Did expansion of health insurance coverage reduce horizontal inequity in healthcare finance? A decomposition analysis for China — Wang 2019

This study aimed to examine the issue of "horizontal inequity" in China's healthcare financing system, which occurs when people with equal income pay different amounts for healthcare. The study analyzed two rounds of national household health surveys in Heilongjiang Province in 2002 and 2007, using the decomposition method of Aronson et al to measure redistributive effects and horizontal inequity in healthcare finance. The study found that horizontal inequity in total healthcare financing decreased over the period, with out-of-pocket payments contributing the most to the extent of horizontal inequity. The reduction in out-of-pocket payments was observed in both urban and rural areas, while public health insurance showed mixed results. Overall, the study suggests that China's healthcare financing system has become less horizontally inequitable over time.

Wang, Z., Zhou, X., Gao, Y., Chen, M., Palmer, A. J., & Si, L. (2019). Did expansion of health insurance coverage reduce horizontal inequity in healthcare finance? A decomposition analysis for China. BMJ Open, 9(1), e025184. https://doi.org/10.1136/bmjopen-2018-025184