Improvement of the reduction in catastrophic health expenditure in China’s public health insurance

Wu, Dejun; Fang, Yu; Nie, Wei

doi:10.1371/journal.pone.0194915

Cited by 18 publications

(22 citation statements)

References 43 publications

(41 reference statements)

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“…As for the indicator of catastrophic health expenditure, recent national studies showed that China made progress in reducing the rate of catastrophic health expenditure, especially for low-income groups 7 8. However, the financial burden for medical services of patients remains high 9 10…”

Section: Financial Protectionmentioning

confidence: 99%

Towards universal health coverage: achievements and challenges of 10 years of healthcare reform in China

et al. 2020

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Universal health coverage (UHC) has been identified as a priority for the global health agenda. In 2009, the Chinese government launched a new round of healthcare reform towards UHC, aiming to provide universal coverage of basic healthcare by the end of 2020. We conducted a secondary data analysis and combined it with a literature review, analysing the overview of UHC in China with regard to financial protection, coverage of health services and the reported coverage of the WHO and the World Bank UHC indicators. The results include the following: out-of-pocket expenditures as a percentage of current health expenditures in China have dropped dramatically from 60.13% in 2000 to 35.91% in 2016; the health insurance coverage of the total population jumped from 22.1% in 2003 to 95.1% in 2013; the average life expectancy increased from 72.0 to 76.4, maternal mortality dropped from 59 to 29 per 100 000 live births, the under-5 mortality rate dropped from 36.8 to 9.3 per 1000 live births, and neonatal mortality dropped from 21.4 to 4.7 per 1000 live births between 2000 and 2017; and so on. Our findings show that while China appears to be well on the path to UHC, there are identifiable gaps in service quality and a requirement for ongoing strengthening of financial protections. Some of the key challenges remain to be faced, such as the fragmented and inequitable health delivery system, and the increasing demand for high-quality and value-based service delivery. Given that China has committed to achieving UHC and ‘Healthy China 2030’, the evidence from this study can be suggestive of furthering on in the UHC journey and taking the policy steps necessary to secure change.

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Section: Financial Protectionmentioning

confidence: 99%

Towards universal health coverage: achievements and challenges of 10 years of healthcare reform in China

et al. 2020

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“…The World Health Organization (WHO) proposed that CHE occurs when health care payments equal or exceed 40% of a household's non-subsistence income [12]. Indeed, residents in China are faced with higher economic burden of diseases, and the overall incidence of CHE is about 13%, while the incidence of CHE can be more than 50% for low-income rural families [13,14].…”

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confidence: 99%

The effect of medical insurance on catastrophic health expenditure: evidence from China

Sun

Lyu

2020

Cost Eff Resour Alloc

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Background: The Chinese government has established a nationwide multiple-level medical insurance system. However, catastrophic health expenditure (CHE) causes great harm to the quality of life of households and pushes them into poverty. The objective of this paper is to assess the effect of medical insurance on CHE in China and compare the financial protection effects of different medical insurances. Methods: Panel data were obtained from China Family Panel Studies (CFPS) conducted in the years of 2012, 2014, and 2016. CHE incidence was measured by performing a headcount, and its intensity was estimated using overshoot and mean positive overshoot (MPO). In addition, concentration index (CI) was used to measure the degree of socioeconomic inequality of CHE occurrence. Furthermore, random effects panel Probit regression model was employed to assess the effect of medical insurance on CHE. Lastly, random effects panel Logit regression model was adopted to perform a robustness check. Results: From 2012 to 2016, the total CHE incidence jumped from 15.05% to 15.24%, and the CI in CHE changed from − 0.0076 to − 0.1512. Moreover, the total overshoot increased from 0.0333 to 0.0344, while the total MPO grew from 0.2213 to 0.2257. Furthermore, the global regression results show that residents covered by Supplementary Medical Insurance (SMI) were linked to a decreased probability of experiencing CHE. In addition, the regression results by gender indicate that SMI coverage for male residents had a significant effect on the prevention of CHE, while the effect was not significant for female residents. The regression results by health status show that SMI had a significant impact on reducing the likelihood of CHE occurrence for healthy residents, whilst the impact was not significant for unhealthy residents. Lastly, the robustness check results were consistent with those of previous findings. Conclusion: The results of this study suggest that CHE incidence and intensity became relatively higher among households. In addition, CHE occurrence was concentrated among the poorer households and the equality status worsened. Moreover, financial protection effects of the four medical insurance schemes against CHE varied significantly. Furthermore, the protection effect of SMI against CHE shows significant gender and health status disparities.

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“…First, we observed the incidence and intensity of CHE rose over the study period with two measurement standards. The previous study had reported that the possibility of CHE could be higher than 50% of lowincome rural households in China [18]. This was unexpected because many policies were adopted in this period for reducing the level of CHE.…”

Section: Discussionmentioning

confidence: 95%

“…Additionally, the determinants of CHE have been extensively explored by previous studies. Household economic status, the inpatient rate, presence of an elderly or disabled household member, and the presence of a household member with chronic illness were commonly associated with CHE [16][17][18]. While it was thought that health insurance would help to alleviate some of the economic burden brought about by disease, the evidence has remained unclear.…”

Section: Introductionmentioning

confidence: 99%

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Measurement and determinants of catastrophic health expenditures among the elderly in China using longitudinal data from the CHARLS

Liu

Coyte

et al. 2020

Preprint

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Introduction: Catastrophic health expenditures (CHE) among Chinese elderly is an issue worthy of attention. However, the incidence, intensity and determinants of CHE have not been fully investigated by previous studies. This study explores the incidence, intensity and determinants of CHE among elderly Chinese citizens, i.e. those aged 60 years or older.Methods: Data were obtained from three waves of the China Health and Retirement Longitudinal Study (CHARLS): 2011, 2013 and 2015. Cutoff points used in this study for catastrophic health expenditures were 10% of the total expenditures and 40% of non-food expenditures. Under the guidance of the Andersen model of health services utilization, this study used the logistic regression analysis to explore the determinants of catastrophic health expenditures.Results: The incidence of catastrophic health expenditures rose over the study period, 2011-2015, from 20.86% (95% CI: 19.35% to 22.37%) to 31.00% (95% CI: 29.28% to 32.72%) with 40% non-food expenditure. The intensity of CHE had also increased. The Overshoot(O) rose from from 3.12% (95% CI: 2.71% to 3.53%) to 8.75% (95% CI: 8.14% to 9.36%) with 40% non-food expenditure, while the mean positive overshoot (MPO) rose from 14.96% (95% CI: 12.99% to 16.92%) to 28.23% (95% CI: 26.26% to 30.19%), which means that the problem of catastrophic health expenditures was even more serious in 2015 than in 2011. Logistic regression revealed that households were more likely to face CHE if they: had a spouse as a household member, reported an inpatient event in the last year, reported an outpatient visit in the last month, are disabled; are members of a poor expenditure quartile, are located in the middle and western zones and reside in an Urban area. In contrast, catastrophic health expenditures were not significantly affected by age above 75 years, household size, having a chronic health condition or insurance type.Conclusion: Key policy recommendations include efforts to gradually improve medical assistance and to expand the use of health insurance to reduce household liability exposure for health expenditures.

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Improvement of the reduction in catastrophic health expenditure in China’s public health insurance

Cited by 18 publications

References 43 publications

Towards universal health coverage: achievements and challenges of 10 years of healthcare reform in China

Towards universal health coverage: achievements and challenges of 10 years of healthcare reform in China

The effect of medical insurance on catastrophic health expenditure: evidence from China

Measurement and determinants of catastrophic health expenditures among the elderly in China using longitudinal data from the CHARLS

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