Minimizing the Risk of Catastrophic Health Expenditure in China: A Multi-Dimensional Analysis of Vulnerable Groups

Abstract

Background: In moving toward universal health coverage in China, it is crucial to identify which populations should be prioritized for which interventions rather than blindly increasing welfare packages or capital investments. We identify the characteristics of vulnerable groups from multiple perspectives through estimating catastrophic health expenditure (CHE) and recommend intervention priorities.Methods: Data were from National Health Service Survey conducted in 2003, 2008, and 2013. According to the recommendation of WHO, this study adopted 40% as the CHE threshold. A binary regression was used to identify the determinants of CHE occurrence; a probit model was used to obtain CHE standardized incidence under the characteristics of single and two dimensions in 2013.Results: The total incidence of CHE in 2013 was 13.9%, which shows a general trend of growth from 2003 to 2013. Families in western and central regions and rural areas were more at risk. Factors related to social demography show that households with a female or an unmarried head of household or with a low socioeconomic status were more likely to experience CHE. Households with older adults aged 60 and above had 1,524 times higher likelihood of experiencing CHE. Among the health insurance schemes, the participants covered by the New Rural Cooperative Medical Scheme had the highest risk compared with the participants of all basic health insurance schemes. Households with several members seeking outpatient, inpatient care or with non-communicable diseases were more likely to experience CHE. Households with members not seeing a doctor or hospitalized despite the need for it were more likely to experience CHE. Characteristics such as a household head with characteristics related to low socioeconomic status, having more than two hospitalized family members, ranked high. Meanwhile, the combination of having illiterate household heads and with being covered by other health insurance plans or by none ranked the first place. Cancer notably caused a relatively high medical expenditure among households with CHE.Conclusion: In China, considering the vulnerability of the population across different dimensions is conducive to the alleviation of high CHE. Furthermore, people with multiple vulnerabilities should be prioritized for intervention. Identifying and targeting them to offer help and support will be an effective approach.

The Impact of Multimorbidities on Catastrophic Health Expenditures among Patients Suffering from Hypertension in China: An Analysis of Nationwide Representative Data

“…Our study found that patients suffering from hypertension enrolled in URRBMI and NRCMS had a higher CHE risk, but other insurance schemes also did not protect patients from CHE. Due to the defects of a low financing level, low compensatory benefits level, and poor ability of cost-sharing [39], many studies have also found that people covered by NRCMS have a greater CHE risk [40][41][42]. Additionally, there is evidence that many NRCMS funds do not include outpatient fees, rehabilitation, or long-term care for the elderly [39], which can further explain why middle-aged and elderly patients suffering from hypertension covered by NRCMS had a high CHE risk.…”

“…Meanwhile, for URRBMI, following the integration of URBMI and NRCMS, compared to inpatient services, outpatient insurance policies still covered very limited diseases and had lower reimbursement ratios in most areas [22]. Therefore, medical expenses related to hypertension and most chronic diseases suitable for outpatient treatment can only be reimbursed after the use of inpatient services; thus, these patients either paid high fees or sought hospitalization [22,41].…”

The Global Status of Universal Health Coverage and Oncology Care

“…Using oncology treatment modalities is dependent on socioeconomic status and financial protection provided by the states (12). Cancer treatment costs have been one of the major determinants of CHE in many countries, with an upward trend in recent years (13). Although there has been progress toward universal health coverage for non-communicable diseases, including cancer, since the announcement of the sustainable development goals in 2015, there is still a need for financial protection, especially for high-cost anti-cancer drugs (14).…”

Rural health dialogue for the sustainability of help-seeking behaviors among older patients: Grounded theory approach

“…Dialogue with peers and medical professionals can improve HSBs' quality and quantity and is particularly essential for older people. In communities, people engage in dialogue with others regarding their health conditions and may modify their HSBs based on others' suggestions [12,13]. In particular, older people change their HSBs based mainly on their relatives and family's dialogues and suggestions due to limited access to communication resources and interactions with others [9,14].…”