Measurement Study On Benefit Incidence Analysis Of Public Health Expenditure

BackgroundAs a kind of welfare expenditure, public health expenditure aims to improve medical service quality, level and efficiency, promote the accessibility and equity of healthcare utilization, benefit the average health status, raise the intellectual level and advance the economic and social wellbeing of the population by subsidizing healthcare service delivery.Public health expenditure or per capita of public health expenditure is the most effective factor in improving social health conditions. In China, on the one hand, government has increased investment in public health and driven the further development of health care. On the other hand, with the change of living standards, aging and disease spectrum, medical services expenditure percentage to consumption expenditure has improved constantly in residents. Meanwhile, there are many imbalance and inequity issues in all sectors of society. States often allocate funds to the equity considerations to ensure that public expenditure is pro-poor and the subsidies are well targeted. Even though governments set clear policy goal of equity, it is another matter to translate these into public health expenditure. Benefit incidence analysis (BIA) provides a reference for this study. Using this tool, we could interpret who acquires health expenditure benefit, whether the poor and low-income people obtain more expenditure benefit, what degree of government goals in pro-poor and improving income distribution equity have been achieved.Research ObjectivesThis research chose S province as a research sample, analyzed the health service utilization by economy, measured the average benefit, benefit equity and marginal benefit of public health expenditure, attempted to find whether the redistribution effects of public health expenditure were more inclined to the low-income groups. This study aimed at providing evidence to improve government performance and achieve the universal health coverage goal.Data SourcesBased on the analysis tool, the information and data sources consist of three parts: firstly, the government health expenditure data. Data sources from China Financial Yearbook and China Statistical Yearbook for Regional Economy. Secondly, the data of medical services utilization in S province from the Health Statistics Yearbook of S province. Thirdly, S Provincial Health Services Survey data was also employed. All of the data were collected from Health Information Statistics Center of S province.Research Contents and MethodsBecause expenditure benefit of public health service was approximately equity, this research made medical service as research subject to measure and evaluate benefit incidence of public health expenditure. According to the international experience, medical service was divided into three classes, primary medical service, outpatient service (OP), and inpatient service (IP).1. Average benefit analysis of public health expenditureUsing average benefit analysis method, the research analyzed average benefit of public health expenditure by urban-rural, economy, and poverty characteristics. The research also compared the difference of average benefit between province and regions.2. Benefit equity analysis of public health expenditureUsing concentration curve, Lorenz curve, concentration index and Kakwani index to compare benefit equity of public health expenditure by characteristics. By the mean of dominance test, the research analyzed the dominance issue in regions.3. Decomposition analysis of public health expenditureUsing decomposition technology (household behavioral component, demographic component, and government behavior) of Gaddis, the research also analyzed the affecting factors in public health expenditure benefit.4. Marginal benefit analysis of public health expenditureThe research measured the issue of how changes in the health budget will be distributed across the quintiles by Wodon model and Younger model, and compared average benefit and marginal benefit among medical services.Research Results1. Average benefit analysis of public health expenditure(1) The subsidy of primary medical service in rural residents was higher than those in urban residents, the share were 54.96 percent and 45.04 percent, respectively.(2) Through the comparison of different economic levels, the research found that the lowest and lower groups were more inclined to primary medical service. The subsidies benefit they received were more than proportionate share of 20 percent. While those people obtained the fewest subsidies benefit in hospital services.(3) Non-poor received the most subsidies benefit in the whole services by poverty.2. Benefit equity analysis of public health expenditure(1) The concentration curve of primary medical service subsidy crossed with 45°line, CI was negative and showed a weak pro-poor.(2) CI of the OP and IP subsidies were positive and over 0.1. In hospital service, subsidies benefit preferred to high-income groups.(3) Among three kinds of services, all Kakwani indexes were negative, which displayed that all services were in favor of realizing the social fairness.(4) Dominance test found that, although CI of primary medical service subsidies in many regions were negative, there were no significant using MCT.(5) In the cross-region analysis, economy was the major factor to influence low-income group benefit.3. Decomposition analysis of public health expenditure(1) In the decomposition of primary medical service subsidies benefit, both lowest and higher groups displayed that household behavior was clearly the most important proximate determinant.(2) There were obviously pro-rich in OP and IP subsidies, but household behavior also was the most important factor.4. Marginal benefit analysis of public health expenditure(1) By grouped data, the study found that when the government health budget changed, the lowest group would receive more benefit than 1 in both primary medical service and OP subsidies.(2) Marginal benefit in different groups were kept steady by individual data, the marginal benefit value fluctuated around 1 and the share ranged from 16 percent to 23 percent.(3) Compared average benefit with marginal benefit, it could be found that when the government health budget increased, the lowest group would receive more benefit than currently with the timing, except for IP by grouped data.Research Conclusions1.Public health expenditure in primary medical service was pro-poor. The research found that rural residents and low-income groups got more subsidies benefit in primary medical service. While the total subsidy benefit was pro-rich.2.Public health expenditure benefit had progressivity. Although there were pro-rich in OP and IP subsidies, the concentration curves were flatter than Lorenz curve and the Kakwani indexes were negative, which demonstrated that all services could help narrow the wealth gap and improve the equity.3.Household behavior was the major factor in public health expenditure benefit. Decomposition result revealed that household behavior was the major factor, and its impact accounted for more than half.4.Marginal benefit of public health expenditure was more inclined to the low-income groups. The MBI discovered that when the government health budget increased, the lowest group would receive more benefit than currently with the timing, whatever using grouped data or individual data.Policy Suggestions1.To clear expenditure target and pay attention to efficiency of policy goals.2.To expand financial input and optimize the structure of financial input.3.To give primary medical care special support in government expenditure.4.To focus on low-income groups using the way of subsidizing demanders.5.To regulate medical behavior and encourage rational treatment.Innovations and LimitationsThe innovations of this study:(1) Combining government input in medical institution and medical security to study public health expenditure benefit.(2) Classifying outpatient service into primary medical service and hospital outpatient service to discuss expenditure benefit incidence.(3) Using average benefit and marginal benefit to measure expenditure benefit incidence.The limitations of this study:(1) This study is a cross-sectional study and there are lack of horizontal and vertical comparison.(2) Lack of analysis on indirect effect of public health expenditure.