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Improving equity in health care financing in China during the progression towards Universal Health Coverage

BACKGROUND: China is reforming the way it finances health care as it moves towards Universal Health Coverage (UHC) after the failure of market-oriented mechanisms for health care. Improving financing equity is a major policy goal of health care system during the progression towards universal coverag...

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Autores principales: Chen, Mingsheng, Palmer, Andrew J., Si, Lei
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5747168/
https://www.ncbi.nlm.nih.gov/pubmed/29284470
http://dx.doi.org/10.1186/s12913-017-2798-7
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author Chen, Mingsheng
Palmer, Andrew J.
Si, Lei
author_facet Chen, Mingsheng
Palmer, Andrew J.
Si, Lei
author_sort Chen, Mingsheng
collection PubMed
description BACKGROUND: China is reforming the way it finances health care as it moves towards Universal Health Coverage (UHC) after the failure of market-oriented mechanisms for health care. Improving financing equity is a major policy goal of health care system during the progression towards universal coverage. METHODS: We used progressivity analysis and dominance test to evaluate the financing channels of general taxation, pubic health insurance, and out-of-pocket (OOP) payments. In 2012 a survey of 8854 individuals in 3008 households recorded the socioeconomic and demographic status, and health care payments of those households. RESULTS: The overall Kakwani index (KI) of China’s health care financing system is 0.0444. For general tax KI was −0.0241 (95% confidence interval (CI): −0.0315 to −0.0166). The indices for public health schemes (Urban Employee Basic Medical Insurance, Urban Resident’s Basic Medical Insurance, New Rural Cooperative Medical Scheme) were respectively 0.1301 (95% CI: 0.1008 to 0.1594), −0.1737 (95% CI: –0.2166 to −0.1308), and −0.5598 (95% CI: –0.5830 to −0.5365); and for OOP payments KI was 0.0896 (95%CI: 0.0345 to 0.1447). OOP payments are still the dominant part of China’s health care finance system. CONCLUSION: China’s health care financing system is not really equitable. Reducing the proportion of indirect taxes would considerably improve health care financing equity. The flat-rate contribution mechanism is not recommended for use in public health insurance schemes, and more attention should be given to optimizing benefit packages during China’s progression towards UHC.
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spelling pubmed-57471682018-01-03 Improving equity in health care financing in China during the progression towards Universal Health Coverage Chen, Mingsheng Palmer, Andrew J. Si, Lei BMC Health Serv Res Research Article BACKGROUND: China is reforming the way it finances health care as it moves towards Universal Health Coverage (UHC) after the failure of market-oriented mechanisms for health care. Improving financing equity is a major policy goal of health care system during the progression towards universal coverage. METHODS: We used progressivity analysis and dominance test to evaluate the financing channels of general taxation, pubic health insurance, and out-of-pocket (OOP) payments. In 2012 a survey of 8854 individuals in 3008 households recorded the socioeconomic and demographic status, and health care payments of those households. RESULTS: The overall Kakwani index (KI) of China’s health care financing system is 0.0444. For general tax KI was −0.0241 (95% confidence interval (CI): −0.0315 to −0.0166). The indices for public health schemes (Urban Employee Basic Medical Insurance, Urban Resident’s Basic Medical Insurance, New Rural Cooperative Medical Scheme) were respectively 0.1301 (95% CI: 0.1008 to 0.1594), −0.1737 (95% CI: –0.2166 to −0.1308), and −0.5598 (95% CI: –0.5830 to −0.5365); and for OOP payments KI was 0.0896 (95%CI: 0.0345 to 0.1447). OOP payments are still the dominant part of China’s health care finance system. CONCLUSION: China’s health care financing system is not really equitable. Reducing the proportion of indirect taxes would considerably improve health care financing equity. The flat-rate contribution mechanism is not recommended for use in public health insurance schemes, and more attention should be given to optimizing benefit packages during China’s progression towards UHC. BioMed Central 2017-12-29 /pmc/articles/PMC5747168/ /pubmed/29284470 http://dx.doi.org/10.1186/s12913-017-2798-7 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Chen, Mingsheng
Palmer, Andrew J.
Si, Lei
Improving equity in health care financing in China during the progression towards Universal Health Coverage
title Improving equity in health care financing in China during the progression towards Universal Health Coverage
title_full Improving equity in health care financing in China during the progression towards Universal Health Coverage
title_fullStr Improving equity in health care financing in China during the progression towards Universal Health Coverage
title_full_unstemmed Improving equity in health care financing in China during the progression towards Universal Health Coverage
title_short Improving equity in health care financing in China during the progression towards Universal Health Coverage
title_sort improving equity in health care financing in china during the progression towards universal health coverage
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5747168/
https://www.ncbi.nlm.nih.gov/pubmed/29284470
http://dx.doi.org/10.1186/s12913-017-2798-7
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