Zhang Qian, Wang Julia Shu-Huah, He Alex Jingwei, Peng Chenhong, Abe Aya, Ku Inhoe, Ng Irene Y H, Zhao Xi
Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China.
Department of Social Work, National Taiwan University, .
Int J Equity Health. 2025 Jul 31;24(1):215. doi: 10.1186/s12939-025-02568-2.
Fighting illness and poverty are intertwined objectives in global development. In recent decades, health financing reforms across many nations have enhanced financial protection for low-income populations and promoted health equity for all citizens. However, prior cross-national comparative studies predominantly focused on examining financing structures or social health insurance (SHI) schemes, neglecting financing schemes targeting the poor, such as medical financial assistance (MFA). This study comparatively explores the design of health financing schemes and financial protection outcomes for low-income populations across six societies in East Asia: mainland China, Hong Kong, Taiwan, Japan, South Korea, and Singapore.
We assess the design of health financing schemes from the dimensions of income-based eligibility, population coverage, and benefit generosity. Policy information was collected from official websites and policy reports. To compare financial protection outcomes, we derived the data through the "model family approach" and jurisdiction-level statistics and simulated catastrophic health spending of lung cancer for individuals across four income levels: (1) no income; (2) earning minimum wage; (3) earning half the national/regional average wage; and (4) earning the national/regional average wage.
We find that health financing schemes in Taiwan and Hong Kong are generous and inclusive for general populations, while Japan, South Korea, and Singapore's financing schemes are protective and offer relatively generous benefits for vulnerable groups. In contrast, mainland China provides limited benefits in SHI and MFA schemes. Health financing schemes reduce the financial burden to varying degrees, with Taiwan, Hong Kong, and South Korea providing financial protection for low-income populations to a higher degree, followed by Japan, Singapore, and mainland China. Notably, our findings highlight inequities for individuals earning half the average wage in Singapore, mainland China, and Japan (and to a lesser extent in Taiwan, Hong Kong and Korea), as these groups face higher risks of catastrophic health spending compared to other income groups.
Our findings further the understanding of health financing designs in East Asia. We also provide evidence for governments to enhance financial protection for low-income populations, particularly near-poor groups, to achieve more equitable health financing arrangements.
抗击疾病与消除贫困是全球发展中相互交织的目标。近几十年来，许多国家的卫生筹资改革加强了对低收入人群的财务保护，并促进了全体公民的健康公平。然而，以往的跨国比较研究主要集中在考察筹资结构或社会医疗保险（SHI）计划，而忽视了针对贫困人口的筹资计划，如医疗财务援助（MFA）。本研究比较探讨了东亚六个社会（中国大陆、香港、台湾、日本、韩国和新加坡）针对低收入人群的卫生筹资计划设计和财务保护结果。
我们从基于收入的资格、人口覆盖范围和福利慷慨程度等维度评估卫生筹资计划的设计。政策信息从官方网站和政策报告中收集。为了比较财务保护结果，我们通过“模型家庭方法”和辖区层面的统计数据得出数据，并模拟了四个收入水平人群（1）无收入；（2）挣最低工资；（3）挣国家/地区平均工资的一半；（4）挣国家/地区平均工资）患肺癌的灾难性卫生支出。
我们发现，台湾和香港的卫生筹资计划对普通人群慷慨且具有包容性，而日本、韩国和新加坡的筹资计划具有保护性，为弱势群体提供相对慷慨的福利。相比之下，中国大陆在社会医疗保险和医疗财务援助计划中提供的福利有限。卫生筹资计划在不同程度上减轻了财务负担，台湾、香港和韩国对低收入人群的财务保护程度较高，其次是日本、新加坡和中国大陆。值得注意的是，我们的研究结果突出了新加坡、中国大陆和日本（在台湾、香港和韩国程度较轻）中挣平均工资一半的人群存在的不公平现象，因为与其他收入群体相比，这些人群面临更高的灾难性卫生支出风险。
我们的研究结果加深了对东亚卫生筹资设计的理解。我们还为政府加强对低收入人群，特别是接近贫困群体的财务保护提供了证据，以实现更公平的卫生筹资安排。
