Research On Health Service Equity In China

Background:As one of the vital thing in people’s livelihood, health service equity is an importantindicator in social equity. Nowadays, there are significant differences between urban andrural between different region and between different social layers. The inequity problemssuch as “difficulty and high cost of health service” and “poverty and repoverty caused bymedical cost” are also serious. Thus, the health service equity has been focused andpondered by the government, society and scholars. Along with the process of the new waveof health care system reform, it is imperative to study and improve the health service equity,to steer the reformation in equity and public welfare direction, and to realize the goal of“everyone has a right to basic medical and health care”, which have become importantmission in harmonious society construction and society equity maintaining.Aim:This study is, firstly, to establish a modern equity concept of health service in China;secondly, based on the concept, to evaluate the status, tend and international difference ofChina’s health service equity and analyze the factors and reasons caused health serviceinequity in China; and thirdly, to explore the measurement and approach in public policyand institutional arrangement to eliminate inequity factors. Under the background of thenew wave of health care system reform in economic transformation, aim of this study alsois to provide scientific theory, factual basis and countermeasure for improving healthservice equity and enhancing people’s health rights and health levelContent:From abstract to concrete and from theory to empirical study, this article analyzed thehealth service equity in China seriously, based on the results, and putted forward the policyand institution suggestion for improving health service equity. Firstly, in a philosophy view,the fundamental equity theory of health service in China has been concluded by asystematical study. Under the guidance of the theory, the health service equity in China has been evaluated qualitatively, including the equity of health resource demography andgeographical distribution, the tendency of equity change, and influence factors of healthresource distribution. In the meanwhile, an international health service equity comparativestudy has also been carried out. Based on the national and international qualitative andcomparative analyses, combined with the national condition of China, the policy andinstitution suggestion for realizing health service equity have been proposed. Specifically,the fundamental equity theory study is carried out by considering the equity thinking amongthe Western classic philosophical ethnics, Chinese traditional culture and modernbackground, in which meanings of these theories for composing the health equity theory inChina have been discussed while the viewpoints, content and principle of the health equityin China also have been proposed. In the empirical analysis of health service equity inChina, the health resource distribution was considered as a fundamental ingredient. Thestatus, changes and reasons of health resource distribution equity have been deeplyanalyzed. In the international comparative study, by comprehensive evaluation of the healthservice equity indicators of the representative countries, this article discussed the advancedexperience and efficient measurement for improving health service equity. By comparingChina and the world, disparity and effort direction have been found out. Based on theresearch and analyses above mentioned, form the aspects of equity viewpoint, healthresource distribution, and institution construction, this article concluded the measure andapproach. It proposes the public policy and institutional arrangement for realizing healthservice equity, which explored a new countermeasure and thinking for improving healthservice equity in China.This study tried to establish an integrated health service equity research system inChina including equity theory, status, change, reason, and countermeasure. By thisintegrated study process that derived theory to practice, this article established a stable andinstitutional framework for solving health service equity problem.Methodology:This study is guided by system theory. In the study practice, it adopted a seriesvalidated methods from economics, sociology, management science, logic, and informationscience by comprehensive integration. The document review, induction and deductionmethod were used for health service equity fundamental theory study. In the empirical study of health resource distribution, it not only used the quantitative method but also adopted aseries of WHO recommended indexes, such as survival rate of children, disability adjustedlife year, responsiveness, and health financing equity, for comparative study.Conclusion:According to the study, the viewpoint of health service equity in China has been puttedforward. It indicated that a multilayer synthetically health service system, including equityof health right, equalitarianism distribution of basic medicine and public health service,utilitarianism distribution of non-basic medicine and poverty group medical relief should beestablished. Currently, in China, health service equity viewpoint should insist on the fourfundamental principles of equality, popularization, efficiency and compensation. The resultsof national health service equity study show that the demographic health resourcedistribution is relatively equal (its Gini index <0.3), while the geographic health resourcedistribution is quite unequal (its Gini index>0.6). The Theil index indicated that regionaldifference is the main reason for unequal. It is shown that the increase rate of healthresource is higher than the population increase rate, and the health service accessibility issignificantly enhancing to all resident. However, the Lorentz curve indicated that healthresource allocation is not equal, especially in the allocation of health service institute andmedical human resource. The linear correlation analysis indicates that the economic factorsand the equity of health resource allocation are highly related, in another word, healthresources have the tendency of concentrating to the economically developed region. Healthfinance deflection, health investment deficiency, high personal health cost, the division ofurban and rural, and “three-layer” health service system irrationality are the main reasons ofChina’s health service inequity. International comparative analyses indicate that in largescale health service equity in developed countries is more desirable than developingcountries. However, several developing countries get ahead of developed countries in healthfinance, health level and health service accessibility. China’s health service equity isexcellent in developing countries for most aspects; however, China’s regional inequity,urban and rural disparity, health service inaccessibility, and finance deflection are relativelyserious. The international comparative study further validated that economic developinglevel and institutional factor are the main factor which significantly affect health serviceequity, while urban and rural disparity, wealth gap, age structure, and education level also highly related with the equity of health service.Suggestion:According to the status and problems of China’s health service equity and the reasonsaffected health service equity, combined with the international experiences and lessons, thisarticle proposes that to improve the health service equity and enhance resident’s health levelin China the guideline of health service equity should be followed, the institutionalreformation of medicine should be thoroughly carried out, and everyone’s health rights inthe society should be protected. In one side, overall development plans of health serviceshould be made both in urban and rural region by adjusting the disequilibrium status ofhealth resource allocation geographically, structurally and qualitatively between urban andrural area. In another side, the basic health service system should be consummated both inurban and rural area, at the same time the inner management of health service institute andactivity of health service should be strengthened. Moreover, to realize an integrative healthservice system the health service system with different standard should be integratedbetween urban and rural area. Besides, to improve health finance system and enhance healthservice demand, a multilateral investing health finance mechanism should be built up bygovernment, society and each person. Furthermore, to realize well-ordered health servicemanagement and bring the health development into legal system, legislation in health andmedicine field should be on the agenda. Finally, strengthening supervision in health serviceprocess, examining performance of health service, standardizing service activity, andenhancing health service quality are also important to the improvement of health serviceequity.