Analysis Of Equity Of Health Care Financing In Xinjiang Production And Construction Corps

Objective:To analyse the distribution of health financing among people of different economic levelin Xinjiang Production and Construction Corps in2004and2010and to evaluate the healthfinancing equity.Methods:Used data derived from Health Services Survey in Xinjiang Production and ConstructionCorps in2004and2010to calculate basic indicators including household final consumptionexpenditure, healthcare expenditure, social health security expenditure and equivalent scales.Employed proportional method, exponential method and decomposition of incomeredistribution effect method to estimate health financing equity of various health spending.Results:1. In absolute and relative terms of health financing in Xinjiang Production andConstruction Corps, the health spending of richer families is far more than that of poorerfamilies, the percent of health spending by the richer individuals is higher than that of theirability to pay. The richer individuals are the main contributors to health financing. In respectof income redistribution system, the Gini coefficient has decreased since the implementationof health financing, meaning that health financing can narrow the gap between the rich andthe poor and promote social equity. The Kakwani index of total expenditure on health hasdropped from0.065in2004to0.057in2010. The income redistribution effect has increasedslightly from0.0038in2004to0.0039in2010.2. The concentration index of the ability to pay without has decreased from0.327in2004to0.283in2010. The progressiveness of total expenditure on health has declinedslightly in2010compared to that in2004. The income redistribution effect is positive. Equityof health financing shows negligible changes. Among various kinds of health financingsources, the Kakwani index of social health security expenditure shows the most markedchanges, declining from0.129in2004to0.035in2010. Meanwhile, the income redistributioneffect from taxes has changed the most significant, falling from0.0049in2004to-0.0008in2010. In particular, the progressiveness of direct tax decreases in2010, so does its incomeredistribution effect. By contrast, the regressiveness of indirect tax has improved and itsnegative redistribution effect has diminished from2004to2010.3. Health financing effect of total expenditure on health has altered radically fromregressive to progressive from2004to2010in Xinjiang Production and Construction Corps,so does the income redistribution effect. The income redistribution effects of various healthfinancing sources show few difference between urban and rural areas in Xinjiang Productionand Construction Corps in2004, however these effects in rural areas are higher than that inthe urban areas in2010. 4. Health financing effects of tax, private health insurance expenditure and out-of-pickethealth expenditure have changed from regressive to progressive between2004and2010.Redistribution effects of both out-of-picket health expenditure and social health securityexpenditure have decreased over the same period. The negative redistribution effect of tax hasintensified in urban areas, while the effect has turned positive from negative in rural areas.Particularly, the progressiveness of direct tax has declined. The redistribution effect of directtax has changed from positive to negative in urban areas and the positive redistribution effectof direct tax has fallen. The regressiveness of indirect tax has improved in both urban andrural areas as opposed to that the negative redistribution effects have decreased.Conclusions:1. Equity of health financing has improved in Xinjiang Production and ConstructionCorps in recent years. Current health financing system can adjust the income distribution andpromote social equity.2. Progressiveness of total expenditure on health has fallen slightly from2004to2010.Redistribution effect shows few changes over the same period.3. Health financing effect of total expenditure on health has altered from regressive toprogressive as opposed to redistribution effect between2004and2010. Redistribution effectof health financing in rural areas is greater than urban areas.4. Among different health financing sources, direct tax shows the greatestprogressiveness while indirect tax shows slight regressive. Urban residents basic medicalinsurance shows relative stronger regressiveness and its redistribution effect is negative.Redistribution effect of out-of-picket health expenditure is negative and has fewer impacts onindividuals’ ability to pay.