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西淘麦吴
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1 * CFPS % % 30% World Bank 2004 Davoodi et al Wagstaff et al * liyy@ zufe. edu. cn modernstate@ qq. com ZDA

2 % % 70% 75% 50% 80% / / CHNS Zhou et al NHSS Liu et al Van Doorslaer et al Aaberge et al Spadaro et al

3 CFPS CFPS 1 CFPS CFPS Meerman 1979 Selowsky 1979 benefit incidence analysis BIA 2 Davioodi et al Demery 2000 Younger 2003 BIA O Donnell et al BIA BIA 1 e u j j b j j 1 u j b j b j = e / u j * u j 1 1 u j BIA u j 3 4 u j Van Doorslaer et al need kj noneed mj 2 ^ k ^φ m 3 noneed av m u j = α + k need kj k + φ m noneed mj + ψ j 2 m 1 CFPS 2 Aaron & McGuire 1970 Van de Walle 1998 behavioural approach Spadaro et al Van de Walle 1998 Aaron & McGuire Fleurbaey & Schokkaert Bagod Uva et al Bagod Uva et al. 2009

4 ^u j = ^α + k ^ k need kj + ^φ m noneed av mj 3 m u u j - ^u j + u Aeberge et al r nu d = ^u d / ^u r d ^u d ^u r d r ^u j 2 Small & Rosen 1981 Gundgaard c * j c * j > 0 c j = 1 c j = 0 ν p c j = 1 need j noneed j = p ν j > - η k need kj + k k η k noneed kj need j noneed j need j noneed j 2 5 u j λ j λ j u j E u j x j = exp x ' j β x j β 5 k + m 1 σ 1 σ k ω 1 ω m 5 ^σ 1 ^σ k ^ω 1 ^ω m c * j = η k need kj k + ρ m noneed mj + υ j 4 m u j = σ k need kj + ω m noneed mj + ζ j c j = 1 5 k m Spadaro et al insurance value approach O Donnell et al b j b j BIA s q = b j /e q q s q q j q s q b j 6 CI R j j b珋 135

5 CI = 2 b cov b j R j 6 CFPS CFPS CFPS 1 CFPS CFPS 2 CFPS CFPS 10% 3 CFPS CFPS CFPS Aaberge et al CFPS www. isss. edu. cn /cfps / CFPS % 52. 4% 99. 3% 90. 1% 71. 3% 4. 6% 89. 0% CFPS CFPS Aaberge et al

6 the poorest Quintile % nd rd th the richest P *** *** *** *** ** * P % *** *** * 1% 5% 10% CFPS CFPS 68% 19% Quintile % a b c the poorest nd rd th the richest P *** *** *** *** *** * 1% 5% 10% CFPS a b c

7 % % % 1 Lanjouw & Ravallion 1999 Krusea et al % Quintile the poorest nd rd th the richest P ** CFPS 5 p ** 5% % % * % * % * % % * % * % * % % * % * % * % % * % * % * CI % * 5% CFPS

8 % BIA Warr et al CFPS Van Doorslaer et al Aeberge et al Spadaro et al Spadaro et al logit 4 poisson Vuong odds of participation rate Warr et al CFPS 1 CFPS 3 5 alpha 95% % alpha = 0 Vuong

9 5 Quintile AOP 2008 AOP 2010 AOP 2012 c q c q the poorest nd rd th the richest AOP average odds of participation Smonthill *** *** *** Healthlevel *** *** *** Age Age *** ** *** Age *** *** *** Gender * ** Garbge *** *** *** Water ** Smoke *** Nap ** * Wine Sleep *** Income *** *** *** Insurance *** *** North ** *** Edu * ** ** Urban * *** Hostime ** *** obs Wald chi Prob > chi Pseudo R Log likelihood Correctly classified % % % smonthill healthlevel Age Age3 66 Age4 Gender Garbge Water Smoke Nap Wine Sleep Income Insurance North Edu Urban Hostime Sleep Sleep = 1 Sleep = 0 North = 1 North = 0 Healthlevel 1 5 Edu 1 7 *** ** * 1% 5% 10% 140

10 Currie & Gruber Spadaro et al Quintile the poorest nd rd th the richest CI BIA

11 7 Net-benefit h j h fiscost unit hosfee j h j 1 Net-benefit Net-benefit 0 8 Net - benefit h = fis cos t unit * u j - hosfee j 7 j h income benefit Net-benefit income benefit Net-benefit income benefit Net-benefit 20% 40% 60% 80% 2. 60% % % % % * % * % * % * % * % * % * % * % % % % % * % * % * % * % * % * % * % * % % % % % * % * % * % * % * % * % * % * K * 5% 5% income benefit Net-benefit CFPS % 3% 20% % 50% % 20% 60% % % 1 11 / * j 142

12 % K 2009 Pickett & Wilkinson 2015 Bhattacharjee et al CFPS Xie & Zhou

13 CFPS CFPS CFPS CFPS % 144

14 B Aaberge Rolf Manudeep Bhuller Audun Lang rgen and Magne Mogstad 2010 The Distributional Impact of Public Services When Needs Differ Journal of Public Economics vol Aaron Henry and Martin McGuire 1970 Public Goods and Income Distribution Econometrica vol Bagod Uva Teresa Andrew M. Jones and Eddy van Doorslaer 2009 Measurement of Horizontal Inequity in Health Care UtilisationUsing European Panel Data Journal of Health Economics vol Bhattacharjee Ayona Jong Kook Shin and Chetan Subramanian 2015 Health and Income Inequality An Analysis of Public versus Private Health Expenditure working paper. Currie Janet and Jonathan Gruber 1996 Health Insurance Eligibility Utilization of Medical Care and Child Health Quarterly Journal of Economics vol Davoodi Hamid R. Erwin R. Tiongson and Sawitree S. Asawanuchit 2003 How Useful Are Benefit Incidence Analyses of Public Education and Health Spending IMF Working Paper 03 /227. Davoodi Hamid R. Erwin R. Tiongson and Sawitree Sachjapinan Asawanuchit 2010 Benefit Incidence of Public Education and Public Health Worldwide Evidence from a New Database Poverty and Public Policy vol Demery Lionel 2000 Benefit Incidence A Practitioner s guide The World Bank. Doorslaer E. V. Adam Wagstaff and Hattem van der Burg 2000 Equity in the Delivery of Health Care in Europe and the US Journal of Health Economics vol Doorslaer E. V. et al Catastrophic Payments for Health Care in Asia Health Economics vol Fleurbaey Marc and Erik Schokkaert 2011 Equity in Health and Health Care Handbook of Health Economics vol Gundgaard Jens 2006 Income-related Inequality in Utilization of Health Services in Denmark Evidence from Funen County Scandinavian Journal of Public Health vol Krusea Ioana Menno Pradhanb and Robert Sparrowc 2012 Marginal Benefit Incidence of Public Health Spending Evidence from Indonesian Sub-national Data Journal of Health Economics vol Liu Xiaoning Wenlong Gao and Hong Yan 2014 Measuring and Decomposing the Inequality of Maternal Health Services Utilization in Western Rural China BMC Health Services Research vol Meerman Jacob 1979 Public Expenditure in Malaysia Who Benefits and Why NewYork NY Oxford University Press. O Donnell Owen and Eddy van Doorslaer Adam Wagstaff and Magnus Lindelow 2007 Analyzing Health Equity Using Household Survey Data The World Bank. O Donnell Owen et al The Incidence of Public Spending on Healthcare Comparative Evidence from Asia World Bank Economic Review vol O Donnell Owen et al Who Pays for Health Care in Asia Journal of Health Economics vol Peter Lanjouw and Martin Ravallion 1999 Benefit Incidence Public Spending Reforms and the Timing of Program Capture World Bank Economic Review Vol Pickett Kate E. and Richard G. Wilkinson 2015 Income Inequality and Health A Causal Review Social Science and Medicine vol Selowsky Marcelo 1979 Who Benefits from Government Expenditure New York NY Oxford University Press. Spadaro Amedeo Lucia Mangiavacchi Ignacio Moral-Arce Marta Adiego-Estella and Angela Blanco-Moreno 2013 Evaluating 145

15 the Redistributive Impact of Public Health Expenditure Using an Insurance Value Approach European Journal of Health Economics vol Van de Walle Dominique 1998 Assessing the Welfare Health and Income Inequality An Analysis of Public versus Private Health Expenditure Impacts of Public Spending World Development vol Wagstaff Adam Marcel Bilger Leander R. Buisman and Caryn Bredenkamp 2014 Who Benefits from Government Health Spending and Why A Global Assessment WPS7044. Warr Peter Jayant Menon and Sitthiroth Rasphone 2015 Public Services and the Poor in Laos World Development vol World Bank 2004 Making Services Work for Poor People World Development Report. Xie Yu and Xiang Zhou 2014 Income Inequality in Today s China Proceedings of the National Academy of Sciences of the United States of America vol Younger Stephen D Benefits on the Margin Observations on Marginal Benefit Incidence World Bank Economic Review vol Zhou Zhongliang Jianmin Gao Ashley Fox KeqinRao KeXu Ling Xu and Yaoguang Zhang 2011 Measuring the Equity of Inpatient Utilization in Chinese Rural Areas BMC Health Services Research vol Benefit Incidence of Public Medical Service and Its Effects on Income Distribution Micro Evidences Based on Household Survey Li Yongyou a and Zheng Chunrong b a Zhejiang University of Finance and Economics b Shanghai University of Finance and Economics Abstract Whether is public spending on healthcare an important way to eliminate health inequalities among different income groups and social distribution gap of cash income which depends on who can benefit from the public health service. Based on CFPS and insurance value method this text analyzed benefit incidence of public spending on healthcare after and before China s new medical reform in Results show that the progressive of benefit allocation of public spending on healthcare has been improved and a certain degree of justice has been achieved by expanding health insurance coverage and improving the level of financial assistance after 2009 which made the poorest income group to become the main beneficiaries. The justice distribution of benefit allocation of public spending on healthcare reduced the Gini coefficient by 5 to 7 percentage points. However benefit redistribution of public spending on healthcare has two obvious problems in China one is that the serious bias of public medical service cost towards the poorest income group which significantly reduced the income redistribution effects of public spending on healthcare leading to the Gini coefficient of income distribution rising by 2 to 3 percentage points the other is that the redistribution effect of public spending on healthcare does not occur between the poorest and the richest group but within the top 80% income groups which caused the benefit share achieved from public health services by 60% middle income families to decrease from 55% in 2008 to less than 30% in Key Words Public Spending on Healthcare Inpatient Service Benefit Incidence Distribution Effects JEL Classification F81 R19 146

% 82. 8% You & Kobayashi % 2007 %

% 82. 8% You & Kobayashi % 2007 % 202 2 * 5. 6 995 2008 0 2008 28% Meng 2003 2000 2009 9. 4% 47% 200 % 2% 20% 50% Gruber & Yelowitz 999 Engen & Gruber 200 Chou et al. 2003 200 200 200 Brown et al. 200 2003 2003 2006 2006 * 00084 wubzh@