Analysis Of Equity And Redistribution Of Health Care Financing In Typical Areas Of West China

Objective To analyze the progressivity and redistribution effect of different health financing channels in typical areas of western China,and to evaluate the equity and change of financing.Methods Based on the survey data of residents' household health inquiry in typical areas of western China in 2014 and 2016,combined with the various consumption expenditure tax rates in 2014 and 2016 in China statistical yearbook,the direct and indirect taxes on consumption expenditure are calculated.The equity of direct tax,indirect tax,social medical insurance,commercial health insurance and personal cash health expenditure was evaluated by used the methods of proportion,index and income redistribution effect decomposition.Results1.In 2014,the concentration indexes of direct tax,indirect tax,social medical insurance,commercial health insurance and cash health expenditure in typical areas of western China were 0.495,0.342,0.231,0.305 and 0.290 respectively,and in 2016,they were 0.615,0.366,0.285,0.423 and 0.262 respectively.the concentration indexes of health financing increased by 0.120,0.024,0.054,0.118 and-0.028 respectively.2.The Kakwani index of direct tax,indirect tax,social medical insurance,commercial health insurance and cash health expenditure in the typical areas of western China in 2014 was 0.150,-0.003,-0.114,-0.040,-0.055,respectively.in 2016,it was 0.256,0.007,-0.074,0.064,-0.097,respectively.the Kakwani index of health financing channels increased by 0.106,0.010,0.040,0.104-0.042,respectively.among them,direct tax and commercial health insurance increased obviously,cash health expenditure decreased slightly,and other financing channels3.The Re of total health expenditure,tax,social medical insurance,commercial health insurance and cash health expenditure in typical areas of western China in 2014 were-0.0083,-0.0057,-0.0014,-0.0008,-0.0292 respectively,and in 2016 were-0.0082,0.0017,-0.0025,-0.0001,-0.0391 respectively.the re value of each health financing channel increased by 0.0001,0.0074,-0.0011,-0.0002,-0.0099 respectively,and the redistribution effect did not change obviously.4.The Kakwani index of direct tax,indirect tax,social medical insurance,commercial health insurance and cash health expenditure in typical cities of western China in 2014 was 0.297,0.002,-0.030,0.044,-0.098,and in rural areas-0.063,-0.025,-0.027,-0.256 and 0.015 respectively;In 2016,the urban areas were 0.391,0.310,0.068,0.088,-0.176,and the rural areas were 0.285,-0.037,-0.327,0.140,0.093.Urban health financing is more equitable than rural health financing.Conclusion1.The total health expenditure of the rich families in the typical area of western China is much higher than that of the poor families;Relative to the economic level,the proportion of health expenditure of rich families is higher than the proportion of their affordability among the population,and the rich population is the main contributor to health financing.2.In recent two years,the level of health financing in typical areas of western China is relatively stable,and health financing is progressive.The existing health financing system is conducive to social equity;Redistribution on health financingis not effective,so did redistribution on equity of health financing.3.In the health financing channels,direct tax and commercial health insurance progressive degree increased further,for the benefit of the poor;The redistribution effect of cash health expenditure financing reduced,and the equity of cash health expenditure financing is better.4.In the past two years,urban and rural health financing presents a progressive,urban and rural redistribution effect is negative;Compared with 2014,the urban redistribution effect has improved in 2016,with a slight decline in rural areas.the equity of urban health financing is more equitable than that of rural areas.