A CONSISTENT DECOMPOSITION OF THE REDISTRIBUTIVE,VERTICAL, AND HORIZONTAL EFFECTS OF HEALTH CARE FINANCE BY FACTOR COMPONENTS

In studies on the redistributive, vertical, and horizontal effects of health care financing, the sum of the contributions calculated for each financial instrument does not equal the total effects. As a consequence, the final calculations tend to be overestimated or underestimated. The solution proposed here involves the adaptation of the Shapley value to achieve additive results for all the effects and reveals the relative contributions of different instruments to the change of whole‐system equity. An understanding of this change would help policy makers attain equitable health care financing. We test the method with the public finance and private payments of health care systems in Denmark and the Netherlands. Copyright © 2013 John Wiley & Sons, Ltd.     

甘肃省农村卫生筹资公平性分析研究

目的:研究甘肃省农村各项卫生筹资渠道的公平程度。方法:利用累进性分析方法评价卫生筹资的公平性。运用比例法和指数法,分析甘肃省农村各种卫生筹资渠道的累进性,反映卫生支出在不同社会经济群体间的分布和公平程度。结果:(1)通过税收进行卫生筹资具有良好的公平性;(2)当前新农合的筹资方式缺乏公平性;(3)直接现金卫生支出不具备公平性。结论:卫生筹资应以政府主导,加强利用税收进行卫生筹资,改变新农合的筹资方式,降低直接现金卫生支出在卫生筹资中的比重。     

卫生筹资公平性分析方法研究

综合国内外文献介绍在卫生领域内卫生筹资公平性分析的原理、指标、步骤和评价方法,探讨如何进行数据开发并利用公平性评价方法进行相关的政策分析,以及如何通过累进性分析更好地理解和评价卫生筹资系统的公平性。     

Redistribution or horizontal equity in Hong Kong's mixed public-private health system: a policy conundrum

We examine the distributional characteristics of Hong Kong's mixed public-private health system to identify the net redistribution achieved through public spending on health care, compare the income-related inequality and inequity of public and private care and measure horizontal inequity in health-care delivery overall. Payments for public care are highly concentrated on the better-off whereas benefits are pro-poor. As a consequence, public health care effects significant net redistribution from the rich to the poor. Public care is skewed towards the poor in part not only because of allocation according to need but also because the rich opt out of the public sector and consume most of the private care. Overall, there is horizontal inequity favouring the rich in general outpatient care and (very marginally) inpatient care. Pro-rich bias in the distribution of private care outweighs the pro-poor bias of public care. A lesser role for private finance may improve horizontal equity of utilisation but would also reduce the degree of net redistribution through the public sector.     

广西壮族自治区农村卫生筹资公平性分析研究

目的:分析广西壮族自治区农村各种卫生筹资渠道的公平程度。方法:利用比例法、累进性分析等方法分析2000～2008年广西农村各种卫生筹资渠道的公平性。结果:2000～2008年广西农村通过税收进行筹资的公平性呈上升趋势,2008年略显累进性(kakwani指数为0.0076)。直接现金卫生支出的kakwani指数在-0.1上下波动,筹资的公平性较差。结论:提高政府卫生投入力度,加强利用税收进行卫生筹资,拓宽社会卫生筹资,降低个人卫生支出的比例,从而提高卫生筹资的公平性。     

Reflections on and alternatives to WHO's fairness of financial contribution index

In its 2000 World Health Report (WHR), the World Health Organization argues that a key dimension of a health system's performance is the fairness of its financing system. This paper provides a critical assessment of the index of fairness of financial contribution (FFC) proposed in the WHR. It shows that the index cannot discriminate between health financing systems that are regressive and those that are progressive, and cannot discriminate between horizontal inequity on the one hand, and progressivity and regressivity on the other. The paper compares the WHO index to an alternative and more illuminating approach developed in the income redistribution literature in the early 1990s and used in the late 1990s to study the fairness of various OECD countries' health financing systems. It ends with an illustrative empirical comparison of the two approaches using data on out-of-pocket payments for health services in Vietnam for two years - 1993 and 1998. This analysis is of some interest in its own right, given the large share of health spending from out-of-pocket payments in Vietnam, and the changes in fees and drug prices over the 1990s.     

东中西部城市卫生筹资累进性比较：基于社区卫生综合改革典型城市居民健康询问调查

目的：比较东中西部城市税收、社会医疗保险、商业健康保险和居民现金卫生支出4种卫生筹资渠道的累进性。方法：利用2011年8个社区卫生综合改革典型城市居民健康询问调查数据,采用比例法描述东中西部城市4种卫生筹资渠道的分布,并计算其集中指数和kakwani指数。结果：东中西部城市不同经济水平家庭的社会医疗保险、商业健康保险和居民现金卫生支出构成差异均无统计学意义（χ2社会医疗保险=3.697, P=0.883;χ2商业健康保险=11.349, P=0.183;χ2现金卫生支出=4.146, P=0.844）,而直接税构成差异具有统计学意义（χ2=17.439, P=0.026）,东部城市家庭直接税的公平性好于中部城市。总体上,呈现累进性的筹资渠道是直接税、职工医疗保险、商业健康保险;呈现累退性的是间接税、居民医疗保险,而现金卫生支出在东部城市呈现累退性,在中部和西部城市呈现累进性。结论：发挥税收在筹资公平性的作用;完善社会医疗保险制度;提高卫生服务的可及性。     

卫生筹资累进性分析案例研究

“卫生筹资累进性分析案例研究”是“卫生领域公平性系列研究”的组成部分运用比例法和指数法．对甘肃省城市、农村和全省卫生筹资公平性进行案例研究，分别测量各种卫生筹资渠道的累进性，反映卫生支出在不同社会经济群体之间的分布与公平程度，并在此基础上进行分析与讨论。     

Assessing progressivity of out-of-pocket payment: with illustration to Malaysia

Throughout the world, policy makers are considering or implementing financing strategies that are likely to have a substantial impact on the equity of health financing. The assessment of the equity implication is clearly important, given the potential impact that alternative finance sources have on households. Households incur out-of-pocket payment directly from their budget, apart from their public or private insurance. Out-of-pocket payment is the primary concern, given their undesirable impact on households. Progressivity measures departures from proportionality in the relationship between out-of-pocket payment and ability to pay. It is the most frequently used yardstick to assess the equity of out-of-pocket payments in empirical studies. This paper provides an evaluation of such progressivity measures, undertaken using four approaches (proportion approach, tabulation approach, concentration curve and Kakwani's index), in order to reveal their usefulness and underlying notion. It is illustrated empirically with data on out-of-pocket payment for health care in Malaysia for 1998/ 1999, based on the nationally representative Household Expenditure Survey. Results indicate that out-of-pocket payments are mildly progressive, whilst the four approaches have their benefits and limitations in assessing equity implications. This analysis is of interest from a policy perspective, given Malaysia's heavy reliance on out-of-pocket payments to finance health care.