Health Economics Research Group, Brunel University, Uxbridge, Middlesex, UB8 3PH, UK.
Int J Equity Health. 2008 Jun 9;7:15. doi: 10.1186/1475-9276-7-15.
Equitable financing is a key objective of health care systems. Its importance is evidenced in policy documents, policy statements, the work of health economists and policy analysts. The conventional categorisations of finance sources for health care are taxation, social health insurance, private health insurance and out-of-pocket payments. There are nonetheless increasing variations in the finance sources used to fund health care. An understanding of the equity implications would help policy makers in achieving equitable financing.
The primary purpose of this paper was to comprehensively assess the equity of health care financing in Malaysia, which represents a new country context for the quantitative techniques used. The paper evaluated each of the five financing sources (direct taxes, indirect taxes, contributions to Employee Provident Fund and Social Security Organization, private insurance and out-of-pocket payments) independently, and subsequently by combined the financing sources to evaluate the whole financing system.
Cross-sectional analyses were performed on the Household Expenditure Survey Malaysia 1998/99, using Stata statistical software package. In order to assess inequality, progressivity of each finance sources and the whole financing system was measured by Kakwani's progressivity index.
Results showed that Malaysia's predominantly tax-financed system was slightly progressive with a Kakwani's progressivity index of 0.186. The net progressive effect was produced by four progressive finance sources (in the decreasing order of direct taxes, private insurance premiums, out-of-pocket payments, contributions to EPF and SOCSO) and a regressive finance source (indirect taxes).
Malaysia's two tier health system, of a heavily subsidised public sector and a user charged private sector, has produced a progressive health financing system. The case of Malaysia exemplifies that policy makers can gain an in depth understanding of the equity impact, in order to help shape health financing strategies for the nation.
公平筹资是医疗保健系统的一个关键目标。其重要性在政策文件、政策声明、卫生经济学家和政策分析人员的工作中得到了体现。传统上，卫生保健筹资来源分为税收、社会健康保险、私人健康保险和自费支付。然而，用于资助卫生保健的筹资来源正在不断变化。了解公平筹资的影响将有助于政策制定者实现公平筹资。
本文的主要目的是全面评估马来西亚的卫生保健筹资公平性，这代表了用于定量分析的新技术在新的国家背景下的应用。本文独立评估了五种筹资来源（直接税、间接税、雇员公积金和社会保障组织缴款、私人保险和自费支付）中的每一种，随后将筹资来源结合起来评估整个筹资系统。
利用 Stata 统计软件包对马来西亚 1998/99 年家庭支出调查进行了横断面分析。为了评估不平等，通过 Kakwani 的累进指数衡量了每个筹资来源和整个筹资系统的累进程度。
结果表明，马来西亚以税收为主要筹资来源的系统略有累进，其 Kakwani 的累进指数为 0.186。净累进效应是由四个累进筹资来源（直接税、私人保险费、自费支付、雇员公积金和社会保障组织缴款）和一个累退筹资来源（间接税）产生的。
马来西亚的双层卫生系统，一个是大量补贴的公共部门，另一个是收费的私人部门，产生了一个累进的卫生筹资系统。马来西亚的情况表明，政策制定者可以深入了解公平性影响，从而帮助制定国家卫生筹资战略。
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