Financing Adolescent Health in China: How Much, Who Pays, and Where It Goes.

Purpose: Adolescent health has been gaining increasing attention in the Sustainable Development Goals era. Data on adolescent health financing are essential for evidence-based policy planning and evaluation. Little is known on national expenditure on adolescent health in China. To inform decision-making on national strategies of adolescent health and development, this study estimated expenditure on adolescent health-care utilization in China and identified funding sources and their allocation among different health functions.

Methods: We constructed and implemented an institutional survey and collected primary financial data from health institutions in the nine selected administrative provinces in 2014. We used the collected data to generate estimate of proportion of health spending on adolescent health and its breakdowns by health-care functions, health-care financing schemes, and diseases based on primary diagnosis. We applied the proportion estimates to the 2014 national-level health expenditure data and estimated national-level estimates of spending on adolescent health and breakdowns in aforementioned areas.

Results: Spending on adolescents health in 2014 amounted to CNY82.1 billion (USD 13.4 billion) or 2.6% of the total health expenditures in the year. Per adolescent health expenditures was CNY525 (USD 85.5), less than per capita health spending (CNY2349, USD382.4). National spending on adolescent health was 73.1% on curative care and 10.3% on preventive care. Out-of-pocket spending is the major source of adolescent health financing, contributing to 57.9% of total spending on adolescent health. Spending on respiratory, digestive, injury and poisoning, genitourinary diseases, and neoplasms accounted for 59.8% of curative care expenditures on adolescents.

Conclusions: Current financing mechanism on adolescent health stressed on curative care and imposed a large portion of financial burden on households. Future investment on adolescent health shall focus more on preventive care. Financing schemes shall be adjusted so as to reduce household out-of-pocket spending on medical care used by adolescents.