| BackgroundHealth system is to meet the health care needs of the people, the method to achieve fairness and social unity and stability. According to the health system framework raised by World Health Organization, health systems have the functions of Health Financing, factor productivity, service delivery and management etc, in order to achieve the three goals of health, financing risk protection and reactivity. After the founding of our country in the planned economy period, the rapid establishment of the health system, with lower investment to achieve universal coverage of health services, became respected model of the World Health Organization. Then health system achieved a high fairness, but there was a low efficiency of service delivery, lack of medicine problems. After the reform and opening up, learn from other economic sectors health system reform, introduce new incentives, a rapid increase in medical and health resources, service delivery capacity and efficiency improved significantly, but the ensuing transition since the problem was personal health expenditure, residents disease negative economic heavy,"expensive" problems have become increasingly prominent, which is actually a concentrated expression of Health financing fairness.In the World Health Organization’s " World Health Report2000", the191member states on the achievements and performance of health systems assessment rankings, our country was located in the first61, but in the health system financing assess fairness index rankings, our country ranked No.188, that was the penultimate4. The results of this assessment had strong repercussions in our country, making the fairness of health services to become a focus of attention within and outside the health system. In addition, Fairness of health financing had a great impact to other social areas. Since reform and opening up, China’s poverty alleviation work in rural areas had made great achievements, and China’s rural poor population of250million people in1978had reduced to28.2million in2002, the incidence of absolute poverty from the previous30.7%to3.0%, but China’s poverty alleviation task of the new era is still arduous, poverty population returning poor situation again is a very prominent phenomenon, and " due to illness " is one important reason. Improving health system fairness is China’s future target for a long time. Fairness of health services is one of the focus issues to deepen health reform.The realization of health equity requires the joint action of each module in the health system, and health financing is the core module of the health system, health fund raising, distribution and use is closely related to each other, and play a fundamental role in the implementation of other modules function, such as service providing, resource production, management etc, and directly related to the health system objectives in particular with financing risk protection. Health financing system is the important factor to determine the fairness of health equity, so the World Health Organization regard the health system financing risk protection as one of the three main objectives in "World Health Report2000", and to evaluate and sort it. Therefore, the government and the community have been extensive attention to the fairness of health financing, which has become not only the research focus of sociology, medicine, economics and many other disciplines; but also a major theoretical and practical issues of the social and economic life.Our country has proposed the new goal of building a moderately prosperous society in the2020, and proposed the establishment of social equity security mechanism, health equity especially the fairness of health financing is a core element, China’s medical and health system reform is in the special stage of deepen develop, the research of the fairness from the perspective of the health financing system has important theoretical and practical significance.ObjectivesBased on health financing system functions to research the health financing fairness conditions of S province from the dimension of Health funding fairness, equitable distribution of benefits and financing risk protection, and to analyze the relationship of health funding fairness, equitable distribution of benefits and financing risk protection, in order to provide policy recommendations for the equity-oriented medical and health system reform.MethodsIn this study, Family Services survey data of S Province in2008was used, there were a total of3958samples and12,973people, among Which males accounted for49.43%, females accounted for50.57percent, Data could represent the province. Variables involved in measurement and analysis included family size and age structure, household income, consumption expenditure, health services utilization, OOP for medical service.The survey used a multi-stage stratified cluster random sampling system, and basic sampling unit were the towns and streets in order to ensure the representative of the survey samples,30towns and30streets were extracted, and every town and street were pumping two administrative villages and two neighborhoods, and each village and neighborhood random33samples. The survey involved the province’s14municipalities (state),36counties (district).In this study, we will research health financing fairness from the perspective of health financing system functions, the main idea is to determine the analysis dimensions of the fairness of health financing according to health financing aspects and functions firstly, and to propose analytical framework of the fairness of health financing, and then select the quantitative analytical methods for each funding dimension, using progressive methods to measure the vertical fairness of health funding; using Benefit Incidence Analysis Method to analyze the fairness of government subsidies benefit; funding risk protection can be measured by catastrophic health expenditures and OOP poverty analysis. And measurement and analysis is going with the data of Family Health Services Survey, the final analysis is the change of financing risk protection by using the relationship between different dimensions of the fairness of health financing, and to raise policy recommendations to improve the fairness of health financing in the future.Main Results1. According to functions and aspects of health financing system, fairness of health financing can be divided into three dimensions:health funding fairness, fairness of the allocation of funds to benefit health and risk protection. Among them, the health financing risk protection is one of the ultimate goals of the health system, health funding fairness and fairness of the allocation of funds to benefit health are process indicators of the health system, and the level of health financing risk protection is directly affected by health funding fairness and fairness of the allocation of funds to benefit.2. S provincial health funding progressive results show that in2008Government health expenditure (38.11%) and personal health expenditures (37.23%) were the main part of S provincial health funding. Health financing overall Kakwani index of0.046, was close to geometric not showed significant progressive, the health financing and the income of populations of different economic levels was close to geometric, did not reflect the vertical fairness that high-income people pay more and "Robin Hood "characteristics. In different sources of funding, the government revenue funding nearly geometric, did not reflect significant role in the financing of equity and redistribution, in which direct taxes financing had a higher degree of progressivity, but indirect taxes was slightly regressive. Progressive social health insurance, mainly because part of the population covered by social health insurance as well as financing and reimbursement between different insurers were quite different, actually reflected a deeper level of unfairness.3. S provincial fairness of government health spending to benefit showed that in2008the centralized index of the total government health subsidy benefit was0.289, more than the rich people get grants and subsidies incline to rich people. Hospitalization subsidy benefit was much lower than the fairness of outpatient benefits, in2008the concentration index of outpatient benefit of S province was0.045, close to the geometric, and the concentration index of hospitalization subsidies was0.375, more focused to the more affluent crowd. The fairness benefit of total subsidy of rural and urban residents was consistent with the province, the levels of fairness benefit were very low, in which the degree of tilt to the rich of urban residents benefit from subsidies was higher than rural, Concentration index were0.319and0.229.4. Level of protection of health financing risk was poor in S province. In2008in accordance with the international poverty line of$2.15per person per day, poverty rate of OOP was8.38%, that is,8.38%residents of S province got into poverty because of medical treatment costs, the situation of rural residents is more serious than urban residents. From catastrophic health expenditure side, according to the standard of40%the rate of occurrence of catastrophic health expenditures was17.84%, ie17.84%of the families’ health spending in total household non-food expenditure accounted for more than40%,and the normal consumption structure would be serious influenced, the average gap of catastrophic health expenditures was2.88%and the relative gap was16.65%, incidence of catastrophic health expenditure was relatively close between rural and urban residents, and the urban was slightly higher than the rural.5. There are interactive relationships among the different financing fairness. Health funding fairness and fairness benefit has a great impact on financing risk protection in S province. Overall, S provincial health funding did not reflect vertical equity, failed to achieve "Robin Hood" role, especially the government funding taxation lack of progressivity, while the financing of insurance although looked as progressive but in fact reflected a deeper unfair of Financing because of the population covered by the scope of the insurance financing and decentralized. In the allocation of funds to benefit aspects, the government health spending to benefit did not incline to low-income people, on the contrary to the more affluent crowd. Since the fairness of funding and benefit level was not high, the function of funding risk protection and social redistribution did not work well, which led to a low level of health financing risk protection in S province. Meanwhile fairness of the allocation of funds to benefit health was influenced by health funding fairness and financing risk protection in S provincial, the level of health funding fairness and financing risk protection determined the residents use of health services, health services of low-income people was constrained by the ability to pay, while high-income people would use more health services, resulting in more benefit from government subsidies.Policy Recommendations1. To establish a stable government and society health input mechanism, to establish health financing system leading by public financing.2. To play a role in regulating the redistribution of tax, increase the progressivity of government health funding.3. To narrow the benefit gaps and coordinating range of different social health insurance, and on this basis, to achieve the progressive financing.4. To strengthen government subsidies to targeted to improve the fairness of the benefit funds.5. To establish fee waivers and medical aid system for low-income populations.Innovations and limitationsThe innovations of this study:(1)Based on health financing system functions this study proposes analytical framework and methods for fairness of health financing, from the aspects of health fund raising, distribution and benefit and risk protection, and changing the situation of the past research which has focused on a certain angle, and different methods of financing lack of theoretical foundation and system Contact.(2)This study is based on fair health financing framework and methodology, to compare different dimensions of health financing fairness in the same framework, and this is the first time in the country. (3)In this study, according to the relationship of different dimensions of equity financing, to analysis the internal relations and causes of the changes of fairness of health financing, changing the previous condition of studies were carried out on a particular aspect of fair analysis, lack of combined analysis of different dimensions.The limitations of this study:(1)Fairness analysis of various dimensions mainly around2008data expand, If more than a few years of data is collected for the use of before and after comparison, Through time series analysis will draw funding fairness changes。(2)This study analyzes the fairness of health financing without combination of other indicators,for example the health status of the residents. If health status indicators are introduced, we will find links between different fairness. |
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