Tianjin Health Financing Income Redistribution Effect Research

Objective Using health account data in time series to analyze the trend of the structure of health financing in Tianjin, and with National Health Service Survey data and adopting AJL method to decompose the redistributive effect of Tianjin health care financing system to three components:a progressivity component, a classic horizontal component and a re-ranking component, then to quantify the extent of income redistribution can be changed by each health source as well as evaluate the rationality and progessivity. Finally, some suggestions have been proposed to improve health financing system for Tianjin municipality. Data and methods Utilizing the data of2003and2008National Health Service Survey to acquire the basic data of interest, including household expenditure, social health care premiums, health care expenditure and household escale size, and employing concentration index, concentration curve, Kakwani index and AJL method to measure the concerned data results, as well as based on the data of health accounts in Tianjin to analyze the trend of health financing system. Results (1) To analyze Tianjin as a whole, it finds that private health insurance and indirect tax has pro-rich redistributive effect, while direct tax, social health insurance, OOP (out-of-pocket) as well as all combined health care finance is pro-poor redistributive, which can narrow the primary income distributive gap.(2) Compared to the picture in2003, in2008direct tax has become more progressive, while its redistributive effect decrease due to the existent horizontal inequity and re-ranking; indirect tax is still regressive, OOP has shifted from regressivity to progreesivity, and all combined health care finance become more progressive, which implies the better health financing equity.(3) Measurement by urban and rural area, it finds the two results are common at which redistribution is pro-poor, but the different is in rural area the extent of redistributive effect is bigger than that in urban area, and the health care finance rural area is more progressive than urban area, and its horizontal inequity is less than urban area. Conclusion Direct tax as one of health care financing source is the most pro-poor redistributive, and the most equity and advance, while indirect ax is regressive, so it should strengthen redistributive function of direct tax and enable government to exert its financing dominant role. To get the true picture of redistributive effect of social health insurance, it should distinguish each social health insurance. Here it advices to perfect social health insurance system to guarantee people to use health care. In the progressivity analysis for OOP, it should attach importance to the feint equity when the results present pro-poor redistribution, which actually means the poor are forced to use less health care services than the rich due to the economic difficulty. OOP is regressive in nature and is unfair health care finance source. So OOP should be reduced to a rational extent and to ensure people’s health service utilization in fair. Private health insurance is voluntary, and its redistributive effect is not logic, but it is worthy being developed to meet different needs of people at different economic level.