Who benefits from government healthcare subsidies? An assessment of the equity of healthcare benefits distribution in China

Mingsheng Chen, Guixia Fang, Lidan Wang, Zhonghua Wang, Yuxin Zhao, Lei Si

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: Improving the equitable distribution of government healthcare subsidies (GHS), particularly among low-income citizens, is a major goal of China's healthcare sector reform in China. Objectives: This study investigates the distribution of GHS in China between socioeconomic populations at two different points in time, examines the comparative distribution of healthcare benefits before and after healthcare reforms in Northwest China, compares the parity of distribution between urban and rural areas, and explores factors that influence equitable GHS distribution. Methods: Benefit incidence analysis of GHS progressivity was performed, and concentration and Kakwani indices for outpatient, inpatient, and total healthcare were calculated. Two rounds of household surveys that used multistage stratified samples were conducted in 2003 (13,564 respondents) and 2008 (12,973 respondents). Data on socioeconomics, healthcare payments, and healthcare utilization were collected using household interviews. Results: High-income individuals generally reap larger benefits from GHS, as reflected by positive concentration indices, which indicates a regressive system. Concentration indices for inpatient care were 0.2199 (95% confidence interval [CI], 0.0829 to 0.3568) and 0.4445 (95% CI, 0.3000 to 0.5890) in 2002 (urban vs. rural, respectively), and 0.3925 (95% CI, 0.2528 to 0.5322) and 0.4084 (95% CI, 0.2977 to 0.5190) in 2007. Outpatient healthcare subsidies showed different distribution patterns in urban and rural areas following the redesign of rural healthcare insurance programs (urban vs. rural: 0.1433 [95% CI, 0.0263 to 0.2603] and 0.3662 [95% CI, 0.2703 to 0.4622] in 2002, respectively; 0.3063 [95% CI, 0.1657 to 0.4469] and -0.0273 [95% CI, -0.1702 to 0.1156] in 2007). Conclusions: Our study demonstrates an inequitable distribution of GHS in China from 2002 to 2007; however, the inequity was reduced, especially in rural outpatient services. Future healthcare reforms in China should not only focus on expanding the coverage, but also on improving the equity of distribution of healthcare benefits.

LanguageEnglish
Article numbere0119840
Pages1-15
Number of pages15
JournalPLoS ONE
Volume10
Issue number3
DOIs
Publication statusPublished - 17 Mar 2015
Externally publishedYes

Fingerprint

Government Financing
subsidies
health services
China
Delivery of Health Care
confidence interval
Confidence Intervals
Health Care Reform
Insurance
Inpatients
rural areas
urban areas
Outpatients
socioeconomics
rural health care
income
Health Care Sector
household surveys
Ambulatory Care
Parity

Bibliographical note

Copyright 2015 Chen et al. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

Cite this

Chen, Mingsheng ; Fang, Guixia ; Wang, Lidan ; Wang, Zhonghua ; Zhao, Yuxin ; Si, Lei. / Who benefits from government healthcare subsidies? An assessment of the equity of healthcare benefits distribution in China. In: PLoS ONE. 2015 ; Vol. 10, No. 3. pp. 1-15.
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title = "Who benefits from government healthcare subsidies? An assessment of the equity of healthcare benefits distribution in China",
abstract = "Background: Improving the equitable distribution of government healthcare subsidies (GHS), particularly among low-income citizens, is a major goal of China's healthcare sector reform in China. Objectives: This study investigates the distribution of GHS in China between socioeconomic populations at two different points in time, examines the comparative distribution of healthcare benefits before and after healthcare reforms in Northwest China, compares the parity of distribution between urban and rural areas, and explores factors that influence equitable GHS distribution. Methods: Benefit incidence analysis of GHS progressivity was performed, and concentration and Kakwani indices for outpatient, inpatient, and total healthcare were calculated. Two rounds of household surveys that used multistage stratified samples were conducted in 2003 (13,564 respondents) and 2008 (12,973 respondents). Data on socioeconomics, healthcare payments, and healthcare utilization were collected using household interviews. Results: High-income individuals generally reap larger benefits from GHS, as reflected by positive concentration indices, which indicates a regressive system. Concentration indices for inpatient care were 0.2199 (95{\%} confidence interval [CI], 0.0829 to 0.3568) and 0.4445 (95{\%} CI, 0.3000 to 0.5890) in 2002 (urban vs. rural, respectively), and 0.3925 (95{\%} CI, 0.2528 to 0.5322) and 0.4084 (95{\%} CI, 0.2977 to 0.5190) in 2007. Outpatient healthcare subsidies showed different distribution patterns in urban and rural areas following the redesign of rural healthcare insurance programs (urban vs. rural: 0.1433 [95{\%} CI, 0.0263 to 0.2603] and 0.3662 [95{\%} CI, 0.2703 to 0.4622] in 2002, respectively; 0.3063 [95{\%} CI, 0.1657 to 0.4469] and -0.0273 [95{\%} CI, -0.1702 to 0.1156] in 2007). Conclusions: Our study demonstrates an inequitable distribution of GHS in China from 2002 to 2007; however, the inequity was reduced, especially in rural outpatient services. Future healthcare reforms in China should not only focus on expanding the coverage, but also on improving the equity of distribution of healthcare benefits.",
author = "Mingsheng Chen and Guixia Fang and Lidan Wang and Zhonghua Wang and Yuxin Zhao and Lei Si",
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Who benefits from government healthcare subsidies? An assessment of the equity of healthcare benefits distribution in China. / Chen, Mingsheng; Fang, Guixia; Wang, Lidan; Wang, Zhonghua; Zhao, Yuxin; Si, Lei.

In: PLoS ONE, Vol. 10, No. 3, e0119840, 17.03.2015, p. 1-15.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Who benefits from government healthcare subsidies? An assessment of the equity of healthcare benefits distribution in China

AU - Chen, Mingsheng

AU - Fang, Guixia

AU - Wang, Lidan

AU - Wang, Zhonghua

AU - Zhao, Yuxin

AU - Si, Lei

N1 - Copyright 2015 Chen et al. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

PY - 2015/3/17

Y1 - 2015/3/17

N2 - Background: Improving the equitable distribution of government healthcare subsidies (GHS), particularly among low-income citizens, is a major goal of China's healthcare sector reform in China. Objectives: This study investigates the distribution of GHS in China between socioeconomic populations at two different points in time, examines the comparative distribution of healthcare benefits before and after healthcare reforms in Northwest China, compares the parity of distribution between urban and rural areas, and explores factors that influence equitable GHS distribution. Methods: Benefit incidence analysis of GHS progressivity was performed, and concentration and Kakwani indices for outpatient, inpatient, and total healthcare were calculated. Two rounds of household surveys that used multistage stratified samples were conducted in 2003 (13,564 respondents) and 2008 (12,973 respondents). Data on socioeconomics, healthcare payments, and healthcare utilization were collected using household interviews. Results: High-income individuals generally reap larger benefits from GHS, as reflected by positive concentration indices, which indicates a regressive system. Concentration indices for inpatient care were 0.2199 (95% confidence interval [CI], 0.0829 to 0.3568) and 0.4445 (95% CI, 0.3000 to 0.5890) in 2002 (urban vs. rural, respectively), and 0.3925 (95% CI, 0.2528 to 0.5322) and 0.4084 (95% CI, 0.2977 to 0.5190) in 2007. Outpatient healthcare subsidies showed different distribution patterns in urban and rural areas following the redesign of rural healthcare insurance programs (urban vs. rural: 0.1433 [95% CI, 0.0263 to 0.2603] and 0.3662 [95% CI, 0.2703 to 0.4622] in 2002, respectively; 0.3063 [95% CI, 0.1657 to 0.4469] and -0.0273 [95% CI, -0.1702 to 0.1156] in 2007). Conclusions: Our study demonstrates an inequitable distribution of GHS in China from 2002 to 2007; however, the inequity was reduced, especially in rural outpatient services. Future healthcare reforms in China should not only focus on expanding the coverage, but also on improving the equity of distribution of healthcare benefits.

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