Trends and socio‐economic disparities in catastrophic health expenditure and health impoverishment in China: 2010 to 2016

Abstract

objectives To investigate trends and socio-economic disparities in the catastrophic health expenditure (CHE) and health impoverishment in China after major reform of the health system and to examine the impacts of the chronic disease on CHE and impoverishment.methods We obtained data from four rounds of the China Family Panel Studies 2010-2016, with a sample size of 14 960 households. We defined CHE as the point at which annual household health payments exceeded 40% of annual capacity to pay. Impoverishment is measured by the $1.90 per day poverty line. Multivariate logistic regression models were performed to identify impacts of the family member with chronic disease on CHE and impoverishment.results Between 2010 and 2016, the incidence of CHE in China decreased from 19.37% to 15.11% and from 7.39% to 5.14% for health impoverishment; however, the decrease in level of impoverishment was less in rural areas (from 6.16% down to 3.03%) than in urban areas (from 8.46% down to 7.81%). The gap between impoverishment rates across the income quartiles is growing. Multivariable analysis showed that households with two or more members suffering chronic diseases were significantly more likely to incur CHE (aOR: 2.46, 95% CI: 1.93-3.13) and impoverishment (aOR: 2.66, 95% CI: 1.87-3.78) than households with no members suffering chronic diseases, after adjusting for sociodemographic covariates.conclusions Important advances have been made in achieving greater financial protection for Chinese citizens. Nevertheless, greater attention to the poor households with chronic disease members is needed. Policymakers in China should focus on optimising integrated rural-urban health insurance by expanding the current benefit packages and strengthening poverty alleviation efforts.keywords catastrophic health expenditure, health impoverishment, socio-economic disparity, China Sustainable Development Goals (SDGs): SDG 1 (no poverty), SDG 3 (good health and well-being), SDG 8 (decent work and economic growth), SDG 10 (reduced inequalities), SDG 11 (sustainable cities and communities), SDG 17 (partnerships for the goals)

Urban-rural differences in catastrophic health expenditure among households with chronic non-communicable disease patients : evidence from China Family Panel Studies

“…Here, we found that the CHE incidence of households with NCD patients in urban and rural areas were 19.88% and 26.02%, respectively, which are much higher than the results of another study on the overall proportion of households incurring CHE in China (urban households: 13.06%; rural households: 17.70%) [17]. It indicates that the risk tolerance of households with NCD patients to OOP medical expenditure is lower than the average level of Chinese households.…”

“…Gwatidzo (2017) found that adults aged 50 or above in India were less likely to incur CHE due to diabetes mellitus medication use compared to China [16]. Zhao (2019) identified that the CHE incidence among rural households with NCD patients notably exceeded the average level of urban households with NCD patients in China [17]. Xie (2017) verified the main reasons why households with members suffering from NCDs in rural China were prone to CHE [18].…”

“…Since the substitution of non-food household expenditure for total household expenditure partly avoided the measurement deviations that were often overlooked in poor households, we used non-food household expenditure as the denominator to calculate CHE[22,23]. The nonfood expenditure of a household is defined as the portion of total household expenditure excluding food household expenditure.According to exiting literature[17,22,24,25], the threshold for CHE was defined as 40%. More specifically, if OOP medical expenditure of a household exceeded 40% of its non-food household expenditure, the household was classified as incurring CHE.…”

Socioeconomic Disparities in Cancer Treatment, Service Utilization and Catastrophic Health Expenditure in China: A Cross-Sectional Analysis

“…Most of the previous studies focus on the rural/urban, geographical/regional disparities [13][14][15][16], and sex disparities in cancer incidence and mortality [17,18], as well as disparities in treatment options [19]. In China, a few studies have examined the healthcare disparities among people with chronic diseases, such as hypertension, cardiovascular diseases, chronic obstructive pulmonary disease, and multimorbidity [20][21][22][23][24][25]. However, there is limited evidence of socioeconomic disparities in treatment, health service utilization, and financial protection among cancer patients following China's health system reform in 2009 [26].…”

What fragile factors hinder the pace of China’s alleviation efforts of poverty-stricken population?

“…8 From 1995 to 2012, the average annual growth rate of per capita transfer payments in the western region was 20.3%, higher than that in the central region. 9 Meanwhile, according to our calculations, the reimbursement rate in the central region (55.9%) was lower than that in the western region (58.2%). Therefore, it is obvious that the economic burden of diseases depends not only on the level of economic development of the region itself, but also on the healthcare needs and service utilization of the people and the design of the medical insurance system and other welfare systems.…”