adopted to calculate the equity of health finance in all over the world by WHO. A lot of experts in China consider that it's inequity in health care finance in China, but so far no research on it were reported and no reference about inequity in health care finance were published. This study calculated the inequity of Chinese health finance and explored its influence factors. The inequity of health finance accounting for the income gap between provinces and government expenditure on health care were estimated. Furthermore, horizontal inequity and vertical inequity were calculated. In this study, inequity in regions and individuals were calculated because inequity of health finance presented not only in different regions but also in individuals. Provinces were grouped in three type of regions, inequity in which is the provinces' inequity. Individual's inequity means inequity in household. To approve the suitable in China, evaluation to method of health care finance provided by WHO were made. MethodologyIn order to calculate the inequity of health care finance in different regions and different provinces, Theil index and Gini index were introduced. To calculate the degree of inequity health care finance influenced by economic status and government expenditure on health care in different regions and different provinces, difference in difference was used. In addition, we adopted HFC(health financial contribution) and FFC(fairness of financial contribution) to calculated inequity of household health financial contribution. With res...