Does the critical illness insurance reduce patients’ financial burden and benefit the poor more: a comprehensive evaluation in rural area of China

Jiang, Junnan; Chen, Shanquan; Xin, Yanjiao; Wang, Xuefeng; Zeng, Li; Zhong, Zhengdong; Li, Xiang

doi:10.1080/13696998.2019.1581620

Cited by 20 publications

(25 citation statements)

References 37 publications

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“…This is consistent with the findings of a domestic study in which the unmet needs for healthcare in a low-income group exerted a negative impact on health [10]. As an example, China introduced the Critical Illness Insurance System in 2012 to improve health equality by reducing patients' burden of health expenditure and allowing timely treatment, which led to both short-and long-term health improvement [21]. Moreover, after China launched the New Cooperative Medical Scheme system in 2003, and expanded insurance coverage in 2009, inequality in catastrophic health expenditure declined [30].…”

Section: Discussionsupporting

confidence: 86%

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Unmet Healthcare Needs, Catastrophic Health Expenditure, and Health in South Korea’s Universal Healthcare System: Progression Towards Improving Equity by NHI Type and Income Level

2020

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This study examined the effects of healthcare inequality on personal health. It aimed to determine how health insurance type and income level influence catastrophic health expenditure and unmet healthcare needs among South Koreans. Unbalanced Korean Health Panel data from 2011 to 2015, including 33,374 adults, were used. A time-trend and panel regression analysis were performed. The first to identify changes in the main variables and, the second, mediating effects of unmet healthcare needs and catastrophic health expenditure on the relationship between health insurance type, income level, and health status. The independent variables were: high-, middle-, low-income employee insured, high-, middle-, low-income self-employed insured, and medical aid. The dependent variable was health status, and the mediators were unmet needs and catastrophic health expenditure. The medical aid beneficiaries and low-income self-employed insured groups demonstrated a higher probability of reporting poor health status than the high-income, insured group (15.6%, 2.2%, and 2.3%, respectively). Participants who experienced unmet healthcare needs or catastrophic health expenditure were 10.7% and 5.6% higher probability of reporting poor health, respectively (Sobel test: p < 0.001). National policy reforms could improve healthcare equality by integrating insurance premiums based on income among private-sector employees and self-employed individuals within the health insurance network.

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Section: Discussionsupporting

confidence: 86%

“…Expanded insurance coverage could reduce catastrophic health expenditure and unmet healthcare needs, improving health outcomes [20,21]. In the past decade, Korea has implemented several policies to demonstrate its commitment to expand insurance coverage.…”

Section: Introductionmentioning

confidence: 99%

Unmet Healthcare Needs, Catastrophic Health Expenditure, and Health in South Korea’s Universal Healthcare System: Progression Towards Improving Equity by NHI Type and Income Level

2020

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“…Previous studies concerning the effect of CII on relieving financial burden have yielded mixed results. Some studies held the view that the effect is limited from the perspective of CII reimbursement level [22,23,42], while other studies indicated that economic burden decreased after CII implementation [3,43,44]. In our study, a household with members having CII was a factor to protect households from CHE incidence, but it significantly increased CHE intensity.…”

Section: Discussionmentioning

confidence: 53%

Effect of Critical Illness Insurance on Household Catastrophic Health Expenditure: The Latest Evidence from the National Health Service Survey in China

Shi

Yang

et al. 2019

IJERPH

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Background: China fully implemented the critical illness insurance (CII) program in 2016 to alleviate the economic burden of diseases and reduce catastrophic health expenditure (CHE). With an aging society, it is necessary to analyze the extent of CHE among Chinese households and explore the effect of CII and other associated factors on CHE. Methods: Data were derived from the Sixth National Health Service Survey (NHSS, 2018) in Jiangsu Province. The incidence and intensity of CHE were calculated with a sample of 3660 households in urban and rural areas in Jiangsu Province, China. Logistic regression and multiple linear regression models were used for estimating the effect of CII and related factors on CHE. Results: The proportion of households with no one insured by CII was 50.08% (1833). At each given threshold, from 20% to 60%, the incidence and intensity were higher in rural households than in urban ones. CII implementation reduced the incidence of CHE but increased the intensity of CHE. Meanwhile, the number of household members insured by CII did not affect CHE incidence but significantly decreased CHE intensity. Socioeconomic factors, such as marital status, education, employment, registered type of household head, household income and size, chronic disease status, and health service utilization, significantly affected household CHE. Conclusions: Policy effort should further focus on appropriate adjustments, such as dynamization of CII lists, medical cost control, increasing the CII coverage rate, and improving the reimbursement level to achieve the ultimate aim of using CII to protect Chinese households against financial risk caused by illness.

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“…[ [15] In a study from two poor Chinese counties, Jiang et al (2019) found that the medical debt incidence was 60%-70% among low-and middle-income households and the debt was not decreased by the CII between 2013 and 2016. [24] Using data on the poorest families in 29 provinces in China, Jiang (2018) found more than 60% of families in poverty suffered from medical debt, no matter whether from urban or rural areas. [23] There is, however, a paucity of nationwide studies on medical debt of middle-and low-income Chinese families and medical debt induced poverty.…”

Section: Introductionmentioning

confidence: 99%

“…[33] Hao et al 2010defined debt as money owed to clinics or others [15], while Jiang et al(2019) defined the long-term medical debt burden as borrowed money. [24] We take a narrow definition of medical debt, based on the response to the 2015 CHFS question: 'How much in total did your household borrow to pay medical debts?' Similar to other studies, the answer included bank and credit union loans and private loans from friends and family [15,33].…”

Section: Introductionmentioning

confidence: 99%

Medical Debt and Catastrophic Health Expenditures among Middle- and Low-Income Families in China

Li¹,

Chen²,

Xu³

et al. 2019

Preprint

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Background Medical debt is a persistent global issue and a crucial and effective indicator of long-term family medical financial burden. This paper fills a research gap on the incidence and causes of medical debt in Chinese low and middle-income households.Method Data was obtained from the 2015 China Household Finance Survey and medical debt measured as borrowings from families, friends and third parties. Tobit regression models were used to analyze the data. The concentration index was employed to measure the extent of socioeconomic inequality in medical debt incidence.Results We found that 2.42% of middle-income families had a medical debt, averaging US$6278.25, or 0.56 times household yearly income; and 3.92% of low-income families had medical debts averaging US$5419.88, which was equivalent to 2.49 times household yearly income. The concentration index for low and middle-income families’ medical debt was significantly pro-poor. Medical debt impoverished about 10% of all non-poverty households and pushed poor households deeper into poverty. While catastrophic health expenditure was the single most important factor in medial debt, age, education, and health status of householder, hospitalization and types of medical insurance were also significant factors determining medical debt.Conclusions Using a narrow definition of medical debt, the incidence of medical debt in Chinese low and middle-income households was relatively low. But, once medical debt happened, it imposed a long-term financial burden on medical indebted families, tipping many low and middle-income households into poverty and imposing on households several years of debt repayments. Further studies need to use broader definitions of medical debt to better assess the long-term financial impact of medical debt on Chinese families. Policy makers need to modify basic medical insurance schemes to manage out-of-pocket medical expenses better and take account of pre-existing medical debt when addressing this problem.

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Does the critical illness insurance reduce patients’ financial burden and benefit the poor more: a comprehensive evaluation in rural area of China

Cited by 20 publications

References 37 publications

Unmet Healthcare Needs, Catastrophic Health Expenditure, and Health in South Korea’s Universal Healthcare System: Progression Towards Improving Equity by NHI Type and Income Level

Unmet Healthcare Needs, Catastrophic Health Expenditure, and Health in South Korea’s Universal Healthcare System: Progression Towards Improving Equity by NHI Type and Income Level

Effect of Critical Illness Insurance on Household Catastrophic Health Expenditure: The Latest Evidence from the National Health Service Survey in China

Medical Debt and Catastrophic Health Expenditures among Middle- and Low-Income Families in China

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