The temporal and spatial interpretation of China's health financing: what do Chinese' government 'do' in new healthcare reform?

Objective: The analysis of health expenditure and its structure takes on a critical significance in national health policy research, and the public welfare of national health undertakings can be manifested by the government's investment in health. In this study, the aim was to analyze total health care costs, the structure of health financing, and the government's investment in health, so as to provide a reference for China's health policy adjustment.

Methods: Description and cluster analysis were conducted using R language to analyze total health care costs and the structure of health financing of 31 regions in China between 1990 and 2020 to gain insights into the temporal and spatial changes total health care costs and the structure of health financing in China. The government's investment in health was analyzed using description and abundance heatmap to know the temporal and spatial changes of the government's health investment.

Results: The total health expenditure per capita reached 5112.3 yuan in 2020, and the total health expenditure accounted for 7.10% of GDP. The government health expenditure took up a significantly lower share of the total health expenditure in 1993-2006 (17.09% [16.30,17.88]), whereas it has been nearly 30% (29.56% [28.73,30.3]) over the past few years. As to 31 regions in China, the government health expenditure per total health expenditure reached 67.94% in Tibet, whereas a level of 27.866% (25.629-30.103) were maintained in other regions. Beijing and Shanghai have achieved over 50.00% of social health expenditure per total health expenditure in recent five years, it was significantly higher than other regions. The per capita government expenditure as a fraction of GDP of Tibet (6.842%) was the highest region in 2011-2019, while Jiangsu (only 0.937%) was the lowest region.

Conclusions: Sustainable increases in total health expenditure as a percent of GDP take on a critical significance to adequate health financing. Equity in health financing has been insufficient in China, and spatial and temporal differences of China's health financing structure are significant. The region' governments should adjust policy based on typical regions to weaken the differences.