Assessing equity in benefit distribution of government health subsidy in 2012 across East China: benefit incidence analysis

Background: Improving the equitable benefit distribution of government health subsidies, particularly among the country's poorer socioeconomic groups, is a major goal of China's healthcare sector reform. Methods: Benefit incidence analysis was employed to measure the distribution of government health subsidies by income quintile. The concentration index (CI) of different levels of health care facility in urban and rural areas was calculated. A household survey complete through multistage stratified sampling was conducted in 2013 in urban areas (16,908 respondents) and rural areas (19,525 respondents). Results: The overall CI for urban patients was 0.1068 for outpatient care and 0.1237 for inpatient care. For outpatient care, the CI was 0.0795, 0.0465 and 0.3456, respectively, at primary, secondary and tertiary health care facilities; for inpatient care, the CI was -0.2179, 0.0752 and 0.2883 at the corresponding facility levels. The overall CI for rural outpatients was -0.0659 and 0.0036 for inpatients. For outpatient care, the CI was -0.0818, 0.0567 and 0.0271 at primary, secondary and tertiary facilities, respectively; for inpatient care, the CI was -0.0050, 0.0084 and 0.0252 at the corresponding facility levels. Conclusions: China's primary level health care facilities were found to have a more equitable benefit distribution of government health subsidies than the secondary- and tertiary- level facilities. Increased government budget allocations and insurance imbursement rates, and the provision of technical support and qualified medical staff to lower-level hospitals were key factors. However, the provision of equal subsidies to all socioeconomic levels was found to be a potential threat to the equity of government health subsidy distribution.