Degree of protection provided by poverty alleviation policies for the middle-aged and older in China: evaluation of effectiveness of medical insurance system tools and vulnerable target recognition

Abstract

Background China’s medical insurance schemes and poverty alleviation policy at this stage have achieved population-wide coverage and the system's universal function. At the late stage of the elimination of absolute poverty task, how to further exert the poverty alleviation function of the medical insurance schemes has become an important agenda for targeted poverty alleviation. To analyse the risk of catastrophic health expenditure (CHE) occurrence in middle-aged and older adults with vulnerability characteristics from the perspectives of social, regional, disease, health service utilization and medical insurance schemes. Methods We used data from the 2018 China Health and Retirement Longitudinal Study (CHARLS) database and came up with 9190 samples. The method for calculating the CHE was adopted from WHO. Logistic regression was used to determine the different characteristics of middle-aged and older adults with a high probability of incurring CHE. Results The overall regional poverty rate and incidence of CHE were similar in the east, central and west, but with significant differences among provinces. The population insured by the urban and rural integrated medical insurance (URRMI) had the highest incidence of CHE (21.17%) and health expenditure burden (22.77%) among the insured population. Integration of Medicare as a medical insurance scheme with broader benefit coverage did not have a significant effect on the incidence of CHE in middle-aged and older people with vulnerability characteristics. Conclusions Based on the perspective of Medicare improvement, we conducted an in-depth exploration of the synergistic effect of medical insurance and the poverty alleviation system in reducing poverty, and we hope that through comprehensive strategic adjustments and multidimensional system cooperation, we can lift the vulnerable middle-aged and older adults out of poverty.

Effects of Urban and Rural Resident Basic Medical Insurance on Healthcare Utilization Inequality in China

“…This might have something to do with the fact that inpatient care has higher reimbursement rates and more medical services than outpatient care ( 38 ). Existing research has shown that health insurance has little association with the out-of-pocket cost of outpatient services, and patients can only receive greater reimbursement through inpatient care ( 36 , 39 , 40 ). This suggests that patients would reduce their use of outpatient care in favor of more inpatient care ( 41 ).…”

Study on the Path to Optimize the Medical Insurance System for the Elderly

“…At the same time, the government should strengthen the management and regulation of medical institutions, enhance the supervision of the quality of medical services, and ensure the medical safety and rights of the elderly. Finally, the government should strengthen the publicity and education of the healthcare system for the elderly, improve the elderly's understanding of and awareness of healthcare, and enhance their awareness of healthcare protection [2].…”

Gender differences in caregiver attitudes and unmet needs for activities of daily living (ADL) assistance among older adults with disabilities

“…This definition aligns with previous research [ 9 – 14 ]. In China, due to ‘China’s One Child Policy‘ adopted in 1979 [ 15 ] and the lack of a social nursing insurance system [ 16 ] and nursing homes [ 17 ], caregivers experience a much heavier burden than before. It has also been reported that older adults living in the community have a higher percentage of unmet ADL needs—approximately 56% in a population-representative study conducted in China [ 18 ].…”