title: Who benefits from government healthcare subsidies? An assessment of the equity of healthcare benefits distribution in China.
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.
  
  
  OBJECTIVE
  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.
authors.affiliation: School of Health Policy & Management, Nanjing Medical University, Nanjing, China.
authors.forename: Mingsheng
authors.initials: M
authors.lastname: Chen
authors.affiliation: School of Health Administration, Anhui Medical University, Hefei, China.
authors.forename: Guixia
authors.initials: G
authors.lastname: Fang
authors.affiliation: School of Health Administration, Anhui Medical University, Hefei, China.
authors.forename: Lidan
authors.initials: L
authors.lastname: Wang
authors.affiliation: School of Health Policy & Management, Nanjing Medical University, Nanjing, China.
authors.forename: Zhonghua
authors.initials: Z
authors.lastname: Wang
authors.affiliation: National Health Development Research Center, Ministry of Health of the People's Republic of China, Beijing, China.
authors.forename: Yuxin
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: School of Health Administration, Anhui Medical University, Hefei, China; Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
authors.forename: Lei
authors.initials: L
authors.lastname: Si
mesh_terms: D002681:China; D005380:Financing, Government / Q000191:economics*; D018166:Health Care Reform; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D007348:Insurance, Health / Q000191:economics / Q000706:statistics & numerical data; D011203:Poverty / Q000191:economics; D012959:Socioeconomic Factors