Background China never stops taking effort to reform its health care system. Health care financing, which is one of the essential control knobs to health care system, has significant influences on the sustainability of the health system, the quality of services it delivers, the health status of the population as well as the success of the whole health care reform process. Objectives This article aims to summarize the evolution of China’s health care financing system, its current situation and challenges, discuss what lessons China can learn from the successful experiences or unsuccessful pitfalls of others countries on its health care financing reform. Methods Articles were searched through PubMed and CNKI. Further relevant articles were identified by searching the citations listed in retrieved articles manually. 96 articles were reviewed. Statistics about China’s health care system were mainly from government white paper, SHA technical paper, Chinese government websites and WHO website. The information about the performance of health care systems in other countries was mainly from OECD database and WHO website. Results In China, insufficient government expenditure and high out-of-pocket payments; social health insurance providing limited risk protection, with low-level risk pooling; escalation of costs; inefficient financing resources allocation in providers; disparities among regions and provinces all lead to the inequity and inefficiency of the health care financing system and create heavy financial burden on patients. Based on experiences from other countries, the total health expenditure in China could take an even larger proportion of GDP in the future; it is reasonable to increase general government expenditure to further reduce the household out-of-pocket payment and provide financial protection and ensure equity; expanding services coverage and proportion of the costs covered, gradually merging the risk-pool units and different schemes can make social health insurance a more powerful tool to make sure people’s access to basic health care; a new payment mechanism and stricter supervision on supply side can effectively contain the escalation of the costs; government should inject more funding to front-line institutions and the function of primary care in China can be stimulated by a good primary health care delivery system, in which the role of primary care provider is clearly defined as the gatekeeper of the health care system, with a proper referral mechanism; more responsibility should be taken by central government to allocate financing resources based on the fiscal capability of local governments; Chinese government should foresee the demand of aging population and take actions before it is too late. Conclusion It is consensus that China’s health care reform is heading at the right direction. However, there are a lot of problems in China health care financing system remaining to be solved. Health care financing system varies greatly in each country and there is no perfect health care financing system in the world. Thus no single country can be one hundred percent copied by China. But general principles and one or some most successful and advanced portions of other countries’ health care financing systems can still be used as references by China after further assessment. Unsuccessful oversea experiences are also precious lessons for preventing Chinese government from making same mistakes. A good health care financing system should be designed on the basis of a systematic review of all domestic financing policy and previous international experiences. / published_or_final_version / Public Health / Master / Master of Public Health

This research evaluates government education and health spending in China and explores the underlying determinants of its spatial pattern. A framework defining local needs at three levels is proposed to analyze whether the expenditure has been reasonably allocated. Results show that both government education and health spending closely respond to local needs at the general level. The illiteracy rate is positively correlated with government education spending while the life expectancy is negatively correlated with government health spending. On the demand and supply sides, while government education spending is more responsive to local demand measured by student number, the needs from the supply side represented by the number of medical personnel appear to be more relevant when governments distribute resources into the health sector. One particular area that needs more effort is the responsiveness to the needs arising from the lack of teaching staff. The student-teaching ratio is now largely ignored when governments make decisions of education outlays. Given that the adequacy of teaching staff is a must to ensure the quality of teaching, governments are thus suggested to put more weights to this aspect in its decision-making process. As for the determinants of government education and health spending, this study takes a close look at three groups of key potential explaining factors identified in the existing literature – economic development, openness and decentralization. The findings pose challenges to the existing mainstream theories developed in the western context. Only per capita gross regional product is found to have significant explanatory power for budgetary expenditure on education and a significant negative relationship is revealed. On the other hand, both economic development and the degree of fiscal dependency are significant in explaining the spatial pattern of government health spending; and their relationships are both non-linear. The fixed-effects panel data regression model predicts that, ceteris paribus, a province with a per capita gross regional product of 20,265 yuan would have the most government health outlays while a province with a fiscal dependency ratio of 63.6% would have the lowest public health expenditure. Provinces with either higher or lower per capita GRP (fiscal dependency ratio) than the threshold value allocate fewer (more) resources into government health outlays. The most important recommendation derived from the findings of this dissertation is that the central government should keep an eye on those provinces that are neither fully financially dependent nor fully financially independent, because their government health spending tends to be particularly inadequate. / published_or_final_version / China Development Studies / Master / Master of Arts in China Development Studies

University of Macau / Faculty of Social Sciences / Department of Economics