| ObjectiveThe health financing fairness evaluation indicators were used to evaluate health financing equity by describing the current condition of the health financing from different dimensions at Enhancing TB control and the quality of primary health care through the realignment of provider incentives in China project;we also found the possible reasons for the fairness and developed the strong policy advice.The results would be provided reference for improvement of rural health policy and healthcare reform in the future in local province.MethodsMulti-stage stratified random sample method was used at baseline survey in 2009,all subjects were the household.In 2015,we carried out a follow-up survey,all subjects included the household of baseline and follow-up survey in 2011,2012,In my study,the subjects also included the alternative households,which the study need to decreased loss rate at baseline and two follow-up surveys.ResultsThere are six key results that will showed as follow:(1)The Fairness of Financial Contribution in project counties is 0.49,the Health Financial Contribution in Haiyuan county is higher than that in Yanchi county(28.81% & 22.91%),Otherwise,the Fairness of Financial Contribution in Haiyuan(0.46)is lower than in Yanchi(0.71)for rural household.(2)Ten groups were divided by ability to pay such as,the Health Financial Contribution is highest(43.79%)in 10% group;in 80% group,there are the lowest(15.02%),the family health expenditure proportion in lower ability to pay groups is more than higher ability to pay groups.The Fairness of Financial Contribution in 20% group is highest(0.83),and 0% group is lowest(0.47),With the increasing of ability to pay,the Fairness of Financial Contribution showed reverse U-shaped curve.(3)The gap of the self-pay Health Financial Contribution among ten groups is small,self-pay family health expenditure proportion in every groups are also small,and variability of self-pay family health expenditure proportion are also small among the ten groups.(4)There are 298 households with family catastrophic health expenditure in sample pools,the rate of family catastrophic health expenditure is 7.75%.The rate of family catastrophic health expenditure was compared among the ten groups,and the results showed significant different.(5)In the study,the average Gini coefficient is 0.42.For government expenditure financing channel,NCMS financing channel,commercial insurance financing channel,out-of-pocket financing channel,the Kakwani index was-0.31,-0.35;0.02;-0.03 respectively.(6)The results showed that the concentration curve of NCMS and government health expenditure are lived in the top of the Lorenz curve.But,the concentration curve of commercial insurance and out-of-pocket are cross overlap with Lorenz curve for individual’ ability to payConclusionThe health financing fairness of project counties is in a low level,and Yanchi county’s health financing fairness is better than Haiyuan county’s.To compare with the self-pay Health Financial Contribution and the self-pay Fairness of Financial Contribution in different ability to pay groups,the vertical fairness in the lower groups is pooer,the horizontal fairness in every groups,except the lowest group,is better,these results showed that health financing fairness of individual have strong relationship with government health expenditure.The rate of family catastrophic health expenditure is lower in samples;however,the rate of family catastrophic health expenditure is higher in higher ability to pay households because of self-pay health expenditure directly,furthermore,the key reasons were related to the choice of medical institutions and the compensation mechanism.According to the different health financing channels’ Kakwani indexes and the position between the concentration curves and the Lorenz curve,we can conclude that the government health expenditure and NCMS is regressive obviously,out-of-pocket is faint regressive;the commercial insurance is faint progressive. |
PDF Full Text Request