School of Sociology and Political Science, Shanghai University, Shanghai, China.
Int J Health Plann Manage. 2020 Sep;35(5):1111-1126. doi: 10.1002/hpm.3017. Epub 2020 Jul 28.
This study aims to assess the association between Chinese out-of-pocket payments and government health spending, investigating their variation ratio in the context of OECD countries. Aggregated time-series data of 37 countries (from China and official OECD members) were collected from the World Bank Open Data source and analyzed using the multiple linear regression models. Benchmarking approach was applied to evaluate the causes of healthcare expenditure rise per capita. The results showed that China's government health expenditure was positively associated with out-of-pocket payment rise, with a higher variation score of 42.70%. The association was statistically significant at 5%. Likewise, the association between government expenditure and out-of-pocket payment in the OECD countries was positively significant at 1%, and their variation score was 2.41%. Health financing in OECD countries showed higher stability and equity than that in China. Policy implications for China is to reduce the distributional disparity of government health funds by tax adjustments in health services, universal health coverage, the removal of social health insurance disparities, and a single health payment method.
本研究旨在评估中国自费支出与政府卫生支出之间的关联，并考察在经合组织（OECD）国家背景下两者之间的变化比例。本研究从世界银行公开数据资源中收集了来自中国和经合组织正式成员国的 37 个国家的汇总时间序列数据，并使用多元线性回归模型进行了分析。本研究采用基准方法评估了人均医疗支出增长的原因。结果表明，中国政府卫生支出与自费支出增长呈正相关，变化比例为 42.70%，得分较高。这种关联在 5%的水平上具有统计学意义。同样，OECD 国家政府支出与自费支出之间的关联在 1%的水平上呈正相关，其变化比例为 2.41%。OECD 国家的卫生筹资比中国更稳定和公平。对中国的政策启示是，通过调整卫生服务税收、全民健康覆盖、消除社会医疗保险差异以及单一的卫生支付方式，减少政府卫生资金的分配差距。
