Objectives:
To assess inequity in health care financing and utilisation, its associated socio-economic variables and consequences, with focus on the impact of alternative health financing systems.
Methods
Econometric and multivariate analysis of cross-sectional and retrospective household survey data from six counties in three provinces in Central China.
Findings:
The old Cooperative Medical System (CMS) was associated with a five times less risk of financial difficulties, half the risk of care-induced debt (non-significant, 95%CI 0.2-1.1) and not one CMS participant having to forego care due to cost. CMS was associated with better health, three times less risk of illness with duration of at least one month. Other health insurance systems were associated with higher risk of illness, higher outpatient expenditure without evidence of reducing barriers to care. The elderly (60 years +) had a more than five times increased risk of illness for at least one month, (OR = 5.2, 95%CI = 3.2-8.3). The illness concentration index confirmed that the poor suffer from a higher prevalence of morbidity. The Le Grand index confirmed strong bias in utilisation favouring the rich. The Kakwani index confirmed an extremely high degree of regressivity in the financing of health services, (-0.73) for outpatient and (-0.94) for inpatient services. The New Cooperative Medical System (NCMS) differs from the old CMS in critical aspects.