Zhang Lufa, Liu Nan
School of International and Public Affairs, Shanghai Jiao Tong University, Room 2015, Xinjian Building, 1954 HuaShan Road, Xuhui District, Shanghai 200030, China. E-mail:
Health Policy Plan. 2014 Mar;29(2):217-26. doi: 10.1093/heapol/czt006. Epub 2013 Feb 21.
China's ongoing new health reform aims to reduce individual out-of-pocket (OOP) payments for healthcare services. The aim of this article is to analyse the impact of this reform and to draw policy implications.
Data are retrieved from the relevant government publications. Polynomial regression models are used to predict future health expenditures. An extensive sensitivity analysis is conducted to investigate the ratios of OOP payments to the total health expenditures (THEs) and to the disposable personal income (DPI) for 2009-11 under different scenarios of cost projections and personal income distributions. Both quantitative and qualitative analyses are carried out to draw conclusions.
The ratios of OOP payments to THE and DPI vary significantly across scenarios tested. Only if all committed government investments and social health expenditure are realized can China's new health reform reduce both ratios and achieve its target goals. In particular, the ratio of OOP payments to DPI can also be significantly reduced by improving income distribution. Due to the complicated interplay among different cost components in health expenditures, these two ratios may not change in the same direction, indicating that both need to be examined when evaluating the reform.
The new health reform in China aims to alleviate the high OOP payments for healthcare services, but it has not yet been able to reduce both OOP-to-THE and OOP-to-DPI ratios simultaneously. Major reasons include (1) inability of local governments to fulfil their responsible investments due to health finance decentralization and uneven economic development in China and (2) a serious cost inflation in health expenditures coupled with a low level of income distribution. It is suggested that the central government should bear more financial responsibility and assist local governments to fully invest, and should improve individual incomes, in particular for the poor.
中国正在进行的新医改旨在降低个人医疗保健服务的自付费用。本文旨在分析这项改革的影响并得出政策启示。
数据取自相关政府出版物。使用多项式回归模型预测未来的医疗支出。进行了广泛的敏感性分析，以调查在不同成本预测和个人收入分配情况下2009 - 2011年自付费用与总医疗支出（THEs）以及可支配个人收入（DPI）的比率。通过定量和定性分析得出结论。
在所测试的不同情景下，自付费用与THE以及DPI的比率差异显著。只有当所有承诺的政府投资和社会医疗支出得以实现时，中国的新医改才能降低这两个比率并实现其目标。特别是，通过改善收入分配也可以显著降低自付费用与DPI的比率。由于医疗支出中不同成本组成部分之间复杂的相互作用，这两个比率可能不会朝着相同方向变化，这表明在评估改革时两者都需要进行审视。
中国的新医改旨在减轻高额的医疗保健服务自付费用，但尚未能够同时降低自付费用与THE以及自付费用与DPI的比率。主要原因包括：（1）由于卫生财政分权以及中国经济发展不平衡，地方政府无法履行其应承担的投资责任；（2）医疗支出成本严重膨胀，同时收入分配水平较低。建议中央政府应承担更多财政责任，协助地方政府充分投资，并应提高个人收入，特别是穷人的收入。
