Department of Social Medicine and Health Management School of Public Health, Shandong University, Road44# Jinan, Shandong, CN, China.
Department of Global Health Systems and Development, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA.
Int J Equity Health. 2018 May 18;17(1):61. doi: 10.1186/s12939-018-0775-3.
Government health subsidy (GHS) is an effective tool to improve population health in China. Ensuring an equitable allocation of GHS, particularly among the poorer socio-economic groups, is a major goal of China's healthcare reform. The paper aims to explore how GHS was allocated across different socioeconomic groups, and how well the overall health system was performing in terms of the allocation of subsidy for different types of health services.
Data from China's National Health Services Survey (NHSS) in 2013 were used. Benefit incidence analysis (BIA) was applied to examine if GHS was equally distributed across income quintile. Benefit incidence was presented as each quintile's percentage share of total benefits, and the concentration index (CI) and Kakwani index (KI) were calculated. Health benefits from three types of healthcare services (primary health care, outpatient and inpatient services) were analyzed, separated into urban and rural populations. In addition, the distribution of benefits was compared to the distribution of healthcare need (measured by self-reported illness and chronic disease) across income quintiles.
In urban populations, the CI value of GHS for primary care was negative. (- 0.14), implying an allocation tendency toward poor region; the CI values of outpatient and inpatient services were both positive (0.174 and 0.194), indicating allocation tendencies toward rich region. Similar allocation pattern was observed in rural population, with pro-poor tendency of primary care service (CI = - 0.082), and pro-rich tendencies of outpatient (CI = 0.153) and inpatient services (CI = 0.203). All the KI values of three health services in urban and rural populations were negative (- 0.4991,-0.1851 and - 0.1651; - 0.482, - 0.247and - 0.197), indicating that government health subsidy was progressive and contributed to the narrowing of economic gap between the poor and rich.
The inequitable distribution of GHS in China exited in different healthcare services; however, the GHS benefit is generally progressive. Future healthcare reforms in China should not only focus on expanding the coverage, but also on improving the equity of distribution of healthcare benefits.
政府卫生补贴（GHS）是提高中国人口健康水平的有效工具。确保 GHS 在社会经济弱势群体中的公平分配，是中国医疗改革的主要目标。本文旨在探讨 GHS 在不同社会经济群体中的分配情况，以及整个卫生系统在不同类型卫生服务的补贴分配方面的表现如何。
使用 2013 年中国国家卫生服务调查（NHSS）的数据。受益情况分析（BIA）用于检验 GHS 是否在收入五分位数之间平均分配。受益情况表示为每个五分位数的总受益份额的百分比，同时计算了集中指数（CI）和 Kakwani 指数（KI）。分析了三种类型的医疗服务（初级卫生保健、门诊和住院服务）的卫生效益，分别按城乡人口进行分析。此外，还比较了收入五分位数之间的卫生需求（自我报告的疾病和慢性病衡量）的分布与受益分布。
在城市人口中，初级保健 GHS 的 CI 值为负数（-0.14），表明存在向贫困地区分配的倾向；门诊和住院服务的 CI 值均为正数（0.174 和 0.194），表明存在向富裕地区分配的倾向。农村人口也观察到类似的分配模式，初级保健服务呈有利于穷人的倾向（CI=-0.082），门诊（CI=0.153）和住院服务（CI=0.203）呈有利于富人的倾向。城乡三种卫生服务的所有 KI 值均为负数（-0.4991、-0.1851 和-0.1651；-0.482、-0.247 和-0.197），表明政府卫生补贴是累进的，有助于缩小贫富之间的经济差距。
中国不同医疗服务中存在 GHS 分配不均等的情况；然而，GHS 受益总体上是累进的。中国未来的医疗改革不仅应注重扩大覆盖面，还应注重提高卫生效益分配的公平性。
