IDEAS home Printed from https://ideas.repec.org/a/plo/pone00/0119840.html
   My bibliography  Save this article

Who Benefits from Government Healthcare Subsidies? An Assessment of the Equity of Healthcare Benefits Distribution in China

Author

Listed:
  • Mingsheng Chen
  • Guixia Fang
  • Lidan Wang
  • Zhonghua Wang
  • Yuxin Zhao
  • Lei Si

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.

Suggested Citation

  • Mingsheng Chen & Guixia Fang & Lidan Wang & Zhonghua Wang & Yuxin Zhao & Lei Si, 2015. "Who Benefits from Government Healthcare Subsidies? An Assessment of the Equity of Healthcare Benefits Distribution in China," PLOS ONE, Public Library of Science, vol. 10(3), pages 1-15, March.
    • Handle: RePEc:plo:pone00:0119840
    DOI: 10.1371/journal.pone.0119840
    as

    Download full text from publisher

    File URL: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0119840
    Download Restriction: no
    File URL: https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0119840&type=printable
    Download Restriction: no
    File URL: https://libkey.io/10.1371/journal.pone.0119840?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Castro-Leal, Florencia & Dayton, Julia & Demery, Lionel & Mehra, Kalpana, 1999. "Public Social Spending in Africa: Do the Poor Benefit?," The World Bank Research Observer, World Bank, vol. 14(1), pages 49-72, February.
    2. Owen O'Donnell & Eddy van Doorslaer & Adam Wagstaff & Magnus Lindelow, 2008. "Analyzing Health Equity Using Household Survey Data : A Guide to Techniques and Their Implementation," World Bank Publications - Books, The World Bank Group, number 6896.
    3. Wanchuan Lin & Gordon G. Liu & Gang Chen, 2009. "The Urban Resident Basic Medical Insurance: a landmark reform towards universal coverage in China," Health Economics, John Wiley & Sons, Ltd., vol. 18(S2), pages 83-96, July.
    4. Mr. Erwin H Tiongson & Mr. Hamid R Davoodi & Sawitree S. Asawanuchit, 2003. "How Useful Are Benefit Incidence Analyses of Public Education and Health Spending," IMF Working Papers 2003/227, International Monetary Fund.
    5. Ajay Mahal & Anup Karan & Victoria Y Fan & Michael Engelgau, 2013. "The Economic Burden of Cancers on Indian Households," PLOS ONE, Public Library of Science, vol. 8(8), pages 1-10, August.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Mingsheng Chen & Zhonghua Wang, 2022. "Benefits for Older People from Government Subsidies for Healthcare in China: Is the Distribution Equitable?," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 160(2), pages 505-521, April.
    2. Micheal Kofi Boachie & K. Ramu, 2018. "Distribution of the benefits from public health expenditures in Ghana," Quality & Quantity: International Journal of Methodology, Springer, vol. 52(1), pages 415-430, January.
    3. Xueqian Song & Yongping Wei & Wei Deng & Shaoyao Zhang & Peng Zhou & Ying Liu & Jiangjun Wan, 2019. "Spatio-Temporal Distribution, Spillover Effects and Influences of China’s Two Levels of Public Healthcare Resources," IJERPH, MDPI, vol. 16(4), pages 1-18, February.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Micheal Kofi Boachie & K. Ramu, 2018. "Distribution of the benefits from public health expenditures in Ghana," Quality & Quantity: International Journal of Methodology, Springer, vol. 52(1), pages 415-430, January.
    2. Shen, Ke & Wang, Feng & Cai, Yong, 2016. "Patterns of inequalities in public transfers by gender in China," The Journal of the Economics of Ageing, Elsevier, vol. 8(C), pages 76-84.
    3. Kausik K. Bhadra, 2016. "Inequality Effects of Fiscal Policy: Analysing the Benefit Incidence on Health Sector in India," Working Papers id:8433, eSocialSciences.
    4. Runu Bhatka, 2016. "Educational Attainment of Young Adults in India: Measures, Trends and Determinants," Working Papers id:8435, eSocialSciences.
    5. Essama-Nssah, B., 2008. "Assessing the redistributive effect of fiscal policy," Policy Research Working Paper Series 4592, The World Bank.
    6. Pierre‐Richard Agénor, 2004. "Macroeconomic Adjustment and the Poor: Analytical Issues and Cross‐Country Evidence," Journal of Economic Surveys, Wiley Blackwell, vol. 18(3), pages 351-408, July.
    7. Robson, Matthew & O’Donnell, Owen & Van Ourti, Tom, 2024. "Aversion to health inequality — Pure, income-related and income-caused," Journal of Health Economics, Elsevier, vol. 94(C).
    8. Pan, Jay & Qin, Xuezheng & Li, Qian & Messina, Joseph P. & Delamater, Paul L., 2015. "Does hospital competition improve health care delivery in China?," China Economic Review, Elsevier, vol. 33(C), pages 179-199.
    9. Nora Lustig & Florencia Amábile & Marisa Bucheli & George Gray Molina & Sean Higgins & Miguel Jaramillo & Wilson Jiménez Pozo & Veronica Paz Arauco & Claudiney Pereira & Carola Pessino & Máximo Rossi , 2014. "El impacto del sistema tributario y del gasto social sobre la desigualdad y la pobreza en Argentina, Bolivia, Brasil, México, Perú y Uruguay: Un panorama general," Commitment to Equity (CEQ) Working Paper Series 1313S, Tulane University, Department of Economics.
    10. Andrew J. Mirelman & Miqdad Asaria & Bryony Dawkins & Susan Griffin & Richard Cookson & Peter Berman, 2020. "Fairer Decisions, Better Health for All: Health Equity and Cost-Effectiveness Analysis," World Scientific Book Chapters, in: Paul Revill & Marc Suhrcke & Rodrigo Moreno-Serra & Mark Sculpher (ed.), Global Health Economics Shaping Health Policy in Low- and Middle-Income Countries, chapter 4, pages 99-132, World Scientific Publishing Co. Pte. Ltd..
    11. Ahmed Shoukry Rashad, 2014. "The Catastrophic Economic Consequences of Illness and their Effect on Poverty Estimates in Egypt, Jordan, and Palestine," Working Papers 842, Economic Research Forum, revised Oct 2014.
    12. Kinyondo, Abel Alfred & Ntegwa, Magashi Joseph & Masawe, Cresencia Apolinary, 2022. "Socioeconomic Inequality in Maternal Healthcare Services: The Case of Tanzania," African Journal of Economic Review, African Journal of Economic Review, vol. 10(01), January.
    13. Rahman, Md Mizanur & Jung, Jenny & Islam, Md Rashedul & Rahman, Md Mahfuzur & Nakamura, Ryota & Akter, Shamima & Sato, Motohiro, 2022. "Global, regional, and national progress in financial risk protection towards universal health coverage, 2000–2030," Social Science & Medicine, Elsevier, vol. 312(C).
    14. Ben Jann, 2008. "A Stata implementation of the Blinder-Oaxaca decomposition," ETH Zurich Sociology Working Papers 5, ETH Zurich, Chair of Sociology, revised 14 May 2008.
    15. Hai Zhong, 2010. "The impact of missing data in the estimation of concentration index: a potential source of bias," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 11(3), pages 255-266, June.
    16. Tomson Ogwang & Germano Mwabu, 2024. "Adaptation of the Foster‐Greer‐Thorbecke poverty measures for the measurement of catastrophic health expenditures," Health Economics, John Wiley & Sons, Ltd., vol. 33(10), pages 2419-2436, October.
    17. Slawa Rokicki & Mark E. McGovern, 2020. "Heterogeneity in Early Life Investments: A Longitudinal Analysis of Children's Time Use," Review of Income and Wealth, International Association for Research in Income and Wealth, vol. 66(3), pages 647-676, September.
    18. Genova, Christian & Umberger, Wendy J. & Peralta-Sanchez, Maria-Alexandra & Newman, Suzie & Zeng, Di, 2021. "The Impact of Smallholder Vegetable Production on Rural Vietnamese Children’s Nutrition Outcomes," 2021 Conference, August 17-31, 2021, Virtual 315293, International Association of Agricultural Economists.
    19. Zhongliang Zhou & Yu Fang & Zhiying Zhou & Dan Li & Dan Wang & Yanli Li & Li Lu & Jianmin Gao & Gang Chen, 2017. "Assessing Income-Related Health Inequality and Horizontal Inequity in China," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 132(1), pages 241-256, May.
    20. Marcel Fafchamps & Bart Minten, 2007. "Public Service Provision, User Fees and Political Turmoil," Journal of African Economies, Centre for the Study of African Economies, vol. 16(3), pages 485-518, June.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:plo:pone00:0119840. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: plosone (email available below). General contact details of provider: https://journals.plos.org/plosone/ .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.