Leung Gabriel M, Tin Keith Y K, O'Donnell Owen
Department of Community Medicine and School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China.
Health Econ. 2009 Jan;18(1):37-54. doi: 10.1002/hec.1342.
We examine the distributional characteristics of Hong Kong's mixed public-private health system to identify the net redistribution achieved through public spending on health care, compare the income-related inequality and inequity of public and private care and measure horizontal inequity in health-care delivery overall. Payments for public care are highly concentrated on the better-off whereas benefits are pro-poor. As a consequence, public health care effects significant net redistribution from the rich to the poor. Public care is skewed towards the poor in part not only because of allocation according to need but also because the rich opt out of the public sector and consume most of the private care. Overall, there is horizontal inequity favouring the rich in general outpatient care and (very marginally) inpatient care. Pro-rich bias in the distribution of private care outweighs the pro-poor bias of public care. A lesser role for private finance may improve horizontal equity of utilisation but would also reduce the degree of net redistribution through the public sector.
我们研究了香港公私混合医疗体系的分布特征，以确定通过医疗保健公共支出实现的净再分配情况，比较公共和私人医疗在与收入相关的不平等和不公平方面的情况，并衡量总体医疗服务提供中的横向不公平。公共医疗支付高度集中于富裕人群，而福利则倾向于穷人。因此，公共医疗实现了从富人到穷人的显著净再分配。公共医疗向穷人倾斜，部分原因不仅在于根据需求进行分配，还在于富人选择退出公共部门，消费了大部分私人医疗服务。总体而言，在普通门诊护理和（非常轻微地）住院护理方面存在有利于富人的横向不公平。私人医疗分配中的亲富偏见超过了公共医疗的亲贫偏见。减少私人融资的作用可能会提高利用的横向公平性，但也会降低通过公共部门进行的净再分配程度。
