A Comparative Study On Gansu Province Health Financing Equity Before And After Health Care Reform

Objective First, to analyze the development and changes of health care financing system in Gansu province; second, to estimate health care financing equity before and after health care reform, then analyze its changes and impact; third, with referring to related policies, in order to explore reasons of difference in equity; lastly, to make policy recommendations to further improve the fairness of health care financing.Methods Through the utilization of the Fourth and Fifth National Health Services Survey data in Gansu Province, employing the progressive analysis of health care financing, the paper focused on the ratio method, the graphing method (concentration curve) and index method (concentration index, Kakwani index), contrasted the equity of health care funding before and after health care reform.Results The Kakwani index for total health care financing was 0.0155 and slightly progressive in the year 2012/13. The Kakwani index for direct taxes, indirect taxes, social medical insurance and out-of-pocket was respectively 0.2547,0.0011,0.0440 and 0.0323. Before health care reform, total health care financing was also progressive and its Kakwani index was 0.0721. In this year, the mildly regressive financing sources was indirect taxes, and its Kakwani index was-0.0127, however, the others were progressive, including direct taxes, social medical insurance and out-of-pocket, whose Kakwani indices were respectively 0.3243,0.1680 and 0.0132. It found through comparative analysis:direct taxes progressivity was still the largest source of financing; indirect taxes and social insurance financing sources were close to be proportional; direct payment varied from progressive to regressive. Progressivity of health financing mainly concentrated on the social health insurance in urban and rural areas. After health care reform the Kakwani indices of urban and rural areas were 0.0850,-0.0157 respectively, whose value was 0.0743,-0.2641 before the reform. It was concluded that social medical insurance was regressive funding sources in rural areas.Conclusion After the reform, the Gansu Provincial health financing mainly has the following three characteristics:first, health funding structure optimized significantly, but to achieve "the Twelfth Five-year" Medical Reform Plan established goals, the government needs to play its leading role, and it needs to continue to increase health input. Second, although the progressivity for overall financing system is a slight decline after health care reform, it is still progressive. There were two main reasons. One reason was social insurance coverage to low-income groups, which stimulated their demand to release, accordingly enhancing health services utilization; the other reason was a high proportion of out-of-pocket expenditure in the total health expenditure, contributing to its high weight of equity. From this perspective, after health care reform the fairness of Gansu Province has been improved. Third, health financing reform should reduce dependence on direct payment and play the role of market sufficiently on the basis of existing social medical insurance scheme.