The Research On The Determinants Of Out-of-pocket Expenditures In China From1978to2011

Objective Since the reform and opening, the government and residents economic burden of disease were enhanced due to the rapid increasing of medical expenditures, as a result，high out‐of‐pocket healthcare spending puts individual at great financial risk,“kanbinggui,kanbingnan”and poverty caused by disease still exist. For this purpose, since2003the governmental health investment has been strengthened to reduce the financial burden ofhouseholds, and lead to the share of out‐of‐pocket health expenditure decreased from60.0percent in2001to34.9percent in2011. But at the same time, we also observed that out‐of‐pocket on catastrophic health and poverty caused by diseases has been increasing. The high burden for medical expenditures are not truly changed both government and households. So it’s important to explore the key impact factors for OOP payments and reduce heavy financial burden on many households. Based on the change of government investment on healthcare, this paper tried to explore the impact factors of OOP and to analyze influence of the government health disbursement on OOP, then put forward the suggestions.Methods Bases on the data from1978to2011about health care expenditures, we established time series model to explore the impact factors on OOP and analyzed the disbursement of the government health on OOP by using Unit Root Test, Cointegration Test, Error Correction Model, Granger Causality and Principal Component Analysis.Results The association between percentage OOP and government health disbursement, population aging, economic development, supply of health care，technology improvement is permanent proportionate; The government health disbursement is the key reason on reducing the percentage of OOP;The economic development and population aging were positive on increasing OOP; The supply of health care service and technology improvement had double‐sides impact on OOP; The impact of economic growth and technology improvement on OOP was visible in short term, but the impact of the aging and induced demand for provider on OOP was visible in long‐term and had little impact in short‐term; Granger causality shows that economic growth was the granger cause of the aging; the OOP increasing was the granger cause of government health disbursement growth; and the OOP increasing was the granger cause of total health expenditures in GDP.Conclusion With the rapid growth of economic and the aging, the developmentof health care system waslagging, this conflict leads to the OOP increasing. It is imperative to control the increasing of OOP through bettering the mechanism of government health disbursement, increasing total amount of government health investment moderately, transforming investment structure, and regulating investment direction.