Catastrophic health expenditure and health-related quality of life among older adults in China

Catastrophic health expenditure and health-related quality of life among older adults in Shandong, China: the moderation effect of daily care by adult children

BACKGROUND

Catastrophic health expenditure (CHE) has a considerable impact on older people in later life, but little is known about the relationship between catastrophic health expenditure and health-related quality of life (HRQOL). The aim of this study was to examine the relationship between catastrophic health expenditure and health-related quality of life in older people, and to explore whether the daily care provided by adult children is a moderator in this relationship.

METHODS

Data from the sixth National Health Services Survey in Shandong Province, China. The sample consisted of 8599 elderly people (age ≥ 60 years; 51.7% of female). Health-related quality of life was measured by the health utility value of EQ-5D-3 L. Interaction effects were analyzed using Tobit regression models and marginal effects analysis.

RESULTS

The catastrophic health expenditure prevalence was 60.5% among older people in Shandong, China. catastrophic health expenditure was significantly associated with lower health-related quality of life (β= - 0.142, P < 0.001). We found that adult children providing daily care services to their parents mitigated the effect of catastrophic health expenditure on health-related quality of life among older people (β = 0.027, P = 0.040).

CONCLUSIONS

Our findings suggested that catastrophic health expenditure was associated with health-related quality of life and the caring role of older adult children moderated this relationship. Reducing the damage caused by catastrophic health expenditure helps to improve health-related quality of life in older people. Adult children should increase intergenerational contact, provide timely financial and emotional support to reduce the negative impact of catastrophic health expenditure on health-related quality of life.

China's aging population: A review of living arrangement, intergenerational support, and wellbeing

China's rapid population aging and remarkable family-level changes have raised concerns about the weakening of its family-based elderly care. The last decade indeed has seen a clear departure from multigenerational living to alternative living arrangements such as living with spouse only and solo living. However, ample evidence suggests that Chinese families have demonstrated considerable resilience amidst profound sociodemographic changes. This review article highlights the importance of government-society cooperation in meeting the social challenges of population aging. A key factor is the persistient filial piety norms, which enable children living far or close, migrant or nonmigrant, to rearrange financial, instrumental, and emotional support to aging parents. Equally important is the step-in of the government to share elderly care responsibilities, provide support through deepening pension and healthcare reforms, and implement the active and healthy aging agenda. How the two factors play out over the next decade and beyond will have profound implications on the living arrangement, intergenerational support, and wellbeing of older adults in China.

Does Welfare Receipt Change Consumption on Health among Older Families? The Case of China

Population aging has been occurring rapidly in China. It raises the issue of unmet needs of health-related consumption among older families. Using data from the China Health and Retirement Longitudinal Study and a propensity score matching method, this article examines whether welfare receipt is associated with changed consumption patterns among older families (i.e., main respondent was 60 years old or older or whose spouse was 60 years old or older if married). We found that welfare receipt was significantly associated with increased health expenditures of older families in rural but not in urban China. In neither area did it affect these families' spending to meet daily survival needs such as food and clothing. For rural older families, welfare receipt was associated with increased expenditures on informal health care. It also enabled less vulnerable households to have more self-treatment expenses. However, welfare receipt did not boost expenditures on clinic and hospital visits for either rural or urban families.

The ideal neighbourhoods of successful ageing: A machine learning approach

Ageing outcomes are shaped by not only health conditions, but also their interactions with the external environment. While the effects of some specific neighbourhood characteristics such as rurality on ageing have been evaluated in various studies, we still know little about the relative importance of particular natural and urban environments and how the impact varies at different stages of the ageing process. This article addresses these knowledge gaps by analysing survey data from 33 European countries using a machine learning method called multivariate regression trees (MRT). Multiple wellbeing indicators are combined to form an ageing profile for each individual in the survey. After studying these profiles using MRT, we find that generally the affordability of health facilities is a major determinant of life satisfaction, self-rated health condition and mental wellbeing for individuals in most age groups. Other important but age-specific determinants are neighbourhood safety and accessibility to cultural facilities and to green areas. In contrast, characteristics such as urbanity, transportation and air quality do not significantly influence ageing outcomes. Our findings lend support to the resources theory in explaining ageing outcomes and suggest that more resources may have to be directed to improve the affordability and quality of health care services, the policing services and the accessibility to cultural and green areas in order to achieve more favourable ageing outcomes.

Catastrophic health expenditure and mental health in the older Chinese population: The moderating role of social health insurance

OBJECTIVES

Catastrophic health expenditure (CHE) has considerable effects on household living standards, but little is known regarding the relationships between CHE and people's mental health. Using China as an example, this study examines the association between CHE and mental health and investigates whether the association differs between those with and without social health insurance (SHI).

METHODS

The data came from three waves of the China Health and Retirement Longitudinal Study (CHARLS 2011, 2013, and 2015, N = 13,166). We focused on older people aged 60 and above. We built panel data regression and quantile regression models to analyse the data.

RESULTS

Incurring CHE is significantly associated with poor mental health. The association is weakened among older people receiving SHI, which indicates that SHI has a protective effect. Moreover, the association between CHE and mental health and the protective effect of SHI are stronger among those with mild or moderate mental health problems.

DISCUSSION

Our findings provide empirical evidence that encourages the integration of psychologically informed approaches in health services. We also urge governments in low- and middle-income countries to consider more generous health financing mechanisms for older people with greater healthcare needs.

Association between changes in economic activity and catastrophic health expenditure: findings from the Korea Health Panel Survey, 2014-2016

Background

The rate of catastrophic health expenditure (CHE) continues to rise in South Korea. This study examined the association between changes in economic activity and CHE experiences in South Korea.

Methods

This study analyzed the Korea Health Panel Survey data using a logistic regression analysis to study the association between changes in economic activity in 2014–2015 and the participants’ CHE experiences in 2015. The study included a total of 12,454 individuals over the age of 19. The subgroup analyses were organized by sex, age, health-related variables, and household level variables, and the reasons for leaving economic activity.

Results

Those who quit economic activities were more likely to experience CHE than those who continued to engage in economic activities (OR [odds ratio] = 2.10; 95% CI [confidence interval]: 1.31–3.36). The subgroup analysis results, according to health-related variables, showed that there is a tendency to a higher Charlson comorbidity index, a higher OR, and, in groups that quit their economic activities, people with disabilities were more likely to experience CHE than people without disabilities (OR = 5.63; 95% CI 1.71–18.59, OR = 1.82; 95% CI 1.08–3.08, respectively). Another subgroup analysis found that if the reason for not participating in economic activity was a health-related issue, the participant was more likely to experience CHE (active → inactive: OR = 2.40; 95% CI 0.61–9.43, inactive → inactive OR = 1.65; 95% CI 1.01–2.68).

Conclusions

Those individuals who became unemployed were more likely to experience CHE, especially if health problems precipitated the job loss. Therefore, efforts are needed to expand coverage for those people who suffer from high medical expenses.