Author(s)

Weiwei Liu, Xin Zhao and Han He

Corresponding Author

Han He

Abstract

Since 2009s China’s health system reform has been implemented, there still exists the problem of uneven coverage of medical insurance. This study was to analyze the impact of implementing universal health coverage on reduction of financial burden of healthcare placed on people living in the rural areas of Chongqing. Sources of data used mainly come from the National Health Accounts (NHA) from 2010-2014 which covered 38 counties, National Health Service Survey(NHSS) in 2008 and 2013 in Chongqing. The key performance indicators included: the Total Health Expenditures (THE), the Out of Pocket Payment (OOP), Per Capita annual Disposable Income (PCDI), Outpatient expenditures (OP expenditure) and Inpatient expenditures (IP expenditures), as well as other socio-economic and health indicators, were used to examine changes in health service utilization and expenditure, and analyze changes in equity in access to, and financing of, healthcare among the targeted population. Therefore, this paper will compare the financial burden before and after 2009s health reform policy in China, to evaluate whether the financial burden is reduced during these periods in rural residents. The paper will use Chongqing, the western part of China as an example, analysis mainly from the following aspects: 1) Health Expenditure: Data from NHA 2010-2014, THE per capita average growth rate (GR) from high, middle and low-income districts has, respectively increased 13.99%, 13.15% and 13.89%, while the OOP GR was 9.20%, 11.13% and 12.55% respectively. 2) Financial Burden: Data from NHA 2010-2014. Although the OP per capita/PCDI (%) and IP per capital/PCDI (%) average increased rate in low-income level growth lower than the other two levels, the total OP & IP expenditure average GR was higher in low-income level than others. 3) Health Service Utilization: Data from NHSS between 2008 and 2013, both average expenditure in OP and IP visit growth faster in rural than in urban; in 2013, the average OP expenditure as % of PCDI increased faster in rural than in urban; and the average Inpatient expenditure as % of PCDI decreased not significantly in rural than that in urban compared with 2008 and 2013. Therefore, elimination of these barriers would have to require further government policy interventions in order to improve equity in financing of healthcare and to enhance health system resilience and achieve effective universal health coverage in the poor areas of China.

Keywords

Health expenditure, Out-of-pocket payment (OOP, Financial burden, health service utilization