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Okamoto S, Sata M, Rosenberg M, Nakagoshi N, Kamimura K, Komamura K, Kobayashi E, Sano J, Hirazawa Y, Okamura T, Iso H. Universal health coverage in the context of population ageing: catastrophic health expenditure and unmet need for healthcare. HEALTH ECONOMICS REVIEW 2024; 14:8. [PMID: 38289516 PMCID: PMC10826197 DOI: 10.1186/s13561-023-00475-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 12/18/2023] [Indexed: 02/02/2024]
Abstract
BACKGROUND Universal health coverage means that all people can access essential health services without incurring financial hardship. Even in countries with good service coverage and financial protection, the progress towards universal health coverage may decelerate or be limited with respect to the growing older population. This study investigates the incidence/prevalence, determinants, and consequences of catastrophic health expenditure (CHE) and unmet need for healthcare and assesses the potential heterogeneity between younger (≤ 64 years) and older people (65 years≤). METHODS Utilising an annual nationally representative survey of Japanese aged 20 years and over, we estimated the incidence of CHE and unmet need for healthcare using disaggregated estimates by household members' age (i.e. ≤64 years vs. 65 years≤) between 2004 and 2020. Using a fixed-effects model, we assessed the determinants of CHE and unmet need along with the consequences of CHE. We also assessed the heterogeneity by age. RESULTS Households with older members were more likely to have their healthcare needs met but experienced CHE more so than households without older members. The financial consequences of CHE were heterogeneous by age, suggesting that households with older members responded to CHE by reducing food and social expenditures more so than households without older members reducing expenditure on education. Households without older members experienced an income decline in the year following the occurrence of CHE, while this was not found among households with older members. A U-shaped relationship was observed between age and the probability of experiencing unmet healthcare need. CONCLUSIONS Households with older members are more likely to experience CHE with different financial consequences compared to those with younger members. Unmet need for healthcare is more common among younger and older members than among their middle-aged counterparts. Different types and levels of health and financial support need to be incorporated into national health systems and social protection policies to meet the unique needs of individuals and households.
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Affiliation(s)
- Shohei Okamoto
- Research Team for Social Participation and Healthy Aging, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi City, Tokyo, 1730015, Japan.
- Institute for Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku City, Tokyo, Japan.
- Research Center for Financial Gerontology, Keio University, 2-15-45 Mita, Minato City, Tokyo, Japan.
| | - Mizuki Sata
- Institute for Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku City, Tokyo, Japan
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, 35 Shinanomachi, Shinjuku City, Tokyo, Japan
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Campus USÖ, Örebro, SE-701 82, Sweden
| | - Megumi Rosenberg
- World Health Organization Centre for Health Development, I.H.D. Centre Building, 9th Floor 7. 1-5-1 Wakinohama-Kaigandori, Chuo-ku, Kobe City, Hyogo, Japan
| | - Natsuko Nakagoshi
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, 35 Shinanomachi, Shinjuku City, Tokyo, Japan
| | - Kazuki Kamimura
- Research Center for Financial Gerontology, Keio University, 2-15-45 Mita, Minato City, Tokyo, Japan
- Hirao School of Management, Konan University, 8-33 Takamatsucho, Nishinomiya City, Hyogo, Japan
| | - Kohei Komamura
- Research Center for Financial Gerontology, Keio University, 2-15-45 Mita, Minato City, Tokyo, Japan
- Faculty of Economics, Keio University, 2-15-45 Mita, Minato City, Tokyo, Japan
| | - Erika Kobayashi
- Research Team for Social Participation and Healthy Aging, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2 Sakae-cho, Itabashi City, Tokyo, 1730015, Japan
| | - Junko Sano
- Research Center for Financial Gerontology, Keio University, 2-15-45 Mita, Minato City, Tokyo, Japan
- Tokyo Kasei Gakuin University, 22 Sanbancho, Chiyoda City, Tokyo, Japan
| | - Yuzuki Hirazawa
- Faculty of Economics, Keio University, 2-15-45 Mita, Minato City, Tokyo, Japan
| | - Tomonori Okamura
- Department of Preventive Medicine and Public Health, Keio University School of Medicine, 35 Shinanomachi, Shinjuku City, Tokyo, Japan
| | - Hiroyasu Iso
- Institute for Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku City, Tokyo, Japan
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Zhang W, Su M, Li D, Zhang T, Li W. Catastrophic health expenditure and its inequality in rural China: based on longitudinal data from 2013 to 2018. BMC Public Health 2023; 23:1861. [PMID: 37752487 PMCID: PMC10521565 DOI: 10.1186/s12889-023-16692-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 09/04/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Catastrophic health expenditure (CHE) is an important indicator of measuring health inequality. Previous studies mainly focused on specific vulnerable populations rather than a wider range of vulnerable areas through panel data. Rural China is often associated with an underdeveloped economy and insufficient health resources. This study aims to update the information on the extent of and trends in the incidence and inequality of CHE among the households of rural China through longitudinal survey data. METHODS Data were obtained from three waves of the China Health and Retirement Longitudinal Study (CHARLS): 2013, 2015, and 2018. In total, 2,575 households were included in the analysis. CHE was defined as household health expenditures exceeding 40% of non-food expenditures. Inequality in CHE was measured using the concentration curve and concentration index. The contribution to CHE inequality was decomposed using the concentration index decomposition method. RESULTS The incidence of CHE was 0.2341 (95% CI: 0.22, 0.25) in 2013, 0.2136 (95% CI: 0.20, 0.23) in 2015, and 0.2897 (95% CI: 0.27, 0.31) in 2018 in rural China. The concentration curve lay above the equality line, and the concentration index was negative: -0.1528 (95% CI: -0.1941, -0.1115) in 2013, -0.1010 (95% CI: -0.1442, -0. 0577) in 2015, and -0.0819 (95% CI: -0.1170, -0.0467) in 2018. Economic status, age, and chronic diseases were the main contributors to inequality in CHE. CONCLUSIONS The incidence of CHE in rural China displayed an upward trend from 2013 to 2018, although it was not continuous. Furthermore, a strong pro-low-economic inequality in CHE existed in rural China. Mainly economic status, age, and chronic diseases contributed to this pro-low-economic inequality. Health policies to allocate resources and services are needed to satisfy the needs of rural households and provide more accessible and affordable health services. More concern needs to be directed toward households with chronic diseases and older persons to reduce the incidence of CHE and promote health equality.
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Affiliation(s)
- Weile Zhang
- School of Public Administration, Inner Mongolia University, Zhaojun Road, Yuquan District, Hohhot, Inner Mongolia, 010070, China
| | - Min Su
- School of Public Administration, Inner Mongolia University, Zhaojun Road, Yuquan District, Hohhot, Inner Mongolia, 010070, China.
| | - Dongxu Li
- School of Public Administration, Inner Mongolia University, Zhaojun Road, Yuquan District, Hohhot, Inner Mongolia, 010070, China.
| | - Tianjiao Zhang
- School of Public Administration, Inner Mongolia University, Zhaojun Road, Yuquan District, Hohhot, Inner Mongolia, 010070, China
| | - Wenhui Li
- School of Public Administration, Inner Mongolia University, Zhaojun Road, Yuquan District, Hohhot, Inner Mongolia, 010070, China
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Li X, Mohanty I, Zhai T, Chai P, Niyonsenga T. Catastrophic health expenditure and its association with socioeconomic status in China: evidence from the 2011-2018 China Health and Retirement Longitudinal Study. Int J Equity Health 2023; 22:194. [PMID: 37735440 PMCID: PMC10515247 DOI: 10.1186/s12939-023-02008-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 09/09/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND An increase in healthcare utilization in response to universal health coverage may leave massive economic burden on individuals and households. Identifying catastrophic health expenditure helps us understand such burden. This study aims to examine the incidence of catastrophic health expenditure at various thresholds, explore its trend over years, and investigate whether it varies across socioeconomic status (SES). METHODS Data used in this study were from four waves of the China Health and Retirement Longitudinal Study (CHARLS): 2011, 2013, 2015, and 2018. SES was measured by annual per-capita household expenditure, which was then divided into quintiles (Quintile 1 (Q1): the poorest - Quintile 5 (Q5): the wealthiest). Catastrophic health expenditure was measured at both a fixed threshold (40%) and a set of variable thresholds, where the thresholds for other quintiles were estimated by multiplying 40% by the ratio of average food expenditure in certain quintile to that in the index quintile. Multilevel mixed-effects logistic regression models were used to analyze the determinants of catastrophic health expenditure at various thresholds. RESULTS A total of 6,953 households were included in our study. The incidence of catastrophic health expenditure varied across the thresholds set. At a fixed threshold, 10.90%, 9.46%, 13.23%, or 24.75% of households incurred catastrophic health expenditure in 2011, 2013, 2015, and 2018, respectively, which were generally lower than those at variable thresholds. Catastrophic health expenditure often decreased from 2011 to 2013, and an increasing trend occurred afterwards. Compared to households in Q5, those in lower quintiles were more likely to suffer catastrophic health expenditure, irrespective of the thresholds set. Similarly, having chronic diseases and healthcare utilization increased the odds of catastrophic health expenditure. CONCLUSIONS The financial protection against catastrophic health expenditure shocks remains a challenge in China, especially for the low-SES and those with chronic diseases. Concerted efforts are needed to further expand health insurance coverage across breadth, depth, and height, optimize health financing mechanism, redesign cost-sharing arrangements and provider payment methods, and develop more efficient expenditure control strategies.
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Affiliation(s)
- Xi Li
- Health Research Institute, Faculty of Health, University of Canberra, Building 23, 26 University Drive Street, Bruce, Canberra, 2617, Australia.
| | - Itismita Mohanty
- Health Research Institute, Faculty of Health, University of Canberra, Building 23, 26 University Drive Street, Bruce, Canberra, 2617, Australia
| | - Tiemin Zhai
- Department of Health Economics and National Health Accounts Research, China National Health Development Research Center, Beijing, China
| | - Peipei Chai
- Department of Health Economics and National Health Accounts Research, China National Health Development Research Center, Beijing, China
| | - Theo Niyonsenga
- Health Research Institute, Faculty of Health, University of Canberra, Building 23, 26 University Drive Street, Bruce, Canberra, 2617, Australia
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Edeh HC. Exploring dynamics in catastrophic health care expenditure in Nigeria. HEALTH ECONOMICS REVIEW 2022; 12:22. [PMID: 35322315 PMCID: PMC8943930 DOI: 10.1186/s13561-022-00366-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 03/07/2022] [Indexed: 05/11/2023]
Abstract
BACKGROUND The Nigeria's National Health Insurance Scheme aimed at making health care accessible and affordable since it's became operational in 2005. However, many Nigerians still pay out of pocket for medical expenses, and this drive them to incurring catastrophic health expenditures. Although monitoring progress towards UHC is crucial, one single study exploring the dynamics in catastrophic health expenditure proportion, associated factors, inequality concentration, inequality size, together with decomposition using a longer period Nigeria panel household survey datasets is very scarce. METHODS Data was drawn from three rounds of the Nigeria General Household Survey. The fixed percentage and rank-dependent thresholds were used to calculate and compare the proportion of households that incur catastrophic health expenditures. The logistic regression model was employed in analyzing the factors associated with catastrophic health expenditures. The concentration of catastrophic health expenditures inequality was assessed using the concentration curve, whereas the inequality size was determined using the concentration index. The decomposition method was used to decompose the concentration index into determining components. RESULTS Relative to the fixed threshold value, the rank-dependent threshold revealed a higher share of households facing catastrophic health expenditures i.e., from 27% in 2010/2011 to 48% in 2015/2016. The two thresholds reveal similar trend, but differ in percentage points. The key factors associated with catastrophic health expenditures were economic status and geopolitical zone. Inequality in catastrophic health expenditures was found to be concentrated among the poor. The household economic status was uncovered as the major positive contributor to catastrophic health expenditures inequality across the sample periods. CONCLUSION The findings of the study imply that narrowing economic status gap across households, and increasing the depth of insurance are crucial mechanisms to reduce the probability of incurring catastrophic health expenditures among the poor in Nigeria.
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Affiliation(s)
- Henry C Edeh
- Department of Economics, University of Nigeria, Nsukka, Nigeria.
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Mulaga AN, Kamndaya MS, Masangwi SJ. Decomposing socio-economic inequality in catastrophic out-of-pocket health expenditures in Malawi. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000182. [PMID: 36962147 PMCID: PMC10021269 DOI: 10.1371/journal.pgph.0000182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 01/09/2022] [Indexed: 06/18/2023]
Abstract
Reducing health inequalities and inequities is one of the key goals that health systems aspire to achieve as it ensures improvement in health outcomes among all population groups. Addressing the factors contributing to inequality in catastrophic health expenditures is important to reducing inequality in the burden of health expenditures. However, there are limited studies to explain the factors contributing to inequalities in catastrophic health expenditures. The study aimed to measure and decompose socio-economic inequality in catastrophic health into its determinants. Data for the analysis come from the fourth integrated household survey. Data for 12447 households in Malawi were collected from April 2016 to April 2017 by the National Statistical Office. The secondary analysis was conducted from June 2021 to October 2021. Catastrophic health expenditure was estimated as a proportion of households whose out-of-pocket health expenditures as a ratio of non-food consumption expenditures exceeds 40% threshold level. We estimated the magnitude of socio-economic inequality using the Erreygers corrected concentration index and used decomposition analysis to assess the contribution of inequality in each determinant of catastrophic health expenditure to the overall socio-economic inequality. The magnitude of the Erreygers corrected concentration index of catastrophic health expenditure (CI = 0.004) is small and positive which indicates that inequality is concentrated among the better-off. Inequality in catastrophic health expenditure is largely due to inequalities in rural residency (127%), socio-economic status (-40%), household size (14%), presence of a child under five years old (10%) and region of the household (10%). The findings indicate that socio-economic inequality in catastrophic health expenditures is concentrated among the better-off in Malawi. The results imply that policies that aim to reduce inequalities in catastrophic health expenditures should simultaneously address urban-rural and income inequalities.
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Affiliation(s)
- Atupele N. Mulaga
- Department of Mathematics and Statistics, Faculty of Applied Sciences, University of Malawi, Blantyre, Malawi
- School of Science and Technology, Malawi University of Business and Applied Sciences, Blantyre, Malawi
| | - Mphatso S. Kamndaya
- School of Science and Technology, Malawi University of Business and Applied Sciences, Blantyre, Malawi
| | - Salule J. Masangwi
- School of Science and Technology, Malawi University of Business and Applied Sciences, Blantyre, Malawi
- Centre for Water, Sanitation, Health and Appropriate Technology Development (WASHTED), Malawi University of Business and Applied Sciences, Blantyre, Malawi
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Jiang H, Zhao M, Tian G, Zhao Z, Ding D, Yin M. Perceived effect of financial risk protection by the Urban-Rural Resident Basic Medical Insurance Scheme: a mixed-methods study of rural residents in China. BMJ Open 2021; 11:e047699. [PMID: 34667000 PMCID: PMC8527163 DOI: 10.1136/bmjopen-2020-047699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES It is to explore the perceived financial risk protection effect of the Urban-Rural Resident Basic Medical Insurance Scheme (URRBMI) and its influencing factors to provide evidence to further improve the URRBMI. DESIGN It is a cross-sectional survey. PARTICIPANTS This mixed-methods study is conducted in five provinces in rural China. Through stratified cluster random sampling, 1681 rural residents participate in a cross-sectional questionnaire survey (1657 valid questionnaires are retrieved). Thirty rural residents participate in in-depth interviews. PRIMARY AND SECONDARY OUTCOME MEASURES A multivariate logistic regression analysis is adopted to identify factors influencing respondents' perceptions. Semistructured interviews are used to identify the reasons why some respondents believed the URRBMI to be ineffective. RESULTS Overall, 77.5% of respondents believe that the URRBMI is effective. Respondents, who are older, have a higher household income, prefer primary health facilities and provide a higher rating for critical illness compensation and maximum compensatory payouts. They are more likely to give the URRBMI a higher effectiveness rating than their counterparts. Qualitatively, participants who believe the URRBMI to be ineffective list the following reasons: low outpatient service coverage, insufficient or undersupplied drugs and services in the insurance list, problems in the arrangement of deductibles and maximum compensatory payouts, provider-induced behaviour and increased healthcare service price. CONCLUSIONS This exploration focuses on the reasons why rural residents think the scheme is invalid, which are vital for policy reform. Policies should focus on benefits design and coverage, the assumption of a supervisory role, avoiding financial risk stemming from critical illness and cross-sectoral actions to strengthen the primary healthcare system and comprehensive social security wealth.
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Affiliation(s)
- Huan Jiang
- Humanities and Social Sciences College, Harbin Medical University, Harbin, China
| | - Miaomiao Zhao
- Department of health management, Shcool of public health, Nantong university, Nantong, Jiangsu,China
| | - Guomei Tian
- Fourth affiliate hospital of Harbin Medical University, Harbin, Heilongjiang,China
| | - Zihua Zhao
- Scientific Research Department, Harbin Medical University, Harbin, Heilongjiang, China
| | - Ding Ding
- Department of Social Medicine, Dalian Medical University, Dalian, China
| | - Mei Yin
- Humanities and Social Sciences College, Harbin Medical University, Harbin, China
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Kazemi-Karyani A, Woldemichael A, Soofi M, Karami Matin B, Soltani S, Yahyavi Dizaj J. Explaining Socioeconomic Inequality Differences in Catastrophic Health Expenditure Between Urban and Rural Areas of Iran After Health Transformation Plan Implementation. CLINICOECONOMICS AND OUTCOMES RESEARCH 2020; 12:669-681. [PMID: 33204128 PMCID: PMC7666980 DOI: 10.2147/ceor.s261520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 09/29/2020] [Indexed: 11/23/2022] Open
Abstract
Objective Ensuring fair financial contribution is one of the main goals of the Health Transformation Plan (HTP) of Iran. This study aims to estimate socioeconomic inequality differences in catastrophic health expenditure (CHE) between urban and rural areas of Iran after the implementation of the HTP during 2017. Materials and Methods Data from a representative survey of households’ income and xpenditure from the Iran Statistical Center (ISC) were used for the analysis. We applied the World Health Organization (WHO) cut-off of 40% payment for CHE, and Wagstaff’s normalized concentration index (C) to measure and decompose the inequality. Also, Blinder–Oaxaca decomposition analysis was used to decompose contributors of inequality differences between rural and urban areas. Results The overall incidence of CHE among Iranian households during the year 2017 was 3.32% with a standard deviation (SD) of 17.91%, and the mean (SD) levels of CHE in rural and urban areas of Iran were 4.37% (20.45%) and 2.97% (16.99%), respectively. The aggregate socioeconomic status (SES)-related inequality in CHE was significantly (p<0.001) different from zero (C=−0.238) and there was a significant (p<0.05) difference between rural (C=-0.150) and urban (C=0.218) areas. SES was the highest contributor to inequality in both rural (130.09) and urban (144.17) areas. The Blinder–Oaxaca decomposition revealed that SES (175.01%) followed by outpatient services (120.29%) were the main contributors to differences in inequality in rural and urban areas. Sex (−101.42%) and health insurance coverage were among negative contributors to this inequality difference. Conclusion Our findings revealed a significant pro-rich inequality in CHE. Also, some variables, such as sex and region, made different contributions in rural and urban areas. However, SES, itself, made the highest contribution in both areas and explained the greatest share of difference in inequality between the two areas. This issue calls for revision of the HTP to further address the risk of CHE and socioeconomic disparity among Iranian households, especially those with lowSES.
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Affiliation(s)
- Ali Kazemi-Karyani
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Abraha Woldemichael
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Moslem Soofi
- Social Development and Health Promotion Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Behzad Karami Matin
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shahin Soltani
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Jafar Yahyavi Dizaj
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
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Zhao SW, Zhang XY, Dai W, Ding YX, Chen JY, Fang PQ. Effect of the catastrophic medical insurance on household catastrophic health expenditure: evidence from China. GACETA SANITARIA 2020; 34:370-376. [DOI: 10.1016/j.gaceta.2018.10.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 10/03/2018] [Accepted: 10/22/2018] [Indexed: 10/27/2022]
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Xu X, Gu H, You H, Bai L, Li D, Cui N, Wu W, Kou Y. Are People Enrolled in NCMS and CURBMI Susceptible in Catastrophic Health Expenditure? Evidence From China. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2020; 57:46958020919282. [PMID: 32418494 PMCID: PMC7235652 DOI: 10.1177/0046958020919282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This study investigated associations between different types of medical insurance and the incidence of catastrophic health expenditure among middle-aged and the aged in China. The data came from the China Health and Retirement Longitudinal Survey implemented in 2013, with 9782 individuals analyzed. Probit regression models and multiple linear regressions were employed to explore the relationship mentioned above and potential mechanisms behind it. It was found that compared with participants in Urban Resident Basic Medical Insurance, individuals participating in New Cooperative Medical Scheme and Coordinating Urban and Rural Basic Medical Insurance was less likely to undergo catastrophic health expenditure (P < .001, P = .008), especially for low-income and middle-income group. Participants in New Cooperative Medical Scheme and Coordinating Urban and Rural Basic Medical Insurance were more likely to utilize inpatient medical service (P < .001, P = .020) and choose low-level medical institutions for treatment (P = .003, P = .006). And individuals participating in New Cooperative Medical Scheme had lower out-of-pocket expenditure (P = .034). The study showed the significant difference in the incidence of catastrophic health expenditure among participants in different medical insurances. Efforts should be made to improve the service quality of grassroots medical institutions except for the increase of reimbursement ratio, so that rural residents can enjoy high-quality medical services.
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Affiliation(s)
| | - Hai Gu
- Nanjing University, China
| | - Hua You
- Nanjing University, China.,Nanjing Medical University, China
| | | | | | | | | | - Yun Kou
- Zhejiang University, Hangzhou, China
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JieAnNaMu, Xu X, You H, Gu H, Gu J, Li X, Cui N, Kou Y. Inequalities in health-related quality of life and the contribution from socioeconomic status: evidence from Tibet, China. BMC Public Health 2020; 20:630. [PMID: 32375713 PMCID: PMC7203898 DOI: 10.1186/s12889-020-08790-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 04/27/2020] [Indexed: 12/29/2022] Open
Abstract
Background This study aimed to understand the association between socioeconomic status (SES) and Health Related Quality of Life (HRQoL) and the contribution of SES to health inequality among Tibetans of agricultural and pastoral areas (APA) in Tibet, China. Methods The data were from Health Survey of Tibetans in APA conducted in 2014. A total of 816 respondents were enrolled for the analysis Multiple linear regression was employed to examine the relationship between SES and HRQoL. Concentration index (CI) was used to measure the degree of health inequality and a Wagstaff-type CI decomposition method was applied to measure the contribution of SES to inequality. Results SES had significant association with HRQoL among the Tibetans in APA. The high SES group was more likely to have a higher Eq-5d index (0.77 vs. 0.67, P < 0.001) and VAS (72.94 vs. 62.41, P < 0.001) than the low SES group. The Concentration index of the Eq-5d index and VAS for total sample was 0.022 and 0.026 respectively, indicating a slight pro-rich inequality among this population. The decomposition analyses showed the SES is the main contributor to health inequality and contributed 45.50 and 41.39% to inequality for the Eq-5d index and VAS, respectively. Conclusion The results showed SES is positively associated with HRQoL among Tibetans in APA. There was a slight pro-rich inequality in the health of the participants and most health inequality was attributable to SES. This study is helpful in gaining an insight into the HRQoL, health inequality and the relationship between SES and health inequality among Tibetans of APA in China.
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Affiliation(s)
- JieAnNaMu
- Center for Health Policy and Management Studies, Nanjing University, Nanjing, China
| | - Xinpeng Xu
- Center for Health Policy and Management Studies, Nanjing University, Nanjing, China
| | - Hua You
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing, China.
| | - Hai Gu
- Center for Health Policy and Management Studies, Nanjing University, Nanjing, China.
| | - Jinghong Gu
- Nanjing Foreign Language School, Nanjing, China
| | - Xiaolu Li
- Department of Otolaryngology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Nan Cui
- Center for Health Policy and Management Studies, Nanjing University, Nanjing, China
| | - Yun Kou
- Center for Health Policy and Management Studies, Nanjing University, Nanjing, China
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Sun J, Lyu S. The effect of medical insurance on catastrophic health expenditure: evidence from China. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2020; 18:10. [PMID: 32127784 PMCID: PMC7045636 DOI: 10.1186/s12962-020-00206-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 02/18/2020] [Indexed: 11/10/2022] Open
Abstract
Background The Chinese government has established a nationwide multiple-level medical insurance system. However, catastrophic health expenditure (CHE) causes great harm to the quality of life of households and pushes them into poverty. The objective of this paper is to assess the effect of medical insurance on CHE in China and compare the financial protection effects of different medical insurances. Methods Panel data were obtained from China Family Panel Studies (CFPS) conducted in the years of 2012, 2014, and 2016. CHE incidence was measured by performing a headcount, and its intensity was estimated using overshoot and mean positive overshoot (MPO). In addition, concentration index (CI) was used to measure the degree of socioeconomic inequality of CHE occurrence. Furthermore, random effects panel Probit regression model was employed to assess the effect of medical insurance on CHE. Lastly, random effects panel Logit regression model was adopted to perform a robustness check. Results From 2012 to 2016, the total CHE incidence jumped from 15.05% to 15.24%, and the CI in CHE changed from − 0.0076 to − 0.1512. Moreover, the total overshoot increased from 0.0333 to 0.0344, while the total MPO grew from 0.2213 to 0.2257. Furthermore, the global regression results show that residents covered by Supplementary Medical Insurance (SMI) were linked to a decreased probability of experiencing CHE. In addition, the regression results by gender indicate that SMI coverage for male residents had a significant effect on the prevention of CHE, while the effect was not significant for female residents. The regression results by health status show that SMI had a significant impact on reducing the likelihood of CHE occurrence for healthy residents, whilst the impact was not significant for unhealthy residents. Lastly, the robustness check results were consistent with those of previous findings. Conclusion The results of this study suggest that CHE incidence and intensity became relatively higher among households. In addition, CHE occurrence was concentrated among the poorer households and the equality status worsened. Moreover, financial protection effects of the four medical insurance schemes against CHE varied significantly. Furthermore, the protection effect of SMI against CHE shows significant gender and health status disparities.
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Affiliation(s)
- Jian Sun
- 1School of International and Public Affairs, Shanghai Jiao Tong University, No. 1954 Huashan Road, Xuhui District, Shanghai, 200030 China
| | - Shoujun Lyu
- 1School of International and Public Affairs, Shanghai Jiao Tong University, No. 1954 Huashan Road, Xuhui District, Shanghai, 200030 China.,2China Institute for Urban Governance, Shanghai Jiao Tong University, No. 1954 Huashan Road, Xuhui District, Shanghai, 200030 China
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12
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Tran BX, Tran TD, Nathan N, Ngo CQ, Nguyen LT, Nguyen LH, Nguyen HLT, Nguyen CT, Do HP, Nguyen THT, Tran TT, Thai TPT, Dang AK, Nguyen NB, Latkin CA, Ho CSH, Ho RCM. Catastrophic health expenditure of Vietnamese patients with gallstone diseases - a case for health insurance policy revaluation. CLINICOECONOMICS AND OUTCOMES RESEARCH 2019; 11:151-158. [PMID: 30804677 PMCID: PMC6375106 DOI: 10.2147/ceor.s191379] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Purpose Despite gallstone diseases (GSDs) being a major public health concern with both acute and chronic episodes, none of the studies in Vietnam has been conducted to investigate the household expenditure for the GSD treatment. The objective of this study was to estimate the costs of managing GSD and to explore the prevalence and determinants of catastrophic health expenditure (CHE) among Vietnamese patients. Materials and methods A cross-sectional study was conducted from June 2016 to March 2017 in the Department of Hepatobiliary and Pancreatic Surgery, Viet Duc Hospital in Hanoi, Vietnam. A total of 206 patients were enrolled. Demographic and socioeconomic data, household income, and direct and indirect medical costs of patients seeking treatment for GSD were collected through face-to-face interview. Multivariate logistic regression was used to explore factors associated with CHE. Results The prevalence of CHE in patients suffering from GSD was 35%. The percentage of patients who were covered by health insurance and at risk for CHE was 41.2%, significantly higher than that of those noninsured (15.8%). Proportions of patients with and without health insurance who sought outpatient treatment were 30.6% and 81.6%, respectively. Patients who were divorced or widowed and had intrahepatic gallstones were significantly more likely to experience CHE. Those who were outpatients, were women, had history of pharmacological treatment to parasitic infection, and belong to middle and highest monthly household income quantile were significantly less likely to experience CHE. Conclusion The findings suggested that efforts to re-evaluate health insurance reimbursement capacity, especially for acute diseases and taking into account the varying preferences of people with different disease severity, should be conducted by health authority. Further studies concerning CHE of GSD in the context of ongoing health policy reform should consider utilizing WHO-recommended measures like the fairness in financial contribution index, as well as taking into consideration the behavioral aspects of health care spending.
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Affiliation(s)
- Bach Xuan Tran
- Department of Health Economics, Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.,Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Tho Dinh Tran
- Department of Hepatobiliary Surgery, Vietnam-Germany Hospital, Hanoi, Vietnam
| | - Nila Nathan
- University of California, Santa Barbara, Santa Barbara, CA, USA
| | - Chau Quy Ngo
- Department of Internal Medicine, Hanoi Medical University, Hanoi, Vietnam
| | - Loi Thi Nguyen
- Woolcock Institute of Medical Research Vietnam, Hanoi, Vietnam
| | - Long Hoang Nguyen
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | | | - Cuong Tat Nguyen
- Institute for Global Health Innovations, Duy Tan University, Danang, Vietnam,
| | - Huyen Phuc Do
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | - Trang Huyen Thi Nguyen
- Center of Excellence in Evidence-based Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | - Tung Thanh Tran
- Center of Excellence in Evidence-based Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | - Thao Phuong Thi Thai
- Department of General Planning, Friendship Hospital, Hanoi, Vietnam.,Department of Cardiology, Friendship Hospital, Hanoi, Vietnam
| | - Anh Kim Dang
- Institute for Global Health Innovations, Duy Tan University, Danang, Vietnam,
| | - Nam Ba Nguyen
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | - Carl A Latkin
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Cyrus S H Ho
- Department of Psychological Medicine, National University Hospital, Singapore
| | - Roger C M Ho
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam.,Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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13
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Yang X, Chen M, Du J, Wang Z. The inequality of inpatient care net benefit under integration of urban-rural medical insurance systems in China. Int J Equity Health 2018; 17:173. [PMID: 30466451 PMCID: PMC6251195 DOI: 10.1186/s12939-018-0891-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 11/12/2018] [Indexed: 11/10/2022] Open
Abstract
Background China has recently made efforts to integrate urban and rural basic medical insurance systems in order to ensure both urban and rural enrollees obtain unified benefits. However, whether the distribution of government healthcare subsides has become more equitable remains unknown. The purpose of this study was to analyze determinants of and inequality in net inpatient care benefits under the integration of urban-rural medical insurance systems in China. Methods Data were obtained from a nationally representative household survey, the Fifth National Health Services Survey (2013), conducted in Anhui province. A multiple regression model and concentration index (CI) was used to estimate related factors and inequality of inpatient care net benefits. Results Findings indicated that individuals received more inpatient care benefits when urban and rural social healthcare systems were integrated. Factors associated with net benefits included gender, age, marital status, retirement, educational level, history of chronic diseases, health status, willingness to seek inpatient care and per capita income. The rich were found to disproportionately benefit from inpatient care, and the CI of net benefits for integrated insurance enrollees was the lowest among all three available health insurance schemes. These findings indicate that the recent unification of urban-rural social health insurances reduces inequality in net benefits from government subsidies. Some socioeconomic factors, such as per capita income, 60 years of age and over, history of chronic disease and high educational level positively influence inequality. Conclusion In China, accelerating the integration of urban and rural medical insurance systems is an effective way to increase equity of benefit in urban and rural areas. Strategies aimed at reducing inpatient benefit inequality must address socioeconomic factors influencing healthcare outcomes.
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Affiliation(s)
- Xue Yang
- School of Health Policy & Management, Nanjing Medical University, 101Longmian Avenue, Jiangning District, Nanjing, 211166, People's Republic of China
| | - Mingsheng Chen
- School of Health Policy & Management, Nanjing Medical University, 101Longmian Avenue, Jiangning District, Nanjing, 211166, People's Republic of China.,Creative Health Policy Research Group, Nanjing Medical University, Nanjing, 211166, China
| | - Jinglin Du
- School of Health Policy & Management, Nanjing Medical University, 101Longmian Avenue, Jiangning District, Nanjing, 211166, People's Republic of China
| | - Zhonghua Wang
- School of Health Policy & Management, Nanjing Medical University, 101Longmian Avenue, Jiangning District, Nanjing, 211166, People's Republic of China. .,Creative Health Policy Research Group, Nanjing Medical University, Nanjing, 211166, China.
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Zhen X, Zhang H, Hu X, Gu S, Li Y, Gu Y, Huang M, Sun X, Wei J, Dong H. A comparative study of catastrophic health expenditure in Zhejiang and Qinghai province, China. BMC Health Serv Res 2018; 18:844. [PMID: 30413169 PMCID: PMC6234776 DOI: 10.1186/s12913-018-3658-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 10/29/2018] [Indexed: 11/24/2022] Open
Abstract
Background China has made great achievements in health insurance coverage and healthcare financing; however, the rate of catastrophic health expenditure (CHE) was 13.0% in China in 2008, which is higher than that in some other countries. There remain some differences in life-style, national customs, medical conditions, and health consciousness in different provinces in China. This study aimed to compare the rates of households with CHE, further to explore the different performance of factors influencing CHE between Zhejiang and Qinghai province, China. Methods Data were derived from the household surveys conducted in Zhejiang and Qinghai. Sampling on multi-stage stratified cluster random method was adopted. Household with CHE occurs when the out-of-pocket payment for health care equals to or exceeds 40% of a household’s income. Univariate and multivariate logistic regression analyses were used to identify the performance of factors of CHE. Results A total of 1598 households were included in this study, including 995 in Zhejiang and 603 in Qinghai. The average rates of CHE in Zhejiang and Qinghai were 9.6 and 30.5%, respectively. We found that economic status of households and households headed by an employed person are the protective factors for CHE; and number of members with chronic diseases and number of inpatients in household are the risk factors for CHE in the two provinces. Besides, poor/low-insured households in Zhejiang; and households having outpatients and households headed by a minority person in Qinghai are more likely to experience the risk of CHE. Conclusions This study highlights the importance of improving economic development, expanding employment, and adjusting policies to make greater efforts to protect chronic diseases patients, outpatients, and inpatients, further to reduce the risk of CHE. The Chinese government should pay more attention to the actual conditions in different provinces, further to make policy decisions according to the local knowledge.
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Affiliation(s)
- Xuemei Zhen
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Hao Zhang
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.,Hangzhou Normal University, Xuelin Street, Hangzhou, Zhejiang, China
| | - Xiaoqian Hu
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Shuyan Gu
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yuanyuan Li
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Yuxuan Gu
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Minzhuo Huang
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xueshan Sun
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jingming Wei
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Hengjin Dong
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
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15
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Wu D, Yu F, Nie W. Improvement of the reduction in catastrophic health expenditure in China's public health insurance. PLoS One 2018; 13:e0194915. [PMID: 29634779 PMCID: PMC5892907 DOI: 10.1371/journal.pone.0194915] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 03/13/2018] [Indexed: 11/18/2022] Open
Abstract
This study aimed to locate the contributing factors of Catastrophic Health Expenditure (CHE), evaluate their impacts, and try to propose strategies for reducing the possibilities of CHE in the context of China’s current public health insurance system. The financial data of all hospitalization cases from a sample hospital in 2013 were gathered and used to determine the pattern of household medical costs. A simulation model was constructed based on China’s current public health insurance system to evaluate the financial burden for medical service on Chinese patients, as well as to calculate the possibilities of CHE. Then, by adjusting several parameters, suggestions were made for China’s health insurance system in order to reduce CHE. It’s found with China’s current public health insurance system, the financial aid that a patient may receive depends on whether he is from an urban or rural area and whether he is employed. Due to the different insurance policies and the wide income gap between urban and rural areas, rural residents are much more financially vulnerable during health crisis. The possibility of CHE can be more than 50% for low-income rural families. The CHE ratio can be dramatically lowered by applying different policies for different household income groups. It’s concluded the financial burden for medical services of Chinese patients is quite large currently, especially for those from rural areas. By referencing different healthcare policies in the world, applying different health insurance policies for different income groups can dramatically reduce the possibility of CHE in China.
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Affiliation(s)
- Dengfeng Wu
- Economics and Management School, Jiujiang University, Jiujiang City, China
- * E-mail:
| | - Fang Yu
- Economics and Management School, Jiujiang University, Jiujiang City, China
| | - Wei Nie
- Jiujiang University Hospital, Jiujiang City, China
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