Estimating benefit equity of government health subsidy in healthcare Services in Shandong Province, China: a cross-sectional study

Abstract

BackgroundGovernment health subsidy (GHS) is an effective tool to improve population health in China. Ensuring an equitable allocation of GHS, particularly among the poorer socio-economic groups, is a major goal of China’s healthcare reform.The paper aims to explore how GHS was allocated across different socioeconomic groups, and how well the overall health system was performing in terms of the allocation of subsidy for different types of health services.MethodsData from China’s National Health Services Survey (NHSS) in 2013 were used. Benefit incidence analysis (BIA) was applied to examine if GHS was equally distributed across income quintile. Benefit incidence was presented as each quintile’s percentage share of total benefits, and the concentration index (CI) and Kakwani index (KI) were calculated. Health benefits from three types of healthcare services (primary health care, outpatient and inpatient services) were analyzed, separated into urban and rural populations. In addition, the distribution of benefits was compared to the distribution of healthcare need (measured by self-reported illness and chronic disease) across income quintiles.ResultsIn urban populations, the CI value of GHS for primary care was negative. (− 0.14), implying an allocation tendency toward poor region; the CI values of outpatient and inpatient services were both positive (0.174 and 0.194), indicating allocation tendencies toward rich region. Similar allocation pattern was observed in rural population, with pro-poor tendency of primary care service (CI = − 0.082), and pro-rich tendencies of outpatient (CI = 0.153) and inpatient services (CI = 0.203). All the KI values of three health services in urban and rural populations were negative (− 0.4991,-0.1851 and − 0.1651; − 0.482, − 0.247and − 0.197), indicating that government health subsidy was progressive and contributed to the narrowing of economic gap between the poor and rich.ConclusionsThe inequitable distribution of GHS in China exited in different healthcare services; however, the GHS benefit is generally progressive. Future healthcare reforms in China should not only focus on expanding the coverage, but also on improving the equity of distribution of healthcare benefits.

The willingness of patients to make the first visit to primary care institutions and its influencing factors in Beijing medical alliances: a comparative study of Beijing’s medical resource-rich and scarce regions

“…In 2016, outpatient and emergency visits in PCIs accounted for only 56.14% of the total outpatient and emergency visits, while the proportion of hospital visits remained high, and 20.6% of the patients were still concentrated in 0.2% of all Class-three hospitals [9]. This reluctance to visit PCIs leads to a continuously increasing volume of hospital medical services and will severely affect the implementation of a first visit to PCIs [10].…”

The Awareness and Attitude of Contracted Service Among General Medical Practitioners in Community Health Service Centers in Urban China: A Cross-Sectional Study

“…Geographic variety may also contribute to differences in CS signing. The strategies and subsidy for primary health in different areas are not universal but influenced by local health policies and socioeconomic status ( 17 ). People used to seek medical care at large hospitals even for simple health problems possibly because of their low trust of CHS or outdated equipment there ( 15 , 18 , 19 ); therefore, areas with higher large hospital coverage for local population may have lower CS signing proportion.…”

Metodologias para alocação equitativa de recursos financeiros em saúde: uma revisão integrativa

“…Um sexto bloco de estudo se aproxima mais da temática, à medida que foca diretamente na 'testagem da aplicação (alocação) dos recursos' 27,28 . E, por fim, o sétimo e último bloco atinge o cerne da discussão encetada, focando na 'alocação por equidade' [29][30][31] . Assim, três estudos se centram nessa questão.…”

“…No primeiro grupo dos estudos, que apresenta um caráter descritivo-reflexivo, predominou o 'ensaio' como modalidade textual utilizada 11,23,31 . Partindo-se para um segundo grupo de estudos, com metodologias mais rigorosas, quatro deles optaram por uma 'abordagem quantitativa-descritiva' da alocação de recursos 14,17,19,27,29 . O terceiro grupo de estudos foi aquele que optou pelo uso de 'abordagens quantitativas clássicas utilizadas nas ciências econômicas ou na econometria'.…”