Equity in health-care financing in China during the progression toward universal health coverage

Abstract Financing equity has become a major policy goal in China's progression toward universal health coverage since the beginning of the 21st century. In this study, we examine the equity characteristics of health-care financing in a province in the middle of China, comparing the equity performance between urban and rural areas at two different points in time. Progressivity and the corresponding Kakwani index were used to assess four health-care financing sources: indirect and direct taxes, public health insurance, and out-of-pocket payments. Two rounds of surveys were conducted in 2008 (5650 individuals in 1800 households) and 2013 (11,250 individuals in 3598 households). Household socioeconomic status, health-care payments, and utilization information were recorded during household interviews. Total health-care financing was near proportional in 2008 and slightly progressive in 2013 in urban areas, whilst it was marginally progressive in both 2008 and 2013 in rural areas. The health-care financing system was more equitable in 2013 than in 2008. Overall, the performance of China's health-care financing has improved over the period 2008–2013. Using flat-rate contributions to fund health care is not equitable to the poor. Key measures to achieve equitable health-care financing distribution include improvements in the benefit packages offered by health-insurance schemes and provision of essential health services.