Does health insurance decrease health expenditure risk in developing countries? The case of China

Jung, Juergen; Streeter, Jialu Liu

doi:10.1002/soej.12101

Cited by 31 publications

(39 citation statements)

References 25 publications

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“…The results of this study were in agreement with those of Jung and Liu Streeter 34 and some other similar authors, 35,36 who reported that income had a positive effect on the cost of OOP payment.…”

Section: Discussionsupporting

confidence: 93%

<p>The Study of Out-of-pocket Payment and the Exposure of Households with Catastrophic Health Expenditures Following the Health Transformation Plan in Iran</p>

Nemati¹,

Khezri²,

Nosratnejad³

2020

RMHP

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Introduction: One of the main objectives of health systems is providing financial protection against out-of-pocket (OOP) health expenditures. According to the 2011 report by the World Health Organization in the Eastern Mediterranean Regional Office (EMRO), a huge portion of health service in Iran is paid OOP, which is around 58% of the total health system expenditure. Furthermore, all over the world, around 25 million households (100 million people) are trapped in poverty as a result of paying health service costs. Therefore, this research was aimed at investigating the OOP and exposure of households with catastrophic health expenditures (CHE) following the implementation of a health transformation plan in Tabriz, Iran. Methods: A descriptive-analytic study was conducted on a cross-sectional basis. The sample included 400 households, who were interviewed using the World Health Survey questionnaire, and then OOP payment and exposure of households to CHE were estimated, and the effective factors on OOP payment and the determinants of CHE were analyzed using a regression model. Results: After implementing the health transformation plan, the average share of households' OOP payments, toward their ability to pay was 13.2%. In addition, 11.25% of the households were exposed to CHE in Tabriz. The key determinants of OOP were income, dental services, pharmaceuticals, radiology, and physiotherapy. The factors affecting CHE were income, insurance status, marital status, dental services, pharmacy, physiotherapy, and radiological services. Conclusion: Based on the results of the current study and compared to similar research conducted prior to this plan, it is obvious that the transformation plan was able to achieve its goal in "reducing OOP payments". However, health services such as dental, pharmacy, physiotherapy, and radiology would increase the likelihood of facing OOP payments. These variables should be considered by health policy-makers in order to review and revise the content of recent reform to provide financial protection against OOP for people.

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Section: Discussionsupporting

confidence: 93%

<p>The Study of Out-of-pocket Payment and the Exposure of Households with Catastrophic Health Expenditures Following the Health Transformation Plan in Iran</p>

Nemati¹,

Khezri²,

Nosratnejad³

2020

RMHP

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“…While column (3) shows that health insurance increases the probability of using inpatient healthcare, column (4) Jung and Streeter, 2015). Besides the differences in data and methodologies used, the time scopes of the studies could also be a reason for these different findings.…”

Section: Overall Effectmentioning

confidence: 99%

“…This is likely due to healthcare users switching to more costly and higher-level providers, as well as higher utilization rates among the insured (Jung and Streeter, 2015).…”

Section: Introductionmentioning

confidence: 99%

“…Some studies focusing on specific health insurance programs find little or no effect of reducing financial risks (Hou et al, 2014;Lei and Lin, 2009;Li and Zhang, 2013;Meng et al, 2012;Wagstaff et al, 2009a;Yip and Hsiao, 2009), 1 while others arrive at the opposite conclusion (Jung and Streeter, 2015;Meng et al, 2004), due to differences in data sources and methodologies used.…”

Section: Introductionmentioning

confidence: 99%

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Does health insurance reduce out-of-pocket expenditure? Heterogeneity among China's middle-aged and elderly

Zhang

Nikoloski

Mossialos

2017

Social Science & Medicine

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China's recent healthcare reforms aim to provide fair and affordable health services for its huge population. In this paper, we investigate the association between China's health insurance and out-ofpocket (OOP) healthcare expenditure. We further explore the heterogeneity in this association. Using data of 32,387 middle-aged and elderly individuals drawn from the 2011 and 2013 waves of China Health and Retirement Longitudinal Study (CHARLS), we report five findings. First, having health insurance increases the likelihood of utilizing healthcare and reduces inpatient OOP expenditure. Second, healthcare benefits are distributed unevenly: while low-and mediumincome individuals are the main beneficiaries with reduced OOP expenditure, those faced with very high medical bills are still at risk, owing to limited and shallow coverage in certain aspects. Third, rural migrants hardly benefit from having health insurance, suggesting that institutional barriers are still in place. Fourth, health insurance does not increase patient visits to primary care facilities; hospitals are still the main provider of healthcare. Nonetheless, there is some evidence that patients shift from higher-tier to lower-tier hospitals. Last, OOP spending on pharmaceuticals is reduced for inpatient care but not for outpatient care, suggesting that people rely on inpatient care to obtain reimbursable drugs, putting further pressure on the already overcrowded hospitals. Our findings suggest that China's health insurance system has been effective in boosting healthcare utilization and lowering OOP hospitalization expenditure, but there still remain challenges due to the less generous rural scheme, shallow outpatient care coverage, lack of insurance portability, and an underdeveloped primary healthcare system.

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“…More attention should be paid to the PHI market and purchasing behavior in China. Systematic research on health insurance has shown that more attention was paid to SBMI than to PHI-for example, the impact of the NCMS on the reduction of out-of-pocket medical expenditures, thereby improving financial protection [13][14][15], and the role played by other schemes such as UEBMI in containing health expenditures [16]; the role of SBMI in lowering catastrophic health expenditures and increasing outpatient expenditure reimbursement [1][2][3]17,18]. Studies on PHI have mainly focused on the way in which the expansion of SBMI has affected the development of PHI [19].…”

Section: Introductionmentioning

confidence: 99%

What Are the Determinants of the Decision to Purchase Private Health Insurance in China?

Wan

Peng

Shi

et al. 2020

IJERPH

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The objective of this study was to assess the determinants of the decision to purchase private health insurance (PHI) in China. Nationally representative data from the fourth wave of the China Household Finance Survey from 2017 were used, and the dataset comprised 105,691 individuals aged 18 years or older. The Andersen health services utilization model was used to inform the research. Chi-square tests and logistic regression analyses were used to estimate the decision to purchase PHI. The proportion of the sample that had PHI was small, at 5.06%, but coverage for social basic medical insurance (SBMI) was 90.64%. Among PHI holders, the overwhelming majority (87.40%) also had SBMI. Logistic regression analysis demonstrated that predisposing factors (age, education, marital status, household size), enabling factors (household income, SBMI status, geographical factors, household medical expense, and medical debt), and needs-based factors (health status) were statistically significant determinants of the decision to purchase PHI. This study suggests that the socio-economic circumstances of households play a crucial role in the decision to acquire PHI. The findings may be used by the insurance industry to inform actions to enhance PHI coverage and by policy decision-makers that seek to improve equality in access to PHI.

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Does health insurance decrease health expenditure risk in developing countries? The case of China

Cited by 31 publications

References 25 publications

<p>The Study of Out-of-pocket Payment and the Exposure of Households with Catastrophic Health Expenditures Following the Health Transformation Plan in Iran</p>

<p>The Study of Out-of-pocket Payment and the Exposure of Households with Catastrophic Health Expenditures Following the Health Transformation Plan in Iran</p>

Does health insurance reduce out-of-pocket expenditure? Heterogeneity among China's middle-aged and elderly

What Are the Determinants of the Decision to Purchase Private Health Insurance in China?

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