Equity in healthcare service use and financing in China Studies on general healthcare and tuberculosis

Achieving higher degree of equity in healthcare has been a challenge for countries all over the world. Improving the equity in healthcare service use and financing are important pathways to elevate the health status of the overall population, especially for socially vulnerable groups. In China, the healthcare system has also been undergoing constant reforms. This thesis evaluates the impacts of several policy interventions on the healthcare service use and financial burden of these patients, with a focus on the disadvantaged patient groups such as tuberculosis/drug-resistant tuberculosis patients. Results show that the healthcare service use among the general population has achieved a good level of equity across income groups in some areas. For disadvantaged groups like tuberculosis patients, equity in healthcare service use can also be greatly improved through policy interventions such as improving the reimbursement rate and cash transfer. However, the level of equity in financing of healthcare remained relatively low despite the policy interventions, as indicated by the high out-of-pocket health expenditure and high likelihood of incurring catastrophic health expenditure for socially vulnerable patients. Besides, some disadvantaged groups such as internal migrants have not equally enjoyed the improved benefits from healthcare policy reforms. Based on these findings, policy recommendations are proposed that the health insurance structures and payment approach should be reformed to mitigate the benefit gaps across insurance types. Specialized policies should also be developed that include improving reimbursement and cash transfer to provide additional support for tuberculosis/drug-resistant tuberculosis patients, especially for those who are internal migrants.