Details

Autor(en) / Beteiligte

• Zhai, Tiemin, MSc
• Goss, John, Grad Dipl Nutr Diet
• Li, Jinjing, PhD
• Davey, Rachel, Prof
• Kinfu, Yohannes, PhD

Titel

Main drivers of recent health expenditure growth in China: a decomposition analysis

Ist Teil von

• The Lancet (British edition), 2015-10, Vol.386, p.S46-S46

Ort / Verlag

London: Elsevier Ltd

Erscheinungsjahr

2015

Link zum Volltext

Quelle

Elsevier ScienceDirect Journals Complete

Beschreibungen/Notizen

• Abstract Background Total health expenditure in China in real terms has increased from ·124·5 billion in 1993 to ·1165·6 billion in 2012, representing a growth rate of 12·5% per year, which is higher than the growth of the country's economy (9·9% per year). Data from more recent years, particularly since the introduction of the new health reform (2009–12), suggest an even faster growth in health spending, at about 13·1% per year. Cost containment is a key aspect of the new health reform agenda, and the aim of this study was to identify the main drivers of past growth therefore has direct relevance for the country. Method The analysis was conducted in 2014 and early 2015, and covered the period 1993–2012. We used a rate decomposition technique to decompose total health expenditure growth into five components, namely population growth, population ageing, disease prevalence rate, cost per case, and effect of health price inflation. Demographic information for 1993 and 2012 was obtained from the China National Bureau of Statistics. Age-specific and disease-specific expenditure in 1993 and 2012 and prevalence rates for corresponding years were extracted from the China National Health Accounts Reports and the Institute for Health Metrics and Evaluation database, respectively. We estimated health price inflation by comparing charge per discharge for all conditions for the period 2004–12 with the general price index for the same period obtained from government sources. To test the sensitivity of our analysis, we then developed three separate scenarios reflecting excess health price inflation, deflation in health prices, and a scenario representing no excess health price inflation. As the analyses was based on secondary sources no ethical approvals were sought. Findings Growth in total health expenditure in China was mainly driven by rapid increase in real expenditure per case and health price inflation, which respectively contributed 8·2% and 3·0% of the 12·5% growth in total health expenditure. The effects of demographic factors were small, with ageing and population growth each contributing 1·0% and 0·7%, respectively. However, during the same period, a reduction in disease prevalence led to savings of 0·4% in health expenditure. On the other hand, the increase in cost per case for neoplasms, circulatory, and respiratory diseases contributed 6·6%, 12·7%, and 8·1%, respectively, to the changes in total health expenditure. Sensitivity analyses showed the estimates are robust. Interpretation Future action in containing health expenditure in China should address cost per case and health price inflation, especially for neoplasms and diseases of the circulatory and respiratory systems. Funding None.