Medical expenditure and its inequity for people with disabilities: Evidence from the CHARLS 2018 data

Abstract

IntroductionDisabilities may raise heavy medical expenses and rich-poor inequalities. However, data is lacking for the Chinese older populations. This study aimed to measure socioeconomic inequalities in medical expenses amongst the Chinese adult 45 years or older, and explored the main determinants among different disability categories.MethodData from the 2018 China Health and Retirement Longitudinal Study (CHARLS) were used. Disabilities were divided into five categories: physical disabilities, intellectual disability, vision problems, hearing problems, and multiple disabilities. The two-part model was employed to identify the factors that are associated with medical expenditures. Socioeconomic inequalities were measured by the concentration index (CI), and the horizontal inequity index (HI) which adjusts for health needs. Decomposition analysis was further applied to evaluate the contribution of each determinant.ResultsTwo thousand four hundred nineteen people were included in this study. The CIs and HIs of the expenditure were both positive. Amongst the varied types of medical expenses, the highest CIs were found for self-treatment expenses (0.0262). Amongst the five categories of disabilities, the group with vision problem disability reported the highest CIs and HIs for outpatient expenses (CI = 0.0843, HI = 0.0751), self-treatment expenses (CI = 0.0958, HI = 0.1119), and total expenses (CI = 0.0622, HI = 0.0541). The group of intellectual disability reported the highest CI and HI (CI = 0.0707, HI = 0.0625). The decomposition analysis showed that income (80.32%), education (25.14%) and living in the rural areas (13.96%) were the main determinants of medical expenses for HI amongst all types of disabilities.ConclusionFor five types of disabilities, our data shows that medical expenses concentrated in the richer groups in China. Income, education, and rural areas factors were the main contributors to the economic-related inequalities. Health policies to improve the affordability of medical care are needed to decrease inequity of medical expenditures for people with disabilities.

What is the degree of social disability risk in China under the background of the aging population? Social disability risk measurement index system design and evaluation research based on China

“…In response to the continuing increase in the number of people with disabilities due to the aging of the population and the rising prevalence of non-communicable diseases worldwide ( 16 ), the United Nations and other international organizations have taken many actions. To ensure that persons with disabilities are afforded the same rights and opportunities as others ( 17 ), the UN adopted the Convention on the Rights of Persons with Disabilities in 2006 to make visible the ‘invisible' community of persons with disabilities in the traditional UN human rights protection arena. To promote the health and wellbeing of persons with disabilities ( 18 ) and the implementation of the Convention on the Rights of Persons with Disabilities ( 19 , 20 ), the World Health Organization and the World Bank jointly published the World Report on Disability in 2011, which provides a comprehensive analysis of disability issues and recommendations for national and international action.…”