The Basic vs. Ability-to-Pay Approach: Evidence From China's Critical Illness Insurance on Whether Different Measurements of Catastrophic Health Expenditure Matter

Zhang, Ying; Guan, Yongmei; Ding, Hu; Vanneste, Jacques; Zhu, Dongmei

doi:10.3389/fpubh.2021.646810

Cited by 4 publications

(5 citation statements)

References 40 publications

(70 reference statements)

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“…helps explain the lower CHE for families with chronic disease in Shanghai. Henan and Gansu only implemented the family doctor contract system in 2017, with insufficient doctor numbers, low proficiency of medical technicians, and poor infrastructure, including roads and telecommunications, limiting effective chronic disease monitoring and timely intervention (48).…”

Section: Comparison Of Influencing Factors In Che Incidencementioning

confidence: 99%

Regional catastrophic health expenditure and health inequality in China

Wang,

Guo,

Qin

et al. 2023

Front. Public Health

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BackgroundCatastrophic health expenditures (CHE) can trigger illness-caused poverty and compound poverty-caused illness. Our study is the first regional comparative study to analyze CHE trends and health inequality in eastern, central and western China, exploring the differences and disparities across regions to make targeted health policy recommendations.MethodsUsing data from China's Household Panel Study (CFPS), we selected Shanghai, Henan and Gansu as representative eastern-central-western regional provinces to construct a unique 5-year CHE unbalanced panel dataset. CHE incidence was measured by calculating headcount; CHE intensity was measured by overshoot and CHE inequality was estimated by concentration curves (CC) and the concentration index (CI). A random effect model was employed to analyze the impact of household head socio-economic characteristics, the household socio-economic characteristics and household health utilization on CHE incidence across the three regions.ResultsThe study found that the incidence and intensity of CHE decreased, but the degree of CHE inequality increased, across all three regions. For all regions, the trend of inequality first decreased and then increased. We also revealed significant differences across the eastern, central and western regions of China in CHE incidence, intensity, inequality and regional differences in the CHE influencing factors. Affected by factors such as the gap between the rich and the poor and the uneven distribution of medical resources, families in the eastern region who were unmarried, use supplementary medical insurance, and had members receiving outpatient treatment were more likely to experience CHE. Families with chronic diseases in the central and western regions were more likely to suffer CHE, and rural families in the western region were more likely to experience CHE.ConclusionsThe trends and causes of CHE varied across the different regions, which requires a further tilt of medical resources to the central and western regions; improved prevention and financial support for chronic diseases households; and reform of the insurance reimbursement policy of outpatient medical insurance. On a regional basis, health policy should not only address CHE incidence and intensity, but also its inequality.

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Section: Comparison Of Influencing Factors In Che Incidencementioning

confidence: 99%

Regional catastrophic health expenditure and health inequality in China

Wang,

Guo,

Qin

et al. 2023

Front. Public Health

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“…In this study, the total household expenditure was used as the household ATP, for which higher household expenditure signified higher ATP, and vice versa. Household expenditure was a better proxy for ATP as compared to other living standard parameters, such as income, as data on income are deemed sensitive and some are reluctant to share information pertaining to their income or assets [6,17]. Another factor is that data on income tend to fluctuate among households who do not have a permanent employment or fixed income related to seasonal variations, especially among rural households engaged in small-scale industries.…”

Section: Household's Ability To Pay (Atp)mentioning

confidence: 99%

“…Considering the household composition of adults, children and economies of scale, the household expenditure needs to be adjusted according to an adult equivalent scale (ei) [6,17] as shown in the formula: ei = (Ai + 0.5 Ki) 0.75 where Ai is the total number of adults in a household, Ki is the total number of children in a household, and a square root of 0.75 was a recommended economy of scale used in similar study in Malaysia [16]. Subsequently, household ATP was quantified by dividing household expenditure by the adult equivalent scale (ei), which gave the estimate of monthly adult equivalent expenditure per capita, as shown in the formula: Household ATP = Household expenditure (RM)/Adult equivalent scale (ei)…”

Section: Household's Ability To Pay (Atp)mentioning

confidence: 99%

Equity in Out-of-Pocket Payments for Healthcare Services: Evidence from Malaysia

Baharin

Juni

Manaf

2022

IJERPH

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Background: Out-of-pocket (OOP) payments are an inequitable mechanism for health financing as their high share of total health expenditures poses a risk of catastrophic healthcare expenditures. This study aimed to assess the distribution and progressivity of OOP payments made by Malaysian households for various group of healthcare services. Methods: This study utilized data from the Malaysian Household Expenditure Survey (HES) between 2014 and 2015, which involved 14,473 households. Distribution and progressivity of OOP payments were measured through their proportion of household consumption, a concentration curves plot and the Kakwani Progressivity Index (KPI). Results: The mean proportion of Malaysian OOP payments for healthcare of household consumption was 1.65%. The proportion increased across households’ consumption quintiles, from 1.03% made by the poorest 20% to 1.86% by the richest 20%. The OOP payments in Malaysia were progressive with a positive KPI of 0.0910. The OOP payments made for hospital-based services were the most progressive (KPI 0.1756), followed by medical products, appliances and equipment (KPI 0.1192), pharmaceuticals (0.0925) and outpatient-based services (KPI 0.0394) as the least progressive. Conclusions: Overall, the OOP payments for healthcare services in Malaysia were progressive and equitable as they were more concentrated among the richer households.

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“…Certain studies compared CMI policy documents published in various regions, identifying shortcomings in the design and implementation of welfare packages and making recommendations for improvement [ 13 , 14 ]. By simulating various CMI compensation schemes, some studies compared the effects of CMI under various catastrophic health expenditure measurement methods and compensation schemes [ 15 , 16 , 17 , 18 , 19 ]. By examining the effectiveness of CMI implementation using datasets from health insurance information systems and survey data at some regional or national levels, some studies discovered that increased CMI coverage significantly effectively alleviated poverty caused by illness [ 20 ], and reduced vulnerability to poverty and broke the vicious cycle of poverty and disease through increased income [ 21 ].…”

Section: Literature Review and Research Hypothesismentioning

confidence: 99%

Healthcare Expenditures among the Elderly in China: The Role of Catastrophic Medical Insurance

Cao

You

et al. 2022

IJERPH

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China has been piloting the catastrophic medical insurance (CMI) program since 2012 and rolled it out nationally in 2016 to reduce the incidence of catastrophic health expenditure among Chinese residents. Few studies have been conducted to determine its effect on healthcare expenditures, particularly among the elderly. The purpose of this study is to examine the effect of CMI on healthcare expenditures among China’s elderly population. The data for this study were derived from 4 waves of the Chinese Longitudinal Healthy Longevity Survey, which included 344 and 1199 individuals in the treatment and control groups, respectively. To examine the effect of CMI on healthcare expenditures among the elderly, we used difference-in-differences and fixed-effects models. Additionally, a heterogeneity analysis was used to examine the differences in the impact of CMI on different groups. Finally, we confirmed the robustness of the results using robustness and placebo tests. CMI increased total health and out-of-pocket expenditures significantly, as well as inpatient and corresponding out-of-pocket expenditures. The reassults of the heterogeneity analysis indicated that CMI had a greater impact on elderly residents of rural areas. Economic burden protection has been enhanced for low-income groups and patients with serious diseases over the last two years. Our research indicated that CMI can promote the use of inpatient medical services for the elderly to a certain extent. Targeted measures such as expanding the CMI compensation list, establishing a more precise compensation scheme, and specific diseases associated with high healthcare expenditures can be considered in the practice of CMI implementation.

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The Basic vs. Ability-to-Pay Approach: Evidence From China's Critical Illness Insurance on Whether Different Measurements of Catastrophic Health Expenditure Matter

Cited by 4 publications

References 40 publications

Regional catastrophic health expenditure and health inequality in China

Regional catastrophic health expenditure and health inequality in China

Equity in Out-of-Pocket Payments for Healthcare Services: Evidence from Malaysia

Healthcare Expenditures among the Elderly in China: The Role of Catastrophic Medical Insurance

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