Catastrophic Health Expenditure and Rural Household Impoverishment in China: What Role Does the New Cooperative Health Insurance Scheme Play?

Li, Ye; Wu, Qunhong; Liu, George; Kang, Zheng; Xie, Xiande; Yin, Hui; Jiao, Mingli; Liu, Guoxiang; Hao, Yanhua; Ning, Ning

doi:10.1371/journal.pone.0093253

Cited by 127 publications

(167 citation statements)

References 21 publications

Supporting

Mentioning

148

Contrasting

Order By: Relevance

“…However, evidence indicates that households covered by the NRCMI had similar levels of catastrophic health expenditure and medical impoverishment as those without health insurance [12] and the coverage of NRCMI showed no financial protection for households with chronic diseases [13]. …”

Section: Introductionmentioning

confidence: 99%

Catastrophic healthcare expenditure and its inequality for households with hypertension: evidence from the rural areas of Shaanxi Province in China

Zhou

et al. 2017

Int J Equity Health

View full text Add to dashboard Cite

BackgroundChina has been undergoing tremendous demographic and epidemiological transitions during the past three decades and increasing burden from non-communicable diseases and an ageing population have presented great health-care challenges for the country. Numerous studies examine catastrophic healthcare expenditures (CHE) worldwide on whole populations rather than specific vulnerable groups. As hypertension and other chronic conditions impose a growing share of the disease burden in China, they will become an increasingly important component of CHE. This study aims to estimate households with hypertension incurring CHE and its income-related inequality in the rural areas of Shaanxi Province.MethodsData were obtained from the National Household Health Service Surveys of Shaanxi Province conducted in 2013 and 13104 households were identified for analysis. The households were classified into three types: households with non-chronic diseases, households with hypertension only and households with hypertension plus other chronic diseases. CHE was measured according to the proportion of out-of-pocket health payments to non-food household expenditures and the concentration index was employed to measure the extent of income-related inequality in CHE. A decomposition method based on a probit model was used to decompose the concentration index into its determining components.ResultsThe incurring of CHE of households with hypertension is at a disconcerting level compared to households with non-chronic diseases. Households with hypertension only and households with hypertension plus other chronic diseases incurred CHE in 23.48% and 34.01% of cases respectively whereas households with non-chronic diseases incurred CHE in only 13.33%. The concentration index of households with non-chronic diseases is -0.4871. However, the concentration index of households with hypertension only and households with hypertension plus other chronic diseases is -0.4645 and -0.3410 respectively. The majority of observed inequalities in CHE were explained by household economic status and having elder members.ConclusionsThe proportion of households incurring CHE in the rural areas of Shaanxi Province was considerably high in all three types of households and households with hypertension were at a higher risk of incurring CHE. Furthermore, there existed a strong pro-poor inequality of CHE in all three types of households and the results implied more inequality in households with non-chronic diseases compared with two other groups. Our study suggests that more concern needs to be directed toward households with hypertension plus other chronic diseases and households having elder members.

show abstract

Section: Introductionmentioning

confidence: 99%

Catastrophic healthcare expenditure and its inequality for households with hypertension: evidence from the rural areas of Shaanxi Province in China

Zhou

et al. 2017

Int J Equity Health

View full text Add to dashboard Cite

show abstract

“…7 Catastrophic health expenditure and rural household impoverishment study done in China concluded that higher percentage of households experiencing catastrophic health expenditure and medical impoverishment correlates to increased health care need. 8 This study was limited in Information on social security schemes availed by families which would have given exact insight into out of pocket expenditure on health.…”

Section: Resultsmentioning

confidence: 99%

Catastrophic household expenditure on health in an urban slum: a cross-sectional survey

Nagendra

Belur

Nandini

et al. 2016

Int J Community Med Public Health

View full text Add to dashboard Cite

INTRODUCTIONThe World Health Report 2000 identified financial protection against the costs of ill health as a fundamental objective of health systems, on the premise that a fair health system ensures households make health care payments according to their ability to pay rather than the risk of illness.1 Out-of-pocket expenditures are nonreimbursable fees which a patient or family is responsible for paying directly to health practitioners or suppliers, without intervention of a third party.It often occurs, when publicly funded facilities are unable to provide the required health services and supplies for free or through insurance. Health policies are concerned not only with improving health status of population but also with protecting households from financial catastrophe of illness.2 Out-of-pocket spending on health in the previous 30 days that exceeded 10% of the household's total expenditure over the same period was considered to be catastrophic. India was ranked as having the 42 nd highest average out of pocket expenditure with 74.4% of private expenditure being paid as out of pocket. ABSTRACT Background:The World Health Report 2000 identified financial protection against the costs of ill health as a fundamental objective of health systems. Out-of-pocket expenditure accounts for an average increase in poverty by 2.9 percent for urban India. Therefore, this study aims at evaluating the out-of-pocket health expenditures as well as assessing the predictors of catastrophic health costs care in urban slums. The objectives was to find the prevalence of catastrophic household expenditures on health and to assess the determinants and illnesses commonly associated with catastrophic household expenditure on health. Methods: The study was conducted in a notified urban slum of Shivamogga district which was selected randomly and all the households were included in the study. Data was collected after informed consent using pre-tested semistructured questionnaire and analyzed in SPSS vs18. Results: Out of 197 households, 94 (47.7%) households experienced catastrophic health expenditure in past one month. Most common conditions associated with catastrophic expenditure were respiratory infections (cough, cold and fever; p-0.034), arthritis (p-0.001), hypertension (p<0.01) and diabetes (p-0.015). Conclusions: We conclude that almost half of the community incurred catastrophic health expenses. Findings have important policy implications and can be used to ensure higher degree of financial protection against the economic impact of illnesses.

show abstract

“…For example, the analysis period in Wagstaff and Lindelow (2008), ), Lei and Lin (2009), Shi et al (2010, ), Lu et al (2012), Li and Zhang (2013, Li et al (2014), Lei and Lin (2009), Cheng et al (2015), Ma (2016 is around the period from 2000 and 2006, therefore the impact of NCMS on health service utilization is not clear in the long-term. Third, it is thought that the demand of health care may differ by individual characteristics.…”

Section: Introductionmentioning

confidence: 99%

Public Health Insurance System Reform and Its Impact on Health Service Utilization in Rural China: Evidence from CHNS 2000 and 2011

Ma¹,

Cen²

2017

ChnStd

View full text Add to dashboard Cite

This study employs an empirical analysis to investigate the impact of the New Cooperative Medical Scheme (NCMS) on health service utilization in Chinese rural region using the 2000 and 2011 China Health and Nutrition Survey (CHNS) longitudinal survey data and Difference in Difference (DID) analysis method. The major conclusions are as follows. First, individual characteristic factors, enabling factors, health care need factors, and lifestyle factors affect health service utilization, which is consistent with Anderson model. Second, when controlled these factors based on Anderson model, the results indicate that the NCMS did not affect health service utilization (outpatient, inpatient, and health care examination) of individual when ill. Third, to consider the disparity of health care demand and supply, we also employ the analysis utilized the subsamples to take robustness checks. The results indicate that there is no difference statistically in health service utilization between the NCMS enrollment group and the non-enrollment group by age groups (16 -49 aged group and 50 age and over group), income groups (High, Middle and Lowincome groups), and regional groups (East, West and Central Regions). Therefore, it can be said that the NCMS did not improve either health service utilization for patients or preventative health care for rural residents in China.

show abstract

Catastrophic Health Expenditure and Rural Household Impoverishment in China: What Role Does the New Cooperative Health Insurance Scheme Play?

Cited by 127 publications

References 21 publications

Catastrophic healthcare expenditure and its inequality for households with hypertension: evidence from the rural areas of Shaanxi Province in China

Catastrophic healthcare expenditure and its inequality for households with hypertension: evidence from the rural areas of Shaanxi Province in China

Catastrophic household expenditure on health in an urban slum: a cross-sectional survey

Public Health Insurance System Reform and Its Impact on Health Service Utilization in Rural China: Evidence from CHNS 2000 and 2011

Contact Info

Product

Resources

About