School of Health Policy & Management, Nanjing Medical University, No. 101, Longmian Avenue, Nanjing, 211166, China.
Center for Global Health, Nanjing Medical University, Nanjing, China.
Int J Equity Health. 2022 Dec 1;21(1):170. doi: 10.1186/s12939-022-01793-3.
Universal health coverage is a challenge to horizontal equity in healthcare financing. Since 1998, China has extended its healthcare insurance schemes, and individuals with equal incomes but different attributes such as social status, profession, geographic access to health care, and health conditions, are covered by the same health insurance scheme. This study aims to examine horizontal inequity in the Chinese healthcare financing system in 2002 and 2007 using data from two national household health surveys.
Multi-stage stratified random sampling was used to select 3,946 households with 13,619 individuals in 2002, and 3,958 households with 12,973 individuals in 2007. A decomposition method was used to measure the horizontal inequity and reranking in healthcare finance.
Over the period 2002-2007, the absolute value of horizontal inequity in total healthcare payments decreased from 997.83 percentage points to 199.87 percentage points in urban areas, and increased from 22.28 percentage points to 48.80 percentage points in rural areas. The horizontal inequity in social health insurance remained almost the same in urban areas, at around 27 percentage points, but decreased from 110.90 percentage points to 7.80 percentage points in rural areas. Horizontal inequity in out-of-pocket payments decreased from 178.43 percentage points to 80.96 percentage points in urban areas, and increased from 26.06 percentage points to 41.40 percentage points in rural areas.
The horizontal inequity of healthcare finance in China over the period 2002-2007 was reduced by general taxation and social insurance, but strongly affected by out-of-pocket payments. Increasing the benefits from social health insurance would help to reduce horizontal inequity.
全民健康覆盖对医疗保健融资中的横向公平性构成挑战。自 1998 年以来，中国扩大了医疗保险计划，具有相同收入但社会地位、职业、获得医疗保健的地理位置和健康状况等属性不同的个人，都纳入相同的医疗保险计划。本研究旨在利用两项全国家庭健康调查的数据，检验中国医疗保健融资系统在 2002 年和 2007 年的横向不公平性。
采用多阶段分层随机抽样方法，于 2002 年选取了 3946 户家庭，共 13619 人；2007 年选取了 3958 户家庭，共 12973 人。采用分解方法衡量医疗保健融资中的横向不公平性和重新排序。
在 2002-2007 年期间，城市地区总医疗支出的绝对横向不公平性从 997.83 个百分点降至 199.87 个百分点，农村地区从 22.28 个百分点增至 48.80 个百分点。城市地区社会医疗保险的横向不公平性基本保持不变，约为 27 个百分点，而农村地区从 110.90 个百分点降至 7.80 个百分点。城市地区自付支出的横向不公平性从 178.43 个百分点降至 80.96 个百分点，农村地区从 26.06 个百分点增至 41.40 个百分点。
2002-2007 年期间，中国医疗保健融资的横向不公平性通过一般税收和社会保险得到缓解，但受到自付支出的强烈影响。增加社会医疗保险的福利将有助于减少横向不公平性。
