Equity of total health expenditure in China, 2015–2021

To analyze the equity of total health expenditure in China from 2015 to 2021 and to provide a scientific basis for promoting the healthy development of total health expenditure in China. Total health expenditure was divided into three components: government health expenditure, social health expenditure, and out-of-pocket health payments. Data from 2015 to 2021 were extracted, and the concentration index and Kakwani index were used to evaluate the equity. Mainland China (excluding Hong Kong, Macau, and Taiwan) was divided into the northeast, east, central, and west regions, and the health resource density index (HRDI) of the China average was used as the reference standard to calculate the deficiency and deficiency ratio in each region. The stepwise regression analysis was used to analyze the influencing factors of per capita total health expenditure in China. The average percentages of government health expenditure, social health expenditure, and out-of-pocket health payments were 28.26%, 43.94%, and 27.79%, respectively, from 2015 to 2021. The concentration indices of total health expenditure, government health expenditure, social health expenditure, and out-of-pocket health payments were all greater than 0. The Kakwani index of total health expenditure, government health expenditure, and out-of-pocket health payments was less than 0, while the Kakwani index of social health expenditure was greater than 0 overall but became less than 0 in 2021. Both GDP and total health expenditure in the northeast region moved toward lower percentages, and GDP and total health expenditure in the east region moved toward higher percentages. Taking the HRDI of China's average as the reference standard, the HRDI for total health expenditure, government health expenditure, social health expenditure, and out-of-pocket health payments in the east and central regions were higher than the reference standard, and the health expenditure in the east was more than 50% of the reference standard and the central region was more than 4% of the reference standard. The HRDI of total health expenditure, government health expenditure, social health expenditure, and out-of-pocket health payments in the west region was less than the reference standard, and the deficiency ratio of health expenditure in the west region was more than 46%. The HRDI of out-of-pocket health payments in the northeast region was higher than the reference standard from 2015 to 2020, and the HRDI of total health expenditure, government health expenditure, and social health expenditure in the northeast region was lower than the reference standard. Per capita disposable income and the number of health technicians per 1,000 population were the main factors influencing per capita total health expenditure in China from 2015 to 2021. The health financing structure was inappropriate, with a low percentage of government health expenditure and a high percentage of out-of-pocket health payments. Total health expenditure, government health expenditure, social health expenditure, and out-of-pocket health payments, all of the health expenditure tended to regions with higher levels of economic development. Total health expenditure, government health expenditure, and out-of-pocket health payments were regressive, and social health expenditure was progressive overall. Health expenditure was more adequate in the east and central regions and more inadequate in the west region. Per capita disposable income and the number of health technicians per 1,000 population had a greater impact on per capita total health expenditure in China.