Research On Fairness Of Health Financing In Rural Areas,China

BACKGROUNDIn 2000, the World Health Organization evaluated the performance of the 191 membership countries’ health system. China ranked 188 on health financing among the list. It caused an outcry from the government and the scholar, so they organized many studies of evaluation on health financing. However, blocked by some reasons, most of the studies focused on few districts, either using divergent methods. We cannot conclude the actual situation from these studies, especially the rural situation.OBJECTIVEWe made a comprehensive comparison and analysis among the three samples via different calculation methods, to conclude the equity of health financing in the rural of China, and to explore the influencing factors of health financing. Based on this, we will make some suggestions to improve the equity of health financing.METHODS9925 respondents’ personal information was collected from three sample districts by field investigation. Household information, income and expending, the need and usage of health services were referred in the questionnaire. Different calculation methods were used to measure Fairness of Financial Contribution, Kakwani index, Redistributive Effect, and Catastrophic health expenditure family.RESULTS AND CONCLUTIONS1. The Fairness of Financial Contribution of the rural is 0.774, which is higher than the china level in the 2000 WHO health report. That means the equity of health financing is improving after thirteen years reformation and still lower than the developed countries.2. The FFC of Zhejiang/Gansu/Chongqing is 0.860/0.800/0.716 respectively. And the FFC of Zhejiang is 20.11% higher than the FFC of Chongqing. So, difference can be seen from different sample districts.3. The Kakwani index of the rural is -0.153, means that the health financing is regressive in the rural of China. The reason for this is probably finance not related to the income.4. The horizontal equity accounts 65.68% to the Redistributive Effect, which means people who are in the same income level, may have different health expenditure, and horizontal equity is the main reason leading unfairness.5. The proportion of catastrophic health expenditure family is 10.80%, and 12.14% is increased excluding the catastrophic health expenditure families, which means catastrophic health expenditure family is an important influencing factor of health financing.6. The catastrophic health expenditure family of Zhejiang/Gansu/Chongqing is 0.61%/9.30%/43.58% respectively. There is a different proportion of catastrophic health expenditure family among different regions.7. We found that the FFC is increasing with the growth of the income of the household. The gap between the max FFC and the min FFC is 0.153, which means the income of households can influence health financing.8. There are many differences on management mechanism/finance level/reimbursement level among different New Cooperative Medical Systems. The equity of health financing maybe influenced by the New Cooperative Medical System.SUGGESTIONSAt the national level,1. Continue to improve the level of government financing and reduce the proportion of resident pays.2. Enhance the central government’s financial assistance to western areas.3. Expand the funding scope.At the regional level,1. Perfect the NCMS systems in grades of payment.2. Adjust some contents of NCMS policy to improve the ratio of compensation.3. Increase investment on catastrophic health expenditure family’s protection and assistance.