% % 70% 75% 50% 80% / /

* CFPS 2008 2012 5 7 2 3 80% 2010 2012 60% 30% 20 90 1 World Bank 2004 Davoodi et al. 2010 Wagstaff et al. 2014 20 2009 2009 2014 1 * 310018 liyy@ zufe. edu. cn 200433 modernstate@ qq. com 71273223 71473215 15ZDA016 1 132

2016 7 22. 32% 6. 3 7 1 2015 2008 80 380 2014 80% 70% 75% 50% 80% 15 2015 2010 1 2008 34. 2 /10 2014 21. 7 /10 2008 14. 9 2014 8. 9 2 2003 2005 2005 2009 2009 2011 CHNS Zhou et al. 2011 2003 2008 NHSS Liu et al. 2014 10 2005 Van Doorslaer et al. 2007 14 14 2012 2009 2009 2011 Aaberge et al. 2010 Spadaro et al. 2013 1 2010 2013 2013 2014 2 133

2008 2010 2012 CFPS CFPS 1 CFPS CFPS Meerman 1979 Selowsky 1979 benefit incidence analysis BIA 2 Davioodi et al. 2003 Demery 2000 Younger 2003 BIA O Donnell et al. 2007 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. 2000 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. 2013 Van de Walle 1998 Aaron & McGuire 1970 3 Fleurbaey & Schokkaert 2011 4 134 Bagod Uva et al. 2009 Bagod Uva et al. 2009

^u j = ^α + k ^ k need kj + ^φ m noneed av mj 3 m u u j - ^u j + u Aeberge et al. 2010 3 18 50 r nu d = ^u d / ^u r d ^u d ^u r d r ^u j 2 Small & Rosen 1981 Gundgaard 2006 2010 2011 4 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. 2013 insurance value approach 4 5 1 O Donnell et al. 2008 b j b j BIA s q = b j /e q q s q q j q s q b 2016 7 j 6 CI R j j b珋 135

CI = 2 b cov b j R j 6 CFPS CFPS CFPS 1 CFPS CFPS 2 CFPS CFPS 10% 3 CFPS CFPS 4 2008 CFPS Aaberge et al. 2010 5 1 CFPS www. isss. edu. cn /cfps / 2008 2009 2010 25 2 CFPS 3 2012 57. 8% 52. 4% 99. 3% 90. 1% 71. 3% 4. 6% 89. 0% CFPS 2012 4 CFPS 2009 2011 5 136 Aaberge et al. 2010 1

2016 7 1 the poorest Quintile % 2008 2010 2012 2 6 2 6 2 6 0. 22 0. 013 0. 33 0. 015 0. 34 0. 006 0. 55 0. 016 0. 33 0. 009 0. 49 0. 007 2 nd 0. 13 0. 011 0. 25 0. 014 0. 30 0. 007 0. 51 0. 013 0. 30 0. 008 0. 48 0. 005 3 rd 0. 19 0. 013 0. 26 0. 015 0. 25 0. 006 0. 43 0. 016 0. 29 0. 009 0. 44 0. 006 4 th 0. 14 0. 013 0. 23 0. 016 0. 21 0. 006 0. 46 0. 014 0. 28 0. 008 0. 43 0. 006 the richest 0. 12 0. 011 0. 20 0. 014 0. 21 0. 006 0. 39 0. 013 0. 24 0. 008 0. 41 0. 006 P 0. 008 *** 0. 006 *** 0. 006 *** 0. 000 *** 0. 014 ** 0. 067 * P 0. 626 0. 127 0. 131 0. 690 0. 463 0. 348 % 1 2008 4976 2254 2722 2010 31936 17142 14794 2012 31720 17625 14095 *** *** * 1% 5% 10% 1 2 6 2 6 2 6 10 1 2012 2010 2 2 CFPS CFPS 68% 19% 2 2 2 Quintile % a b c the poorest 0. 39 0. 006 0. 47 0. 006 0. 17 0. 005 2 nd 0. 34 0. 007 0. 35 0. 007 0. 25 0. 007 3 rd 0. 32 0. 006 0. 24 0. 006 0. 32 0. 007 4 th 0. 28 0. 007 0. 21 0. 006 0. 39 0. 008 the richest 0. 25 0. 006 0. 13 0. 005 0. 50 0. 008 P 0. 009 *** 0. 000 *** 0. 002 *** 2008 2010 2008 2010 2008 2010 2012 *** *** * 1% 5% 10% CFPS a b 36912 c 43521 137

3 5 6 75% 2008 20% 2012 80% 1 Lanjouw & Ravallion 1999 Krusea et al. 2012 3 % Quintile 2008 2010 2012 the poorest 0. 79 0. 17 0. 84 0. 79 0. 88 0. 79 0. 81 0. 008 2 nd 0. 64 0. 25 0. 81 0. 72 0. 86 0. 81 0. 76 0. 007 3 rd 0. 40 0. 23 0. 80 0. 74 0. 86 0. 85 0. 74 0. 006 4 th 0. 50 0. 39 0. 81 0. 79 0. 86 0. 85 0. 72 0. 005 the richest 0. 68 0. 64 0. 82 0. 81 0. 87 0. 87 0. 68 0. 005 0. 83 0. 008 0. 87 0. 003 0. 90 0. 002 0. 41 0. 009 0. 76 0. 004 0. 82 0. 003 P 0. 047 ** CFPS 5 p ** 5% 4 2008 2010 2012 20% 27. 76% * 2. 773 51. 17% * 2. 331 61. 957% * 2. 008 40% 43. 33% * 2. 978 66. 36% * 2. 190 69. 46% * 1. 974 60% 66. 85% * 2. 668 75. 88% * 2. 002 79. 37% * 1. 765 80% 84. 73% * 2. 115 83. 45% * 1. 920 90. 97% * 1. 381 + + + 45 + + CI - 0. 123 0. 039-0. 457 0. 032-0. 488 0. 026 2 5 5% * 5% 1 5 6 + 45 CFPS 4 2008 1 2009 138

2016 7 27. 76% 2010 2012 45 BIA Warr et al. 2015 1 CFPS 1 2 5 1 5 4 5 4 5 Van Doorslaer et al. 2000 Aeberge et al. 2010 Spadaro et al. 2013 4 5 2 Spadaro et al. 2013 18 35 36 50 51 65 66 0 1 logit 4 poisson 5 5 0 Vuong 3 6 4 4 6 1 2 4 odds of participation rate Warr et al. 2015 4 2 1 CFPS 1 CFPS 3 5 alpha 95% 2008 0. 51 0. 79 2010 0. 91 1. 07 2012 12. 26 13. 83 5% alpha = 0 Vuong 2008 2010 1. 96 2012-4. 13-1. 96 5 139

5 Quintile AOP 2008 AOP 2010 AOP 2012 c q 2010 2008 c q 2012 2010 the poorest 1. 32 1. 66 2. 16 1. 80 3. 03 2 nd 0. 85 0. 69 0. 51 0. 62 0. 20 3 rd 1. 03 0. 62 0. 56 0. 45 0. 46 4 th 0. 70 0. 70 0. 52 0. 70 0. 22 the richest 0. 92 0. 55 0. 48 0. 40 0. 35 2 4 5 6 5 AOP average odds of participation 6 2008 2010 2012 Smonthill 0. 0305795 *** 0. 00792 0. 0958017 *** 0. 00692 0. 1615931 *** 0. 01293 Healthlevel - 0. 0824319 *** 0. 02763-0. 128283 *** 0. 0193-0. 2804262 *** 0. 04222 Age2 0. 0224735 0. 01554-0. 0064162 0. 00517 0. 0025558 0. 00976 Age3 0. 0334667 *** 0. 01256 0. 0131986 ** 0. 00529 0. 0354159 *** 0. 00928 Age4 0. 0668815 *** 0. 02023 0. 026633 *** 0. 00699 0. 1648567 *** 0. 01685 Gender 0. 0112951 * 0. 00641 0. 0106159 ** 0. 00435 0. 0051412 0. 00722 Garbge 0. 0189034 *** 0. 00591 0. 0172825 *** 0. 00471 0. 0333037 *** 0. 00744 Water 0. 0059307 0. 00749 0. 0094865 ** 0. 00376 0. 0081332 0. 00668 Smoke - 0. 0069824 0. 00745-0. 0116464 *** 0. 00446-0. 0027521 0. 00778 Nap 0. 0063748 0. 00568 0. 0074806 ** 0. 0034 0. 0110757 * 0. 00576 Wine - 0. 0035877 0. 00789-0. 0062908 0. 00488-0. 0115693 0. 00813 Sleep - 0. 0073265 0. 00608-0. 0065287 0. 00411-0. 02292 *** 0. 00653 Income - 0. 0189868 *** 0. 0015-0. 0278813 *** 0. 00069-0. 0527697 *** 0. 00119 Insurance - 0. 0060988 0. 00779 0. 0115168 *** 0. 00418 0. 0297318 *** 0. 00761 North - 0. 0120164 ** 0. 00572-0. 009901 *** 0. 00383-0. 0074797 0. 00636 Edu 0. 0037487 * 0. 00207 0. 0037809 ** 0. 00168 0. 0067383 ** 0. 00268 Urban 0. 0117667 0. 00836 0. 0074217 * 0. 00411 0. 0222193 *** 0. 00742 Hostime 0. 0004394 0. 00036 0. 0001229 ** 0. 00007 0. 0005355 *** 0. 00018 obs 4362 27763 15595 Wald chi2 18 373. 97 3596. 61 4513. 13 Prob > chi2 0. 0000 0. 0000 0. 0000 Pseudo R2 0. 1535 0. 2797 0. 4724 Log likelihood - 864. 12458-5793. 3724-3854. 7593 Correctly classified 94. 52% 92. 35% 92. 48% smonthill healthlevel 35 50 Age2 51 65 Age3 66 Age4 Gender Garbge Water Smoke Nap Wine Sleep Income Insurance North Edu Urban Hostime Sleep 22 30 22 30 Sleep = 1 Sleep = 0 North = 1 North = 0 Healthlevel 1 5 Edu 1 7 *** ** * 1% 5% 10% 140

2016 7 6 2010 2012 Currie & Gruber 1996 4 5 3 Spadaro et al. 2013 7 7 5 7 Quintile 2008 2010 2012 the poorest 1. 6718 1. 7898 4. 7320 4. 8421 8. 3806 8. 4538 2 nd 0. 7225 0. 8933 1. 0377 1. 2670 1. 0027 1. 7538 3 rd 1. 1798 1. 3096. 8714 1. 1176 1. 7196 2. 2888 4 th 1. 2743 1. 3943 1. 0284 1. 2730 1. 6966 2. 1234 the richest 1. 1127 1. 3117. 9271 1. 1851 1. 1111 1. 7955 CI - 0. 07 0. 08-0. 05 0. 07-0. 40 0. 03-0. 32 0. 02 - - 0. 48 0. 02-0. 34 0. 01 BIA 1 2 2009 2011 2013 1 2 25 1 141

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 2008 2010 2012 income benefit Net-benefit income benefit Net-benefit income benefit Net-benefit 20% 40% 60% 80% 2. 60% 0. 17 11. 20% 0. 68 24. 96% 1. 47 42. 82% 2. 47 20. 66% * 3. 87 28. 75% * 5. 20 49. 15% * 7. 52 75. 35% * 8. 54 18. 32% * 3. 86 25. 91% * 4. 98 44. 67% * 7. 29 72. 66% * 9. 62 1. 33% 0. 03 6. 73% 0. 09 19. 56% 0. 21 45. 14% 0. 42 46. 55% * 2. 25 59. 95% * 2. 18 69. 30% * 2. 04 81. 20% * 1. 86 45. 06% * 2. 72 58. 05% * 2. 66 67. 35% * 2. 49 80. 34% * 2. 27 0. 51% 0. 03 6. 92% 0. 18 22. 94% 0. 38 46. 35% 0. 67 51. 45% * 2. 00 58. 69% * 2. 06 72. 26% * 2. 10 81. 69% * 1. 24 48. 09% * 2. 37 55. 56% * 2. 43 68. 55% * 2. 50 79. 86% * 45 - - - - + + - + + 1. 46 + + + + + + K - 0. 49-0. 44-0. 95-0. 92-0. 88-0. 84 3 6 * 5% 5% income benefit Net-benefit 2 3 45 45 8 CFPS 2008 20% 3% 20% 2008 2010 2012 20% 50% 2008 20% 20% 60% 2008 55% 2010 2012 35% 1 11 / * j 142

2016 7 30% 2010 2012 45 2012 2010 K 2009 Pickett & Wilkinson 2015 Bhattacharjee et al. 2015 9 2008 2010 2012 0. 5372 0. 026 0. 5769 0. 005 0. 5379 0. 007 1 0. 5779 0. 081 0. 6275 0. 013 0. 5990 0. 021 0. 2681 0. 035 0. 2892 0. 005 0. 3170 0. 008 0. 5584 0. 024 0. 5271 0. 005 0. 4637 0. 007 0. 6086 0. 073 2 0. 5626 0. 012 0. 4709 0. 019 0. 2811 0. 031 0. 2615 0. 005 0. 2216 0. 008 0. 5558 0. 022 0. 5484 0. 006 0. 5043 0. 007 2-0. 6066 0. 075 0. 5814 0. 013 0. 4975 0. 019 0. 2803 0. 032 0. 2696 0. 005 0. 2333 0. 008 0. 5559 0. 024 0. 5481 0. 004 0. 5035 0. 006 2-0. 6068 0. 075 0. 5804 0. 013 0. 5043 0. 019 0. 2804 0. 032 0. 2639 0. 004 0. 2461 0. 007 0. 5 0. 5 9 CFPS 2008 2012 0. 53 0. 491 0. 474 Xie & Zhou 2014 0. 53 0. 55 143

2008 2 2010 2012 2010 5 2012 6. 5 2009 2010 2012 5 6. 5 3 2. 5 30 CFPS2008 2009 CFPS 2010 2012 2009 5 7 CFPS 2010 2012 2 4 CFPS 2008 2012 2012 30% 144

2016 7 2013 5 2009 11 2011 3 2010 6 2011 9 2003 11 2008 5 2005 6 2011 760 3 B. 2005 12 2009 2 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. 94 549 562. Aaron Henry and Martin McGuire 1970 Public Goods and Income Distribution Econometrica vol. 38 907 920. 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. 28 280 289. 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. 111 431 466. 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. 2 5 52. 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. 19 553 583. Doorslaer E. V. et al. 2007 Catastrophic Payments for Health Care in Asia Health Economics vol. 16 1159 1184. Fleurbaey Marc and Erik Schokkaert 2011 Equity in Health and Health Care Handbook of Health Economics vol. 2 1003 1092. Gundgaard Jens 2006 Income-related Inequality in Utilization of Health Services in Denmark Evidence from Funen County Scandinavian Journal of Public Health vol. 34 462 471. 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. 31 147 157. 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. 14 1 7. 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. 2007 The Incidence of Public Spending on Healthcare Comparative Evidence from Asia World Bank Economic Review vol. 21 93 123. O Donnell Owen et al. 2008 Who Pays for Health Care in Asia Journal of Health Economics vol. 27 460 475. Peter Lanjouw and Martin Ravallion 1999 Benefit Incidence Public Spending Reforms and the Timing of Program Capture World Bank Economic Review Vol. 13 257 273. Pickett Kate E. and Richard G. Wilkinson 2015 Income Inequality and Health A Causal Review Social Science and Medicine vol. 128 316 326. 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

the Redistributive Impact of Public Health Expenditure Using an Insurance Value Approach European Journal of Health Economics vol. 14 775 787. 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. 26 365 379. 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. 66 371 382. 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. 111 6928 6933. Younger Stephen D. 2003 Benefits on the Margin Observations on Marginal Benefit Incidence World Bank Economic Review vol. 17 1 89 106. 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. 11 697 699. 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 2009. 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 2012. Key Words Public Spending on Healthcare Inpatient Service Benefit Incidence Distribution Effects JEL Classification F81 R19 146