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Rezaei S, Karimi M, Soltani S, Barfar E, Gharehghani MAM, Badakhshan A, Badiee N, Pakdaman M, Brown H. Household financial burden associated with out-of-pocket payments for healthcare in Iran: insights from a cross-sectional survey. BMC Health Serv Res 2024; 24:1062. [PMID: 39272081 PMCID: PMC11396140 DOI: 10.1186/s12913-024-11477-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: 02/24/2024] [Accepted: 08/22/2024] [Indexed: 09/15/2024] Open
Abstract
BACKGROUND One of the key functions and ultimate goals of health systems is to provide financial protection for individuals when using health services. This study sought to evaluate the level of financial protection and its inequality among individuals covered by the Social Security Organization (SSO) health insurance between September and December 2023 in Iran. METHODS We collected data on 1691 households in five provinces using multistage sampling to examine the prevalence of catastrophic healthcare expenditure (CHE) at four different thresholds (10%, 20%, 30%, and 40%) of the household's capacity to pay (CTP). Additionally, we explored the prevalence of impoverishment due to health costs and assessed socioeconomic-related inequality in OOP payments for healthcare using the concentration index and concentration curve. To measure equity in out-of-pocket (OOP) payments for healthcare, we utilized the Kakwani progressivity index (KPI). Furthermore, we employed multiple logistic regression to identify the main factors contributing to households experiencing CHE. FINDINGS The study revealed that households in our sample allocated approximately 11% of their budgets to healthcare services. The prevalence of CHE at the thresholds of 10%, 20%, 30%, and 40% was found to be 47.1%, 30.1%, 20.1%, and 15.7%, respectively. Additionally, we observed that about 7.9% of the households experienced impoverishment due to health costs. Multiple logistic regression analysis indicated that the age of the head of the household, place of residence, socioeconomic status, utilization of dental services, utilization of medicine, and province of residence were the main factors influencing CHE. Furthermore, the study demonstrated that while wealthy households spend more money on healthcare, poorer households spend a larger proportion of their total income to healthcare costs. The KPI showed that households with lower total expenditures had higher OOP payments relative to their CTP. CONCLUSION The study findings underscore the need for targeted interventions to improve financial protection in healthcare and mitigate inequalities among individuals covered by SSO. It is recommended that these interventions prioritize the expansion of coverage for dental services and medication expenses, particularly for lower socioeconomic status household.
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Affiliation(s)
- Satar Rezaei
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Maryam Karimi
- Hajar Teaching Hospital, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Shahin Soltani
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Eshagh Barfar
- Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Mohammad Ali Mohammadi Gharehghani
- Social welfare Management Research Center, Social Health Research Institute, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Abbas Badakhshan
- School of Health , Golestan University of Medical Sciences, Gorgan, Iran
| | - Nasim Badiee
- Department of Health Management, Economic and Policy, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Pakdaman
- Health Policy and Management Research Center, Department of health management and Economics, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Heather Brown
- Division of Health Research, Lancaster University, Lancaster, UK
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Wang X, Guo Y, Qin Y, Nicholas S, Maitland E, Liu C. Regional catastrophic health expenditure and health inequality in China. Front Public Health 2023; 11:1193945. [PMID: 37927884 PMCID: PMC10624124 DOI: 10.3389/fpubh.2023.1193945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 09/15/2023] [Indexed: 11/07/2023] Open
Abstract
Background Catastrophic 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. Methods Using 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. Results The 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. Conclusions The 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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Affiliation(s)
- Xinyue Wang
- School of Management, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yan Guo
- School of Management, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yang Qin
- Dispatching and Operation Department, Construction and Management Bureau of the North Hu Bei Water Transfer Project, Wuhan, China
| | - Stephen Nicholas
- Australian National Institute of Management and Commerce, Sydney, NSW, Australia
- School of Economics and School of Management, Tianjin Normal University, Tianjin, China
- Research Institute for International Strategies, Guangdong University of Foreign Studies, Guangzhou, China
- Newcastle Business School, University of Newcastle, University Drive, Newcastle, NSW, Australia
| | - Elizabeth Maitland
- School of Management, University of Liverpool, Liverpool, United Kingdom
| | - Cai Liu
- School of Management, Tianjin University of Traditional Chinese Medicine, Tianjin, China
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Mekuria GA, Achalu DL, Tewuhibo D, Ayenew W, Ali EE. Perspectives of key decision makers on out-of-pocket payments for medicines in the Ethiopian healthcare system: a qualitative interview study. BMJ Open 2023; 13:e072748. [PMID: 37433722 DOI: 10.1136/bmjopen-2023-072748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/13/2023] Open
Abstract
OBJECTIVE This study aimed to explore the perspectives of key decision makers on out-of-pocket (OOP) payment for medicines and its implications in the Ethiopian healthcare system. DESIGN A qualitative design that employed audiorecorded semistructured in-depth interviews was used in this study. The framework thematic analysis approach was followed in the analysis. SETTING Interviewees came from five federal-level institutions engaged in policymaking (three) and tertiary referral-level healthcare service provision (two) in Ethiopia. PARTICIPANTS Seven pharmacists, five health officers, one medical doctor and one economist who held key decision-making positions in their respective organisations participated in the study. RESULT Three major themes were identified in the areas of the current context of OOP payment for medicines, its aggravating factors and a plan to reduce its burden. Under the current context, participants' overall opinions, circumstances of vulnerability and consequences on households were identified. Factors identified as aggravating the burden of OOP payment were deficiencies in the medicine supply chain and limitations in the health insurance system. Suggested mitigation strategies to be implemented by the health providers, the national medicines supplier, the insurance agency and the Ministry of Health were categorised under plans to reduce OOP payment. CONCLUSION The findings of this study indicate that there is widespread OOP payment for medicines in Ethiopia. System level constraints such as weaknesses in the supply system at the national and health facility levels have been identified as critical factors that undermine the protective effects of health insurance in the Ethiopian context. Ensuring steady access to essential medicines requires addressing health system and supply constraints in addition to a well-functioning financial risk protection systems.
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Affiliation(s)
- Getahun Asmamaw Mekuria
- Department of Pharmacy, College of Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Daniel Legese Achalu
- Clinical Trials Directorate, Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | | | - Wondim Ayenew
- Department of Social and Administrative Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Eskinder Eshetu Ali
- Department of Pharmaceutics and Social Pharmacy, Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
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Liao H, Li S, Han D, Zhang M, Zhao J, Wu Y, Ma Y, Yan C, Wang J. Associations between social support and poverty among older adults. BMC Geriatr 2023; 23:384. [PMID: 37353734 PMCID: PMC10288788 DOI: 10.1186/s12877-023-04079-7] [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: 06/24/2022] [Accepted: 05/30/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND With population aging becoming a pressing global concern, social support is more meaningful for older adults. In particular, financial supports, such as health insurance and financial assistance derived from family, all play great role in assistance affairs. Research shows social support possibly has an impact on poverty, but the association between formal and informal supports is unclear. We are aimed at verifying the association between distinct social supports and exploring whether this association would affect poverty alleviation for older adults. METHODS A total of 2,683 individuals aged 60 years or older who have medical expenses were included in a survey conducted by the China Health and Retirement Longitudinal Study in 2018. A chi-square analysis and an independent samples T test all were used to explore the differences of social supports among old people with different economic condition. A binary logistic regression was aimed at analyzing the association between social supports and poverty for older adults. The structural equation model was established to evaluate the association between formal support and informal support and the mechanism(s) of social supports affecting poverty. RESULTS The overall average rate of reimbursement for outpatient care was 0.20 with standard deviation 0.22, and the average reimbursement rate of inpatient care for the poor older adults is nearly 5% lower than the average of the non-poor older adults. We found that having private health insurance and higher reimbursement rate of inpatient care were associated with lower likelihood of living in poverty for older adults. Formal support would directly affect poverty, but its impact on poverty through informal support is insignificant even if formal support is negatively associated with informal support. CONCLUSION A dilemma in reducing the economic burden of disease and receiving family assistance for older adults was revealed, and a more complete health security and higher level of medical expenses compensation would be beneficial to prevent poverty. Optimizing the primary healthcare and increasing the percentage of insurance compensation, policies that focus on the specific cultural values and strengthening the role of supplementary insurance are advantaged for alleviating poverty among older adults.
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Affiliation(s)
- Hui Liao
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Sangsang Li
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Dan Han
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Mei Zhang
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Jie Zhao
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Yunyi Wu
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Ying Ma
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Chaoyang Yan
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
| | - Jing Wang
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei China
- The Key Research Institute of Humanities and Social Science of Hubei Province, Huazhong University of Science and Technology, Wuhan, Hubei China
- Institute for Poverty Reduction and Development, Huazhong University of Science and Technology, Wuhan, Hubei China
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Dang Y, Yang Y, Yang A, Cao S, Zhang J, Wang X, Lu J, Hu X. Factors influencing catastrophic health expenditure of households with people with diabetes in Northwest China-an example from Gansu Province. BMC Health Serv Res 2023; 23:401. [PMID: 37098618 PMCID: PMC10131345 DOI: 10.1186/s12913-023-09411-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 04/17/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND Diabetes is a chronic non-communicable disease that causes a substantial economic burden on diabetic suffers and their households. The aim of this study was to explore the prevalence, equity, and determinants of catastrophic health expenditure (CHE) among households with people with diabetes in Northwest China. METHODS A total of 3,000 households were included in the 6th Health services survey in Gansu Province, China of which 270 households with people with diabetes. The equity of CHE was evaluated by concentration curve and concentration index (CI). We adopted the Pareto chart to analyze the main economic intervals of the occurrence of CHE. Finally, we combined the decision tree and logistic model and analyzed the determinants of the occurrence of CHE. RESULTS The incidence of CHE at 15%, 25% and 40% were 75.19%, 58.89% and 35.19%, respectively. CHE tended to occur in households with a lower economic level, with the phenomenon being more pronounced at Z = 40%. The Pareto chart showed that households in the group with an annual per capita income of 0-740 USD (0-5,000 Chinese Yuan) were most likely to experience CHE. Both decision tree and logistic models suggested that economic level, comorbidities, and small household size were potential risk factors. In addition, the decision tree model also suggested the interaction between the influencing factor of health checks in the past 12 months and the number of chronic diseases. CONCLUSIONS In summary, Households with people with diabetes were more likely to incur CHE. It is essential to focus on low- and middle-income households with people with diabetes, strengthen the management of patients with diabetes, and provide timely health interventions to reduce the occurrence of chronic comorbidity and the risk of CHE in households.
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Affiliation(s)
- Ying Dang
- Department of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Yinan Yang
- Department of Pediatric Cardiology, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Aimin Yang
- Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Shuting Cao
- Department of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Jia Zhang
- Department of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Xiao Wang
- Department of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Jie Lu
- Health Statistics Information Center of Gansu Province, Lanzhou, Gansu Province, China
| | - Xiaobin Hu
- Department of Epidemiology and Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, China.
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Medical insurance payment schemes and patient medical expenses: a cross-sectional study of lung cancer patients in urban China. BMC Health Serv Res 2023; 23:89. [PMID: 36703175 PMCID: PMC9881291 DOI: 10.1186/s12913-023-09078-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 01/17/2023] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND As the main cause of cancer death, lung cancer imposes seriously health and economic burdens on individuals, families, and the health system. In China, there is no national study analyzing the hospitalization expenditures of different payment methods by lung cancer inpatients. Based on the 2010-2016 database of insured urban resident lung cancer inpatients from the China Medical Insurance Research Association (CHIRA), this paper aims to investigate the characteristics and cost of hospitalized lung cancer patient, to examine the differences in hospital expenses and patient out-of-pocket (OOP) expenses under four medical insurance payment methods: fee-for-service (FFS), per-diem payments, capitation payments (CAP) and case-based payments, and to explore the medical insurance payment method that can be conducive to controlling the cost of lung cancer. METHOD This is a 2010-2016, 7-year cross-sectional study. CHIRA data are not available to researchers after 2016. The Medical Insurance Database of CHIRA was screened using the international disease classification system to yield 28,200 inpatients diagnosed with lung cancer (ICD-10: C34, C34.0, C34.1, C34.2, C34.3, C34.8, C34.9). The study includes descriptive analysis and regression analysis based on generalized linear models (GLM). RESULTS The average patient age was 63.4 years and the average length of hospital stay (ALOS) was 14.2 day; 60.7% of patients were from tertiary hospitals; and 45% were insured by FFS. The per-diem payment had the lowest hospital expenses (RMB7496.00/US$1176.87), while CAP had the lowest OOP expenses (RMB1328.18/US$208.52). Compared with FFS hospital expenses, per-diem was 21.3% lower (95% CI = -0.265, -0.215) and case-based payment was 8.4% lower (95% CI = -0.151, -0.024). Compared with the FFS, OOP expenses, per-diem payments were 9.2% lower (95% CI = -0.130, -0.063) and CAP was 15.1% lower (95% CI = -0.151, -0.024). CONCLUSION For lung cancer patients, per-diem payment generated the lowest hospital expenses, while CAP meant patients bore the lowest OOP costs. Policy makers are suggested to give priority to case-based payments to achieve a tripartite balance among medical insurers, hospitals, and insured members. We also recommend future studies comparing the disparities of various diseases for the cause of different medical insurance schemes.
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Cao D, Zhou Z, Ren Y, Deng Q, Zhai X, Liu G, Zhao D, Zhao Y, Shen C. The relationship between duration of subjective poverty and health among Chinese adults: Evidence from the China Family Panel Study. Front Public Health 2022; 10:939569. [PMID: 36276380 PMCID: PMC9581302 DOI: 10.3389/fpubh.2022.939569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 09/02/2022] [Indexed: 01/25/2023] Open
Abstract
Introduction The disadvantaged socioeconomic status could have accumulated negative effects on individual. In the Chinese context, studying subjective and relative poverty is more important under the implementation of the Targeted Poverty Alleviation campaign. This study aims to provide evidence of the relationship between the duration of subjective poverty and both physical and mental health among Chinese adults, using nationally longitudinal data from 2010 to 2018. Materials and methods Data were extracted from a nationally representative survey database-the China Family Panel Study (CFPS). The total sample size contains 12,003 adults, with 3,532 in the urban area and 8,471 in the rural area. Self-rated health and depressive symptoms were set as indicators of physical health and mental health, respectively. The duration of subjective poverty was measured by self-rated income level in the local area from 2010 to 2016. A series of ordinary least square regression was adopted to measure the relationship between duration of subjective poverty and health. Results For the urban residents, the average duration of subjective poverty is 1.99 time points, while 1.98 time points for the rural residents. Net of objective poverty, duration of subjective poverty has a significantly negative association with individual's self-rated health in the rural sample (Coef. = -0.10, p < 0.001). Compared with those who have not experienced subjective poverty, the self-rated health score of people who experienced four time points is likely to decrease by 0.54 in the rural area and 0.30 in the urban area. In terms of mental health, 1 unit increase in the duration of subjective poverty is related to 0.15 unit increase in Center for Epidemiologic Studies Depression Scale-8 (CES-D8) scores in the urban sample and 0.46 in the rural sample. Compared with those who have not experienced subjective poverty, the CES-D8 scores of people who experienced four time points are likely to increase by 1.47 in the rural area and 0.95 in the urban area. Conclusion A longer duration of subjective poverty has a cumulatively negative effect on Chinese residents' physical and mental health, especially in rural area. Our study advocates researchers and policymakers pay more attention to the cumulative effect of subjective poverty on health.
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Affiliation(s)
- Dan Cao
- The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China,School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
| | - Zhongliang Zhou
- The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China,School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China,*Correspondence: Zhongliang Zhou
| | - Yangling Ren
- School of Public Administration, Southwestern University of Finance and Economics, Chengdu, China
| | - Qiwei Deng
- School of Public Health, Xi'an Jiaotong University, Xi'an, China
| | - Xiaohui Zhai
- School of Public Health, Xi'an Jiaotong University, Xi'an, China
| | - Guanping Liu
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
| | - Dantong Zhao
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
| | - Yaxin Zhao
- School of Public Health, Xi'an Jiaotong University, Xi'an, China
| | - Chi Shen
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
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Bai R, Gao J, Dong W. Is Travel Time Associated with Health Service Utilization in Northwest China? Evidence from Shaanxi Province. Int J Gen Med 2022; 15:4949-4957. [PMID: 35592541 PMCID: PMC9113551 DOI: 10.2147/ijgm.s360582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 04/26/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Northwest China has a large area, low population density, and few health resources, which makes the utilization of health resources in this region difficult. The objective of this study was to assess utilization of health services and its association with travel time in Shaanxi Province. Patients and Methods Data were obtained from the fifth Household Health Service Survey of Shaanxi Province conducted in 2013. Binary logistic regression was used to assess the relationship between travel time and health service utilization, and negative binomial regression was conducted to assess the relationship between travel time and the frequency of health service utilization. Results A total of 42.6% of patients used health services, with a higher use rate among rural residents than among urban residents (47.0% and 27.4%, respectively). A total of 30.9% of patients traveled more than 15 min to the nearest medical facility (33.3% in rural areas and 22.6% in urban areas). A total of 12.4% of patients traveled more than 30 min to the nearest medical facility (15.1% in rural areas and 3.0% in urban areas). Urban residents living farthest from health care facilities (more than 30 min) had a 2.12-fold higher probability of health service utilization and expected to have a health service utilization rate 1.77 times greater than that of residents with a travel time of less than 5 min. Among the rural population, there was no significant correlation between travel time and health service utilization. Conclusion Urban patients living farthest from hospitals were more likely to use health services and used health services more frequently. This suggests that more attention should be given to urban patients who live far away from health service providers in Shaanxi Province.
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Affiliation(s)
- Ruhai Bai
- School of Public Affairs, Nanjing University of Science and Technology, Nanjing, People’s Republic of China
| | - Jianmin Gao
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Wanyue Dong
- School of Elderly Care Services and Management, Nanjing University of Chinese Medicine, Nanjing, People’s Republic of China
- Correspondence: Wanyue Dong, School of Elderly Care Services and Management, Nanjing University of Chinese Medicine, No. 138 Xianlin Road, Qixia District, Nanjing, 210023, People’s Republic of China, Tel +86 25 858 11301, Email
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Xu Y, Zhou Y, Pramono A, Liu Y, Jia C. A 25-Year Trend of Catastrophic Health Expenditure and Its Inequality in China: Evidence from Longitudinal Data. Risk Manag Healthc Policy 2022; 15:969-981. [PMID: 35592442 PMCID: PMC9112452 DOI: 10.2147/rmhp.s358641] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 05/04/2022] [Indexed: 01/26/2023] Open
Abstract
Purpose The Chinese government has carried out two major cycles of reform to improve the health system and reduce the disease burden on residents. This study aims to comprehensively track the trends in the occurrence of catastrophic health expenditure (CHE) and its inequality in the past 25 years, which may help better understand the influence of health system reforms on CHE and its inequality. Methods The study employed the subset of data from China Health and Nutrition Survey conducted from 1991 to 2015. Health payments and net household income were used to calculate CHE. Concentration index and decomposition analysis were used to measure the magnitude of income-related inequality in CHE and decompose it into determinants, respectively. Results The incidence of CHE in China increased from 3.10% in 1993 to 8.90% in 2004 and still maintained at a high level in the following years. The incidence gap of CHE between the richest and poorest became increasingly wider over year. Moreover, the values of adjusted concentration indexes were all negative in each year, decreasing from −0.202 in 1991 to −0.613 in 2015. Income was consistently the largest contributor to the inequality in CHE. The basic medical insurance did not decrease the incidence of CHE and showed the second largest contribution on its inequality before 2004. However, this contribution began to decline after 2006. Conclusion After the New Health Care Reform, despite many measures taken by the Chinese government, there was still a high incidence of CHE and an increasing inequality from 1991 to 2015. The basic medical insurance in China was not enough to protect households from CHE. The use of big data tools and techniques to effectively screen the poor households, and strengthening the social medical aid system would be helpful to decrease the inequality in CHE.
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Affiliation(s)
- Yongjian Xu
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, People’s Republic of China
- Correspondence: Yongjian Xu, School of Public Policy and Administration, Xi’an Jiaotong University, No. 28 Xianning West Road, Xi’an, 710049, People’s Republic of China, Tel +8618202985437, Email
| | - Yiting Zhou
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Andi Pramono
- Community and Aged Care Services, Hunter New EnglAnd Health, NSW, Australia
| | - Yazhuo Liu
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, People’s Republic of China
| | - Cong Jia
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, People’s Republic of China
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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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11
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Fu XZ. The comparison of catastrophic health expenditure and its inequality between urban and rural households in China. HEALTH ECONOMICS REVIEW 2022; 12:19. [PMID: 35266107 PMCID: PMC8908628 DOI: 10.1186/s13561-022-00365-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 02/25/2022] [Indexed: 05/09/2023]
Abstract
BACKGROUND In recent years, the goal of universal coverage of the basic medical insurance schemes has been basically achieved in China, but the heavy economic burden of diseases is still the main cause of poverty in many households. Exploring catastrophic health expenditure (CHE) and its inequality are highly important for forward-looking policymaking. This study aims to compare the incidence, intensity and inequality of CHE between urban and rural households in China. METHODS This study was based on a national representative household survey-the China Family Panel Studies (CFPS)-that was conducted from 2012 to 2018. Concentration index (CI) was employed to measure the inequality of CHE incidence and overshoot, while the decomposition method of the CI was used to estimate the main influencing factors affecting inequality of CHE incidence. RESULTS From 2012 to 2018, the CHE incidence of urban households increased from 11.01 to 11.88%, while the CHE incidence of rural households decreased from 18.42 to 18.31%. During the same period, the CI of CHE incidence for urban households decreased from - 0.1480 to - 0.1693, while that for rural households declined from - 0.1062 to - 0.1501. The major contribution to the pro-poor inequality in CHE incidence was associated with socioeconomic status, lagged CHE, receiving inpatient services, having elderly members, education of household head, and self-assessed health status of household head. CONCLUSIONS Rural households had higher risk of incurring CHE than urban households. The strong pro-poor inequality for CHE incidence and overshoot could be found in both two groups. The problem of poverty due to illness was more severe among low-income groups in rural areas than in urban areas. The relevant policy interventions should further focus on encouraging the development of supplementary medical insurance and increasing the reimbursement rate for hospitalization expenses in the medical assistance system.
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Affiliation(s)
- Xian-Zhi Fu
- School of Political Science and Public Administration, Wuhan University, Wuhan, 430072, Hubei, China.
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12
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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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13
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Kazungu J, Meyer CL, Sargsyan KG, Qaiser S, Chukwuma A. The burden of catastrophic and impoverishing health expenditure in Armenia: An analysis of Integrated Living Conditions Surveys, 2014-2018. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000494. [PMID: 36962546 PMCID: PMC10021688 DOI: 10.1371/journal.pgph.0000494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 09/05/2022] [Indexed: 11/06/2022]
Abstract
Armenia's health spending is characterized by low public spending and high out-of-pocket expenditure (OOP), which not only poses a financial barrier to accessing healthcare for Armenians but can also impoverish them. We analyzed Armenia's Integrated Living Conditions Surveys 2014-2018 data to assess the incidence and correlates of catastrophic health expenditure (CHE) and impoverishment. Households were considered to have incurred CHE if their annual OOP exceeded 40 percent of the per capita annual household non-food expenditure. We assessed impoverishment using the US$1.90 per person per-day international poverty line and the US$5.50 per person per-day upper-middle-income country poverty line. Logistic regression models were fitted to assess the correlates of CHE and impoverishment. We found that the incidence of CHE peaked in 2017 before declining in 2018. Impoverishment decreased until 2017 before rising in 2018. After adjusting for sociodemographic factors, households were more likely to incur CHE if the household head was older than 34 years, located in urban areas, had at least one disabled member, and had at least one member with hypertension. Households with at least one hypertensive member or who resided in urban areas were more likely to be impoverished due to OOP. Paid employment and high socioeconomic status were protective against both CHE and impoverishment from OOP. This detailed analysis offers a nuanced insight into the trends in Armenia's financial risk protection against catastrophic and impoverishing health expenditures, and the groups predominantly affected. The incidence of CHE and impoverishment in Armenia remains high with a higher incidence among vulnerable groups, including those living with chronic disease, disability, and the unemployed. Armenia should consider different mechanisms such as subsidizing medication and hospitalization costs for the poorest to alleviate the burden of OOP.
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Affiliation(s)
- Jacob Kazungu
- Health Economics Research Unit, KEMRI Wellcome Trust Research Programme, Nairobi, Kenya
| | - Christina L Meyer
- RTI International Center for Global Noncommunicable Diseases, Seattle, WA, United States of America
| | - Kristine Gallagher Sargsyan
- Health, Nutrition, and Population Global Practice, World Bank Group, Washington, D.C., United States of America
| | - Seemi Qaiser
- Health, Nutrition, and Population Global Practice, World Bank Group, Washington, D.C., United States of America
| | - Adanna Chukwuma
- Health, Nutrition, and Population Global Practice, World Bank Group, Washington, D.C., United States of America
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Wang J, Tan X, Qi X, Zhang X, Liu H, Wang K, Jiang S, Xu Q, Meng N, Chen P, Li Y, Kang Z, Wu Q, Shan L, Amporfro DA, Ilia B. Minimizing the Risk of Catastrophic Health Expenditure in China: A Multi-Dimensional Analysis of Vulnerable Groups. Front Public Health 2021; 9:689809. [PMID: 34422747 PMCID: PMC8377675 DOI: 10.3389/fpubh.2021.689809] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/06/2021] [Indexed: 11/29/2022] Open
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.
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Affiliation(s)
- Jiahui Wang
- Centre of Health Policy and Management, Health Management College, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Health Management College, Harbin Medical University, Harbin, China
| | - Xiao Tan
- Shenzhen Hospital of Guangzhou University of Traditional Chinese Medicine (Futian), Shenzhen, China
| | - Xinye Qi
- Centre of Health Policy and Management, Health Management College, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Health Management College, Harbin Medical University, Harbin, China
| | - Xin Zhang
- Centre of Health Policy and Management, Health Management College, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Health Management College, Harbin Medical University, Harbin, China
| | - Huan Liu
- Centre of Health Policy and Management, Health Management College, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Health Management College, Harbin Medical University, Harbin, China
| | - Kexin Wang
- Centre of Health Policy and Management, Health Management College, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Health Management College, Harbin Medical University, Harbin, China
| | - Shengchao Jiang
- Centre of Health Policy and Management, Health Management College, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Health Management College, Harbin Medical University, Harbin, China
| | - Qiao Xu
- Centre of Health Policy and Management, Health Management College, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Health Management College, Harbin Medical University, Harbin, China
| | - Nan Meng
- Centre of Health Policy and Management, Health Management College, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Health Management College, Harbin Medical University, Harbin, China
| | - Peiwen Chen
- Centre of Health Policy and Management, Health Management College, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Health Management College, Harbin Medical University, Harbin, China
| | - Ye Li
- Centre of Health Policy and Management, Health Management College, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Health Management College, Harbin Medical University, Harbin, China
| | - Zheng Kang
- Centre of Health Policy and Management, Health Management College, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Health Management College, Harbin Medical University, Harbin, China
| | - Qunhong Wu
- Centre of Health Policy and Management, Health Management College, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Health Management College, Harbin Medical University, Harbin, China
| | - Linghan Shan
- Centre of Health Policy and Management, Health Management College, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Health Management College, Harbin Medical University, Harbin, China
| | - Daniel Adjei Amporfro
- Centre of Health Policy and Management, Health Management College, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Health Management College, Harbin Medical University, Harbin, China
| | - Bykov Ilia
- Centre of Health Policy and Management, Health Management College, Harbin Medical University, Harbin, China
- Department of Social Medicine, School of Public Health, Health Management College, Harbin Medical University, Harbin, China
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15
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Sun CY, Shi JF, Fu WQ, Zhang X, Liu GX, Chen WQ, He J. Catastrophic Health Expenditure and Its Determinants Among Households With Breast Cancer Patients in China: A Multicentre, Cross-Sectional Survey. Front Public Health 2021; 9:704700. [PMID: 34291034 PMCID: PMC8287064 DOI: 10.3389/fpubh.2021.704700] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 06/08/2021] [Indexed: 12/29/2022] Open
Abstract
Background: Although numerous studies have examined catastrophic health expenditures (CHE) worldwide, most focus on the general population, not on specific vulnerable groups. We aimed to analyse the extent and the influencing factors of CHE in households with breast cancer patients in China, and explore the ability of different insurances to protect these households from CHE. Methods: A multicentre, cross-sectional interview surveys was conducted in households with breast cancer patients across seven provinces/municipalities in China. CHE were defined as out-of-pocket expenditures ≥ 40% of households' non-food expenditures. Chi-square tests and logistic regression analysis were performed to identify the determinants of CHE in household with breast cancer patients. Results: In the 639 participating households with breast cancer patients, the mean out-of-pocket (OOP) expenditure accounted for ~55.20% of the mean households' non-food expenditures. The overall incidence of CHE was 87.95 and 66.28% before and after insurance compensation, respectively. The logistic regression model revealed that education, disease course, health insurance, treatment method, and income were significant predictors of CHE. Conclusions: The results indicated that medical insurance protects some households with breast cancer patients from the impact of CHE. However, their reimbursement rates were relatively low. Therefore, breast cancer still had a significant catastrophic effect on the economy of households. Policy efforts should focus on improving insurance compensation rates and relieving the economic burden of critical illnesses such as breast cancer.
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Affiliation(s)
- Cheng-Yao Sun
- Department of Health Economics, College of Health Management of Harbin Medical University, Harbin, China
| | - Ju-Fang Shi
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wen-Qi Fu
- Department of Health Economics, College of Health Management of Harbin Medical University, Harbin, China
| | - Xin Zhang
- Department of Health Economics, College of Health Management of Harbin Medical University, Harbin, China
| | - Guo-Xiang Liu
- Department of Health Economics, College of Health Management of Harbin Medical University, Harbin, China
| | - Wan-Qing Chen
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jie He
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Yuan Q, Wu Y, Li F, Yang M, Chen D, Zou K. Economic status and catastrophic health expenditures in China in the last decade of health reform: a systematic review and meta-analysis. BMC Health Serv Res 2021; 21:600. [PMID: 34167527 PMCID: PMC8229446 DOI: 10.1186/s12913-021-06408-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 04/16/2021] [Indexed: 02/08/2023] Open
Abstract
Background In order to solve the problem of “expensive medical treatment and difficult medical treatment” for patients and improve the equity of medical services, China started the health-care reform in 2009, and proposed ambitious goals of providing fair and high-quality basic medical and health services to all citizens and reducing economic burden of diseases. This study was to systematically explore the association between population economic status and incidence of catastrophic health expenditures (CHE) in mainland China in the last decade since 2009 health reform. Methods This systematic review was reported according to the standard of preferred reporting items for systematic reviews and meta-analyses (PRISMA). We systematically searched Chinese Electronic literature Database of China Journal Full Text Database, Chinese Biomedical Journal Database, Wan fang Data Resource System, VIP Database, and English literature databases of PubMed, SCI, EMbase and Cochrane Library from January 2000 to June 2020, and references of included studies. Two reviewers independently selected all reports from 2000 to 2020 for empirical studies of CHE in mainland China, extracted data and evaluated the quality of the study. We conducted meta-analysis of the incidence of CHE and subgroup analysis according to the time of the study and the economic characteristics of residents. Results Four thousand eight hundred seventy-four records were retrieved and eventually 47 studies with 151,911 participants were included. The quality scores of most of studies were beyond 4 points (91.49%). The pooled incidence of CHE of Chinese residents in the last two decades was 23.3% (95% CI: 21.1 to 25.6%). The CHE incidence increased from 2000 to 2017, then decreased over time from 2017 to 2020. From 2000 to 2020, the CHE incidence in rural areas was 25.0% (95% CI: 20.9 to 29.1%) compared to urban 20.9% (95% CI: 18.3 to 23.4%); the CHE incidence in eastern, central and western China was 25.0% (95% CI: 19.2 to 30.8%), 25.4% (95% CI: 18.4 to 32.3%), and 23.1% (95% CI: 17.9 to 28.2%), respectively; the CHE incidence was 30.9% (95% CI: 22.4 to 39.5%), 20.3% (95% CI: 17.0 to 23.6%), 19.9% (95% CI: 15.6 to 24.1%), and 23.7% (95% CI: 18.0 to 29.3%) in poverty group, low-income group, middle-income group, and high-income group, respectively. Conclusions In the past two decade, the incidence of CHE in rural areas is higher than that of urban residents; higher in central areas than in eastern, western and other regions; in poverty households than in low-income, middle-income and high-income regions. Further measures should be taken to reduce the incidence of CHE in susceptible people. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06408-1.
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Affiliation(s)
- Qingqing Yuan
- Department of Health Policy and Management, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yuxuan Wu
- West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Furong Li
- Department of Health Policy and Management, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Min Yang
- Department of Health Policy and Management, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China.,West China Research Centre for Rural Health Development, West China School of Public Health, Sichuan University, Chengdu, Sichuan, China
| | - Dandi Chen
- Department of Health Policy and Management, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Kun Zou
- Department of Health Policy and Management, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China. .,West China Research Centre for Rural Health Development, West China School of Public Health, Sichuan University, Chengdu, Sichuan, China.
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17
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Fu XZ. Financial protection effects of private health insurance: experimental evidence from Chinese households with resident basic medical insurance. Int J Equity Health 2021; 20:122. [PMID: 34001149 PMCID: PMC8130397 DOI: 10.1186/s12939-021-01468-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 05/04/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND After achieving universal basic medical insurance coverage, Chinese government put the development of private health insurance (PHI) on its agenda to further strengthen financial risk protection. This paper aims to assess the level of financial protection that PHI provides for its insured households on the basis of resident basic medical insurance (RBMI). METHODS We employed balanced panel data collected between 2015 and 2017 from the China Household Finance Survey (CHFS). Catastrophic health expenditure (CHE) and impoverishment due to health spending were applied to measure the financial protection effects. Random effects panel logistic regression model was performed to identify the factors associated with CHE and impoverishment among households covered by RBMI. In the robustness test, the method of propensity score matching (PSM) was employed to solve the problem of endogeneity. RESULTS From 2015 to 2017, the CHE incidence increased from 12.96 to 14.68 % for all sampled households, while the impoverishment rate decreased slightly from 5.43 to 5.32 % for all sampled households. In 2015, the CHE incidence and impoverishment rate under RBMI + PHI were 4.53 and 0.72 %, respectively, which were lower than those under RBMI alone. A similar phenomenon was observed in 2017. Regression analysis also showed that the households with RBMI + PHI were significantly less likely to experience CHE (marginal effect: -0.054, 95 %CI: -0.075 to -0.034) and impoverishment (marginal effect: -0.049, 95 %CI: -0.069 to -0.028) compared to those with RBMI alone. The results were still robust after using PSM method to eliminate the effects of self-selection on the estimation results. CONCLUSIONS In the context of universal basic medical insurance coverage, the CHE incidence and impoverishment rate of Chinese households with RBMI were still considerably high in 2015 and 2017. PHI played a positive role in decreasing household financial risk on the basis of RBMI.
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Affiliation(s)
- Xian-Zhi Fu
- School of Political Science and Public Administration, Wuhan University, Wuhan, Hubei, 430072, China.
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18
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Fu XZ, Sun QW, Sun CQ, Xu F, He JJ. Urban-rural differences in catastrophic health expenditure among households with chronic non-communicable disease patients: evidence from China family panel studies. BMC Public Health 2021; 21:874. [PMID: 33957893 PMCID: PMC8101026 DOI: 10.1186/s12889-021-10887-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 04/22/2021] [Indexed: 11/23/2022] Open
Abstract
Background The prevalence of chronic non-communicable diseases (NCDs) challenges the Chinese health system reform. Little is known for the differences in catastrophic health expenditure (CHE) between urban and rural households with NCD patients. This study aims to measure the differences above and quantify the contribution of each variable in explaining the urban-rural differences. Methods Unbalanced panel data were obtained from the China Family Panel Studies (CFPS) conducted between 2012 and 2018. The techniques of Fairlie nonlinear decomposition and Blinder-Oaxaca decomposition were employed to measure the contribution of each independent variable to the urban-rural differences. Results The CHE incidence and intensity of households with NCD patients were significantly higher in rural areas than in urban areas. The urban-rural differences in CHE incidence increased from 8.07% in 2012 to 8.18% in 2018, while the urban-rural differences in CHE intensity decreased from 2.15% in 2012 to 2.05% in 2018. From 2012 to 2018, the disparity explained by household income and self-assessed health status of household head increased to some extent. During the same period, the contribution of education attainment to the urban-rural differences in CHE incidence decreased, while the contribution of education attainment to the urban-rural differences in CHE intensity increased slightly. Conclusions Compared with urban households with NCD patients, rural households with NCD patients had higher risk of incurring CHE and heavier economic burden of diseases. There was no substantial change in urban-rural inequality in the incidence and intensity of CHE in 2018 compared to 2012. Policy interventions should give priority to improving the household income, education attainment and health awareness of rural patients with NCDs. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10887-6.
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Affiliation(s)
- Xian-Zhi Fu
- School of Political Science and Public Administration, Wuhan University, Wuhan, 430072, Hubei, China
| | - Qi-Wei Sun
- School of International Education, Wuhan University, Wuhan, 430072, Hubei, China.
| | - Chang-Qing Sun
- Department of Social Medicine and Health Management, College of Public Health, Zhengzhou University, Zhengzhou, 450001, Henan, China
| | - Fei Xu
- Department of Social Medicine and Health Management, College of Public Health, Zhengzhou University, Zhengzhou, 450001, Henan, China
| | - Jun-Jian He
- Department of Social Medicine and Health Management, College of Public Health, Zhengzhou University, Zhengzhou, 450001, Henan, China
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Zhou Y, Wushouer H, Vuillermin D, Guan X, Shi L. Does the universal medical insurance system reduce catastrophic health expenditure among middle-aged and elderly households in China? A longitudinal analysis. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2021; 22:463-471. [PMID: 33582893 DOI: 10.1007/s10198-021-01267-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 01/13/2021] [Indexed: 05/11/2023]
Abstract
BACKGROUND The Chinese government has made great progress in establishing the universal medical insurance system. This study aimed to analyze whether the universal medical insurance system protected middle-aged and elderly households from catastrophic health expenditure (CHE). METHODS The data were obtained from the China Health and Retirement Longitudinal Study. We used household as our unit of analysis and CHE was measured as out-of-pocket expenditures ≥ 40% of nonfood household expenditures. Univariate analysis was deployed to examine the impacts of different medical insurance schemes on CHE, and the factors associated with CHE were estimated using a random-effects logit regression model. RESULTS We identified 10,005, 10,370, and 11,567 households in 2011, 2013, and 2015, respectively, and found 12.9% (2011), 26.6% (2013) and 27.9% (2015) of the households experienced CHE. When compared with no insurance, households enrolled in New Rural Cooperative Medical Insurance Scheme (P = 0.023) were associated with a lower incidence of CHE, but other insurance schemes were not significant. Households with members older than 65 years (P < 0.001), members with chronic diseases (P < 0.001), members with poor self-reported health conditions (P < 0.001), and members receiving health care (P < 0.001) had a higher risk of CHE. Large household size (P < 0.001) and high household income per capita (P < 0.001) were major protective factors to CHE incidence. CONCLUSIONS Despite China's great stride in the medical insurance coverage, it fell short to provide financial protection against medical expenditure burden. To reduce the risk of CHE, an integrated poverty and elderly-oriented medical insurance system could be put in place to address these problems.
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Affiliation(s)
- Yue Zhou
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
| | - Haishaerjiang Wushouer
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
- International Research Center for Medicinal Administration, Peking University, Beijing, China
| | | | - Xiaodong Guan
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China.
- International Research Center for Medicinal Administration, Peking University, Beijing, China.
| | - Luwen Shi
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China
- International Research Center for Medicinal Administration, Peking University, Beijing, China
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Barasa E, Kazungu J, Nguhiu P, Ravishankar N. Examining the level and inequality in health insurance coverage in 36 sub-Saharan African countries. BMJ Glob Health 2021; 6:e004712. [PMID: 33903176 PMCID: PMC8076950 DOI: 10.1136/bmjgh-2020-004712] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 04/07/2021] [Accepted: 04/08/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Low/middle-income countries (LMICs) in sub-Saharan Africa (SSA) are increasingly turning to public contributory health insurance as a mechanism for removing financial barriers to access and extending financial risk protection to the population. Against this backdrop, we assessed the level and inequality of population coverage of existing health insurance schemes in 36 SSA countries. METHODS Using secondary data from the most recent Demographic and Health Surveys, we computed mean population coverage for any type of health insurance, and for specific forms of health insurance schemes, by country. We developed concentration curves, computed concentration indices, and rich-poor differences and ratios to examine inequality in health insurance coverage. We decomposed the concentration index using a generalised linear model to examine the contribution of household and individual-level factors to the inequality in health insurance coverage. RESULTS Only four countries had coverage levels with any type of health insurance of above 20% (Rwanda-78.7% (95% CI 77.5% to 79.9%), Ghana-58.2% (95% CI 56.2% to 60.1%), Gabon-40.8% (95% CI 38.2% to 43.5%), and Burundi 22.0% (95% CI 20.7% to 23.2%)). Overall, health insurance coverage was low (7.9% (95% CI 7.8% to 7.9%)) and pro-rich; concentration index=0.4 (95% CI 0.3 to 0.4, p<0.001). Exposure to media made the greatest contribution to the pro-rich distribution of health insurance coverage (50.3%), followed by socioeconomic status (44.3%) and the level of education (41.6%). CONCLUSION Coverage of health insurance in SSA is low and pro-rich. The four countries that had health insurance coverage levels greater than 20% were all characterised by substantial funding from tax revenues. The other study countries featured predominantly voluntary mechanisms. In a context of high informality of labour markets, SSA and other LMICs should rethink the role of voluntary contributory health insurance and instead embrace tax funding as a sustainable and feasible mechanism for mobilising resources for the health sector.
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Affiliation(s)
- Edwine Barasa
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Center for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Jacob Kazungu
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Peter Nguhiu
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Nirmala Ravishankar
- Stratetic purchasing for PHC, Thinkwell, Washington, District of Columbia, USA
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21
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Liu S, Coyte PC, Fu M, Zhang Q. Measurement and determinants of catastrophic health expenditure among elderly households in China using longitudinal data from the CHARLS. Int J Equity Health 2021; 20:62. [PMID: 33608014 PMCID: PMC7893946 DOI: 10.1186/s12939-020-01336-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 11/26/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Catastrophic health expenditure (CHE) among the Chinese elderly warrants attention. However, the incidence, intensity and determinants of CHE have not been fully investigated. This study explores the incidence, intensity and determinants of CHE among elderly Chinese citizens, i.e., those aged 60 years or older. METHODS Data were obtained from three waves of the China Health and Retirement Longitudinal Study (CHARLS): 2011, 2013 and 2015. The cut-off points used in this study for CHE were 10% of the total expenditures and 40% of non-food expenditure. Under the guidance of Andersen's model of health services utilization, this study used logistic regression analysis to explore the determinants of CHE. RESULTS The incidence of CHE defined as more than 40% of non-food expenditure rose over the study period, 2011-2015, from 20.86% (95% CI: 19.35 to 22.37%) to 31.00% (95% CI: 29.28 to 32.72%). The intensity of CHE also increased. The overshoot (O) based on non-food expenditure rose from 3.12% (95% CI: 2.71 to 3.53%) to 8.75% (95% CI: 8.14 to 9.36%), while the mean positive overshoot (MPO) rose from 14.96% (95% CI: 12.99 to 16.92%) to 28.23% (95% CI: 26.26 to 30.19%). Thus, the problem of CEH was even more serious in 2015 than in 2011. Logistic regression revealed that households were more likely to face CHE if they had a spouse as a household member, reported an inpatient event in the last year, reported an outpatient visit in the last month, were disabled, were members of a poor expenditure quartile, lived in the middle and western zones or resided in an urban area. In contrast, CEH was not significantly affected by respondents being older than 75 years or having a chronic health condition, by household size or by insurance type. CONCLUSIONS Key policy recommendations include the gradual improvement of medical assistance and the expansion of the use of health insurance to reduce household liability for health expenditures.
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Affiliation(s)
- Shiai Liu
- Center for Social Security Studies of Wuhan University, Wuhan, Hubei, China
| | - Peter C Coyte
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Mingqi Fu
- Center for Social Security Studies of Wuhan University, Wuhan, Hubei, China
| | - Qilin Zhang
- Center for Social Security Studies of Wuhan University, Wuhan, Hubei, China.
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22
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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] [Grants] [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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An J, Kim S. Medical cost trends under national health insurance benefit extension in Republic of Korea. Int J Health Plann Manage 2020; 35:1351-1370. [PMID: 32754947 DOI: 10.1002/hpm.3018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 04/13/2020] [Accepted: 06/05/2020] [Indexed: 11/10/2022] Open
Abstract
This study examines whether the burden of medical expenses on households has gradually decreased since South Korea began implementing benefit expansion policies to strengthen health insurance coverage. Using Korea's Household Income & Expenditure Survey from 1995 to 2014, the annual average monthly household expenditures and the catastrophic health expenditure (CHE) indicator were analyzed. The latter is an indicator of household impoverishment resulting from out-of-pocket healthcare expenditures exceeding a defined threshold proportion of the household's income. Through descriptive and frequency data analyses and using P-values, the annual trends and differences in absolute values and share of CHE prevalence across households were measured. The study finds that the proportion of income spent on medical expenses increased from 2.47% (1995) to 4.94% (2014) on average. CHE also increased 3.6 times, 6.3 times, 9.8 times, and 11.1 times for assumed threshold sizes of 10%, 20%, 30%, and 40%, respectively. The lowest income group had the highest increase in CHE incidence. These results suggest that the benefit extension policy has lowered medical use thresholds and led to an increase in medical resource use. Therefore, the Ministries of Health and Welfare, and of Economy and Finance should collaborate to design policies for vulnerable groups.
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Affiliation(s)
- Jinha An
- Department of Public Health, Graduate School, The Catholic University of Korea, Republic of Korea
| | - Sukil Kim
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Bado AR, Susuman AS. Determinants of under-5 mortality in Burkina Faso. J Public Health (Oxf) 2020; 41:550-560. [PMID: 30272205 DOI: 10.1093/pubmed/fdy168] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 08/22/2018] [Accepted: 09/05/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The aim of this article is to determine the factors associated with under-5 mortality and their evolution from 1993 to 2010 and to analyse the contributors of socioeconomic inequalities in mortality of children under-5 years during the same period. DATA AND METHODS The data used in this study were derived from the four rounds of Demographic and Health Survey (DHS) conducted in Burkina Faso in 1993, 1998 and 2010. Concentration measurement, logistics regression and Oaxaca-Blinder decomposition method were used to analyse data. RESULTS Multivariate analysis revealed that being the first child (odds ratio = 1.8 for 1993, 1.7 for 1998, 1.2 for 2003 and 1.3 for 2010) or a twin (odds ratio = 4.5 for 1993, 2.8 for 1998, 2.7 for 2003 and 4.8 for 2010) were also significantly associated with the probability of dying. The variable (parity) was the main contributor to the part of the inequality due to differences in group characteristics and that would be due to the fact that women from poor households have greater parity compared to those from rich households. CONCLUSION For a reduction in mortality and inequalities related to mortality, the implementation of actions in favour of poor households and promotion of family planning programmes for birth spacing will be required.
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Affiliation(s)
- Aristide Romaric Bado
- Institut de Recherche en Science de la Santé, Centre National de la Recherche Scientifique et Technologique (CNRST), Ouagadougou, Burkina Faso.,School of Public Health, University of Montreal, Montreal, Canada
| | - A Sathiya Susuman
- Department of Statistics & Population Studies, University of the Western Cape, Cape Town, South Africa
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25
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Hernández-Vásquez A, Rojas-Roque C, Vargas-Fernández R, Rosselli D. Measuring Out-of-pocket Payment, Catastrophic Health Expenditure and the Related Socioeconomic Inequality in Peru: A Comparison Between 2008 and 2017. J Prev Med Public Health 2020; 53:266-274. [PMID: 32752596 PMCID: PMC7411247 DOI: 10.3961/jpmph.20.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 05/20/2020] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES Describe out-of-pocket payment (OOP) and the proportion of Peruvian households with catastrophic health expenditure (CHE) and evaluate changes in socioeconomic inequalities in CHE between 2008 and 2017. METHODS We used data from the 2008 and 2017 National Household Surveys on Living and Poverty Conditions (ENAHO in Spanish), which are based on probabilistic stratified, multistage and independent sampling of areas. OOP was converted into constant dollars of 2017. A household with CHE was assumed when the proportion between OOP and payment capacity was ≥0.40. OOP was described by median and interquartile range while CHE was described by weighted proportions and 95% confidence intervals (CIs). To estimate the socioeconomic inequality in CHE we computed the Erreygers concentration index. RESULTS The median OOP reduced from 205.8 US dollars to 158.7 US dollars between 2008 and 2017. The proportion of CHE decreased from 4.9% (95% CI, 4.5 to 5.2) in 2008 to 3.7% (95% CI, 3.4 to 4.0) in 2017. Comparison of socioeconomic inequality of CHE showed no differences between 2008 and 2017, except for rural households in which CHE was less concentrated in richer households (p<0.05) and in households located on the rest of the coast, showing an increase in the concentration of CHE in richer households (p<0.05). CONCLUSIONS Although OOP and CHE reduced between 2008 and 2017, there is still socioeconomic inequality in the burden of CHE across different subpopulations. To reverse this situation, access to health resources and health services should be promoted and guaranteed to all populations.
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Affiliation(s)
- Akram Hernández-Vásquez
- Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Centro de Excelencia en Investigaciones Económicas y Sociales en Salud, Lima, Peru
| | | | | | - Diego Rosselli
- Clinical Epidemiology and Biostatistics Department, Pontificia Universidad Javeriana, Medical School, Bogota, Colombia
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Jiang K, Liang L, Wang H, Li J, Li Y, Jiao M, Mao J, Wu Q. Sociodemographic determinants of maternal health service use in rural China: a cross-sectional study. Health Qual Life Outcomes 2020; 18:201. [PMID: 32580744 PMCID: PMC7313189 DOI: 10.1186/s12955-020-01453-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 06/16/2020] [Indexed: 11/15/2022] Open
Abstract
Objective This study examined the relationship between sociodemographic characteristics and maternal health use from a policy perspective. It aimed to provide an overview of maternal health in Heilongjiang’s rural provinces and its implications on rural areas in countries with low and middle income gross domestic products. Design, setting, and participants This cross-sectional study used data from the Fifth Health Service Survey of Heilongjiang Province. Participants included 481 mothers who delivered a baby after August 15, 2008. Trained investigators collected data on their family and sociodemographic characteristics, antenatal care, delivery at specialised obstetric institutions (e.g. hospitals, clinics, other medical institutions), and postnatal care services. Results The number of women with more than five antenatal care visits and the delivery rate at specialised obstetric institutions were high. Approximately 50% of the participants had three or more postnatal care visits. Maternal healthcare use among women less than 20 years old and those with natural deliveries were higher. There were fewer antenatal care visits among women who had been pregnant once or twice before. Conclusions Delivery rates at specialised obstetric institutions and the number of antenatal care visits were higher than the World Health Organization requirements, while the frequency of postnatal care visits were better than most countries. This study identified several demographic characteristics that influenced maternal health service use. Policymakers should consider these findings when developing maternal health policies that protect women’s interests and expand free services. Additional resources should be given to increase the postnatal care capacity and quality of maternal healthcare.
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Affiliation(s)
- Kexin Jiang
- Medical department, General Hospital of Heilongjiang Agricultural Reclamation, Harbin, 150088, China.,Department of Policy and Hospital Management, School of Public Health, Harbin Medical University, Harbin, 150081, China
| | - Libo Liang
- Department of Policy and Hospital Management, School of Public Health, Harbin Medical University, Harbin, 150081, China
| | - Haifeng Wang
- Department of ENT, Linkou County Maternal and Child Health Hospital, Mudanjiang, 150081, China
| | - Jingqun Li
- Department of Cardiology, Heihe First People's Hospital Heihe, Heihe, 157600, China
| | - Yuze Li
- Harbin NO.6 Senior High School, Harbin, 150000, China
| | - Mingli Jiao
- Department of Policy and Hospital Management, School of Public Health, Harbin Medical University, Harbin, 150081, China. .,Department of Policy and Hospital Management, School of Health Management, Harbin Medical University, Harbin, 150081, China.
| | - Jingfu Mao
- Department of Medical Human Resource, School of Public Health, Harbin Medical University, Harbin, 150081, China.
| | - Qunhong Wu
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, 150086, China.
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27
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Jiang K, Liang L, Wang H, Li J, Li Y, Jiao M, Mao J, Wu Q. Sociodemographic determinants of maternal health service use in rural China: a cross-sectional study. Health Qual Life Outcomes 2020. [PMID: 32580744 DOI: 10.1186/s12955-020-01453-6.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE This study examined the relationship between sociodemographic characteristics and maternal health use from a policy perspective. It aimed to provide an overview of maternal health in Heilongjiang's rural provinces and its implications on rural areas in countries with low and middle income gross domestic products. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used data from the Fifth Health Service Survey of Heilongjiang Province. Participants included 481 mothers who delivered a baby after August 15, 2008. Trained investigators collected data on their family and sociodemographic characteristics, antenatal care, delivery at specialised obstetric institutions (e.g. hospitals, clinics, other medical institutions), and postnatal care services. RESULTS The number of women with more than five antenatal care visits and the delivery rate at specialised obstetric institutions were high. Approximately 50% of the participants had three or more postnatal care visits. Maternal healthcare use among women less than 20 years old and those with natural deliveries were higher. There were fewer antenatal care visits among women who had been pregnant once or twice before. CONCLUSIONS Delivery rates at specialised obstetric institutions and the number of antenatal care visits were higher than the World Health Organization requirements, while the frequency of postnatal care visits were better than most countries. This study identified several demographic characteristics that influenced maternal health service use. Policymakers should consider these findings when developing maternal health policies that protect women's interests and expand free services. Additional resources should be given to increase the postnatal care capacity and quality of maternal healthcare.
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Affiliation(s)
- Kexin Jiang
- Medical department, General Hospital of Heilongjiang Agricultural Reclamation, Harbin, 150088, China.,Department of Policy and Hospital Management, School of Public Health, Harbin Medical University, Harbin, 150081, China
| | - Libo Liang
- Department of Policy and Hospital Management, School of Public Health, Harbin Medical University, Harbin, 150081, China
| | - Haifeng Wang
- Department of ENT, Linkou County Maternal and Child Health Hospital, Mudanjiang, 150081, China
| | - Jingqun Li
- Department of Cardiology, Heihe First People's Hospital Heihe, Heihe, 157600, China
| | - Yuze Li
- Harbin NO.6 Senior High School, Harbin, 150000, China
| | - Mingli Jiao
- Department of Policy and Hospital Management, School of Public Health, Harbin Medical University, Harbin, 150081, China. .,Department of Policy and Hospital Management, School of Health Management, Harbin Medical University, Harbin, 150081, China.
| | - Jingfu Mao
- Department of Medical Human Resource, School of Public Health, Harbin Medical University, Harbin, 150081, China.
| | - Qunhong Wu
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, 150086, China.
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Vahedi S, Rezapour A, Khiavi FF, Esmaeilzadeh F, Javan-Noughabi J, Almasiankia A, Ghanbari A. Decomposition of Socioeconomic Inequality in Catastrophic Health Expenditure: An Evidence from Iran. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2020. [DOI: 10.1016/j.cegh.2019.10.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Catastrophic health expenditure: A comparative analysis of smoking and non-smoking households in China. PLoS One 2020; 15:e0233749. [PMID: 32469973 PMCID: PMC7259713 DOI: 10.1371/journal.pone.0233749] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 05/11/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction Smoking is hazardous to health and places a heavy economic burden on individuals and their families. Clearly, smoking in China is prevalent since China is the largest consumer of tobacco in the world. Chinese smoking and nonsmoking households were compared in terms of the incidence and intensity of Catastrophic Health Expenditures (CHEs). The factors associated with catastrophic health expenditures were analyzed. Methods Data for this study were collected from two waves of panel data in 2011 and 2013 from the national China Health and Retirement Longitudinal Study (CHARLS). A total of 8073 households with at least one member aged above 45 were identified each year. Catastrophic health expenditure was measured by the ratio of a household’s out-of-pocket healthcare payments (OOP) to the household’s Capacity to Pay (CTP). A panel logit random-effects model was used to examine correlates with catastrophic health expenditure. Results The incidence of catastrophic health expenditures for Chinese households with members aged 45 and above in 2011 and 2013 were 12.99% and 15.56%, respectively. The mean gaps (MGs) were 3.16% and 4.88%, respectively, and the mean positive gaps (MPGs) were 24.36% and 31.40%, respectively. The incidences of catastrophic health expenditures were 17.41% and 20.03% in former smoking households, 12.10% and 15.09% in current smoking households, and 12.72% and 13.64% in nonsmoking households. In the panel logit regression model analysis, former smoking households (OR = 1.444, P<0.001) were more prone to catastrophic health expenditures than nonsmoking households. Risk factors for catastrophic health expenditures included members with chronic diseases (OR = 4.359, P<0.001), hospitalized patients (OR = 8.60, P<0.001), elderly people aged above 65 (OR = 1.577, P<0.001), or persons with disabilities (OR = 1.275, P<0.001). Protective factors for catastrophic health expenditures included being in an urban household, having a larger family size, and having a higher household income. Conclusions The incidence of catastrophic health expenditures in Chinese households is relatively high. Smoking is one of the primary risk factors for catastrophic health expenditures. Stronger interventions against smoking should be made in time to reduce the occurrence of health issues caused by smoking and the financial losses for individuals, families and society.
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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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Wang J, Zhu H, Liu H, Wu K, Zhang X, Zhao M, Yin H, Qi X, Hao Y, Li Y, Liang L, Jiao M, Xu J, Liu B, Wu Q, Shan L. Can the reform of integrating health insurance reduce inequity in catastrophic health expenditure? Evidence from China. Int J Equity Health 2020; 19:49. [PMID: 32245473 PMCID: PMC7126184 DOI: 10.1186/s12939-020-1145-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 02/13/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND China's fragmentation of social health insurance schemes has become a key obstacle that hampers equal access to health care and financial protection. This study aims to explores if the policy intervention Urban and Rural Residents Basic Medical Insurance (URRBMI) scheme, which integrates Urban Resident Basic Medical Insurance (URBMI) and New Rural Cooperative Medical Scheme (NCMS), can curb the persistent inequity of catastrophic health expenditure (CHE) and further analyses the determinants causing inequity. METHODS Data were derived from the Fifth National Health Service Survey (NHSS). A total of 11,104 households covered by URRBMI and 20,590 households covered by URBMI or NCMS were selected to analyze CHE and the impoverishment rate from medical expenses. Moreover, the decomposition method based on a probit model was employed to analyse factors contributing CHE inequity. RESULTS The overall incidence of CHE under integrated insurance scheme was 15.53%, about 1.10% higher than the non-integrated scheme; however, the intensity of CHE and impoverishment among the poorest was improved. Although CHE was still concentrated among the poor under URRBMI (CI = -0.53), it showed 28.38% lower in the degree of inequity. For URRBMI households, due to the promotion of integration reform to the utilization of rural residents' better health services, the factor of residence (24.41%) turns out to be a major factor in increasing inequity, the factor of households with hospitalized members (- 84.53%) played a positive role in reducing inequity and factors related to social economic status also contributed significantly in increasing inequity. CONCLUSION The progress made in the integrated URRBMI on CHE equity deserves recognition, even though it did not reduce the overall CHE or the impoverishment rate effectively. Therefore, for enhanced equity, more targeted solutions should be considered, such as promoting more precise insurance intervention for the most vulnerable population and including costly diseases suitable for outpatient treatment into benefit packages. Additionally, comprehensive strategies such as favourable targeted benefit packages or job creation are required for the disadvantaged.
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Affiliation(s)
- Jiahui Wang
- Department of Social Medicine, Health Management College, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang Province, China
| | - Hong Zhu
- Department of Social Medicine, Health Management College, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang Province, China
| | - Huan Liu
- Department of Social Medicine, Health Management College, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang Province, China
| | - Ke Wu
- Tong Zhou District's Volunteer Services Guidance Center of Beijing Municipality, Beijing, China
| | - Xin Zhang
- Department of Social Medicine, Health Management College, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang Province, China
| | - Miaomiao Zhao
- Department of Health Management, School of Public Health, Nantong University, Nantong, Jiangsu Province, China
| | - Hang Yin
- Department of Social Medicine, Health Management College, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang Province, China
| | - Xinye Qi
- Department of Social Medicine, Health Management College, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang Province, China
| | - Yanhua Hao
- Department of Social Medicine, Health Management College, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang Province, China
| | - Ye Li
- Department of Social Medicine, Health Management College, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang Province, China
| | - Libo Liang
- Department of Social Medicine, Health Management College, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang Province, China
| | - Mingli Jiao
- Department of Social Medicine, Health Management College, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang Province, China
| | - Jiao Xu
- Department of Social Medicine, Health Management College, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang Province, China
| | - Baohua Liu
- Department of Social Medicine, Health Management College, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang Province, China
| | - Qunhong Wu
- Department of Social Medicine, Health Management College, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang Province, China.
| | - Linghan Shan
- Department of Social Medicine, Health Management College, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang Province, China.
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The Effects of Private Health Insurance on Universal Health Coverage Objectives in China: A Systematic Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020. [PMID: 32204527 DOI: 10.3390/ijerph17062049.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND We conducted a systematic review on the role of private health insurance to complement the social health insurance system towards achieving universal health coverage in China. This review presents the impacts of private health insurance on expanding coverage, increasing access to healthcare, and financial protection. METHODS A systematic review was conducted by searching peer-reviewed articles published between January 2000 and March 2018 in Web of Science, PubMed, and China Knowledge Resource Integrated Database. The search terms included coverage prevalence, access and financial protection related to private health insurance in China. A total of 31 studies were selected. RESULTS Coverage prevalence of private health insurance gradually increased but it was unequally distributed across regions and populations. The expansion of social health insurance has enhanced the total aggregate premium of private health insurance but has had a mixed impact on the take-up of private health insurance. Private insurance beneficiaries were found to limit their utilisation of healthcare services and there was no evidence that it ensured financial protection. CONCLUSION The role of private health insurance (PHI) in extending universal health coverage in China was limited and therefore should not be overstated.
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Wu R, Li N, Ercia A. The Effects of Private Health Insurance on Universal Health Coverage Objectives in China: A Systematic Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E2049. [PMID: 32204527 PMCID: PMC7142974 DOI: 10.3390/ijerph17062049] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 03/16/2020] [Accepted: 03/17/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND We conducted a systematic review on the role of private health insurance to complement the social health insurance system towards achieving universal health coverage in China. This review presents the impacts of private health insurance on expanding coverage, increasing access to healthcare, and financial protection. METHODS A systematic review was conducted by searching peer-reviewed articles published between January 2000 and March 2018 in Web of Science, PubMed, and China Knowledge Resource Integrated Database. The search terms included coverage prevalence, access and financial protection related to private health insurance in China. A total of 31 studies were selected. RESULTS Coverage prevalence of private health insurance gradually increased but it was unequally distributed across regions and populations. The expansion of social health insurance has enhanced the total aggregate premium of private health insurance but has had a mixed impact on the take-up of private health insurance. Private insurance beneficiaries were found to limit their utilisation of healthcare services and there was no evidence that it ensured financial protection. CONCLUSION The role of private health insurance (PHI) in extending universal health coverage in China was limited and therefore should not be overstated.
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Affiliation(s)
- Runguo Wu
- Institute of Population Health Sciences, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AB, UK
- Global Health Policy Unit, School of Social and Political Science, University of Edinburgh, Edinburgh EH8 9LD, UK
| | - Niying Li
- School of Pharmacy, University of Wisconsin-Madison, Madison, WI 53705, USA;
| | - Angelo Ercia
- Division of Informatics, Imaging & Data Sciences, School of Health Sciences, the University of Manchester, M13 9PL Manchester, UK;
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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: 23] [Impact Index Per Article: 5.8] [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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Qin Y, Guo Y, Tang Y, Wu C, Zhang X, He Q, He J. Concordance of chronic conditions among the household members in Shanghai: a cross-sectional study. BMJ Open 2019; 9:e031240. [PMID: 31871256 PMCID: PMC6937075 DOI: 10.1136/bmjopen-2019-031240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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 Members living in the same household tend to share some similar behaviours and environment. We want to quantitatively assess the associations of chronic conditions to investigate the concordance of disease status among the household members. SETTING Shanghai, China. PARTICIPANTS Our data were from the fifth Health Service Survey in Shanghai in 2013. 12 002 households with 31 531 residents were selected in this survey by using a three-stage, stratified, random sampling method. OUTCOME MEASURES Five highly prevalent chronic conditions, namely hypertension, diabetes, ischaemic heart disease (IHD), cerebrovascular disease (CVD) and obesity were chosen. The generalised estimating equations (GEE) model was used to estimate the associations adjusted for age, gender, education status, health insurance status, smoking and drinking. Using a subsample of adult children with parents' chronic conditions as the key risk factor and a subsample of wives with the chronic conditions of the husband as key risk factor, we reran our GEE models to explore chronic condition concordance within these relationships. RESULTS A total of 10 198 households with 27 010 adult participants were included. Using all adult household members, we found positive statistically significant associations between one's chronic conditions and the same disease status of their household members (hypertension (OR=3.26, 95% CI 3.02 to 3.52); diabetes (OR=1.68, 95% CI 1.40 to 2.01); IHD (OR=5.31, 95% CI 3.56 to 7.92); CVD (OR=3.40, 95% CI 1.99 to 5.80); obesity (OR=3.41, 95% CI 2.34 to 4.96)). The results of analysing ad-child subsample and spouse subsample also showed similar associations. Moreover, the potential concordance of different chronic conditions was found between hypertension and diabetes. CONCLUSIONS We found chronic condition concordance within households. This study provides evidence that the chronic conditions of other members of a household may be a significant risk factor for a household member's own health.
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Affiliation(s)
- Yingyi Qin
- Department of Health Statistics, Second Military Medical University, Shanghai, China
| | - Yibin Guo
- Department of Health Statistics, Second Military Medical University, Shanghai, China
| | - Yuanjun Tang
- Department of Clinical Pharmacy, Shanghai General Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Cheng Wu
- Department of Health Statistics, Second Military Medical University, Shanghai, China
| | - Xinji Zhang
- Department of Health Statistics, Second Military Medical University, Shanghai, China
| | - Qian He
- Department of Health Statistics, Second Military Medical University, Shanghai, China
| | - Jia He
- Department of Health Statistics, Second Military Medical University, Shanghai, China
- Tongji University School of Medicine, Shanghai, China
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Progress on Catastrophic Health Expenditure in China: Evidence from China Family Panel Studies (CFPS) 2010 to 2016. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16234775. [PMID: 31795178 PMCID: PMC6926556 DOI: 10.3390/ijerph16234775] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 11/22/2019] [Accepted: 11/26/2019] [Indexed: 12/18/2022]
Abstract
Background: To provide an updated estimate of the level and change in catastrophic health expenditure in China and examine the association between catastrophic health expenditure and family net income, we obtained data from four waves of the China Family Panel Studies conducted between 2010 and 2016. Method: We defined catastrophic health expenditure as out-of-pocket payments equaling or exceeding 40% of the household’s capacity to pay. The Poisson regression with robust variance and generalized estimated equation (Poisson-GEE) model was used to quantify the level and change of catastrophic health expenditure, as well as the association between catastrophic heath expenditure and family net income. Result: Overall, the incidence of catastrophic expenditure in China experienced a 0.70-fold change between 2010 (12.57%) and 2016 (8.94%). The incidence of catastrophic health expenditure (CHE) decreased more in the poorest income quintile than the richest income quintile (annual decrease of 1.17% vs. 0.24% in urban areas, p < 0.001; 1.64% vs. −0.02% in rural areas, p < 0.001). Every 100% increase in income was associated with a 14% relative-risk reduction in CHE (RR = 0.86, 95% CI: 0.85–0.88) after adjusting for demographics, health needs, and health utilization characteristics; this association was weaker in recent years. Conclusion: Our analysis found that China made progress to reduce catastrophic health expenditure, especially for poorer groups. Income growth is strongly associated with this change.
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Mehdizadeh P, Daniyali H, Meskarpour-Amiri M, Dopeykar N, Uzi H. Catastrophic and impoverishing health expenditures and it's affecting factors among health staffs in Iran: A case study in Tehran. Med J Islam Repub Iran 2019; 33:120. [PMID: 32002393 PMCID: PMC6983491 DOI: 10.34171/mjiri.33.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Indexed: 11/17/2022] Open
Abstract
Background: Despite a lot of studies carried out on catastrophic and impoverishing health expenditures, exposure to these expenditures have not been studied among health staffs and their families yet. So that our study has analyzed exposure to CHE (Catastrophic Health Expenditures) and factors affecting them among the health staffs affiliated to army medical universities in Tehran. Methods: This study was a descriptive-analytical and cross-sectional study implemented in 2016. Among all health staffs of a university of medical sciences, the full details of 240 households (838 individuals) were collected by using a stratified random sampling method. The data gathering and analyzing process have been done based on WHO standard guideline. Finally, the odds ratio of CHE determinants is reported using logistic regression by backward elimination method and chi-square test. Results: The results of this study showed that 7.5% (CI: 7.3-7.7) of health staff households (54 individuals) are faced with CHE. The odds of exposure to CHE for households with 3 members and less, households with lower education level and households with two or more outpatient visits were significantly more than others (p<0.05). Households who have used dental services during the past year were 8.77 times (p<0.001) more at risk of CHE. Also, households with 3 members and less, households with lower education level and households with two or more outpatient visits were 8.59, 7.96, and 3.39 times more at risk of such payments, respectively. Conclusion: CHE is a common financing dilemma even among health staffs. Families who have more referring to health centers and less education level and also dental service users are more at risk of exposure. Health policy-makers should pay more attention to such vulnerable and high-risk groups. Finally, our study results recommended the increase of dental insurance coverage as an effective strategy to reduce exposure to CHE.
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Affiliation(s)
- Parisa Mehdizadeh
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Hossein Daniyali
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | | | - Nooredin Dopeykar
- Research Center for Prevention of Oral and Dental Diseases, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Hadi Uzi
- Department of Health Economic and Management, Tehran University of Medical Science, Tehran, Iran
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Fang H, Eggleston K, Hanson K, Wu M. Enhancing financial protection under China's social health insurance to achieve universal health coverage. BMJ 2019; 365:l2378. [PMID: 31227485 PMCID: PMC6598720 DOI: 10.1136/bmj.l2378] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Hai Fang and colleagues highlight the need for better financial protection for poor people
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Affiliation(s)
- Hai Fang
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Karen Eggleston
- Shorenstein Asia Pacific Research Center, Freeman Spogli Institute for International Studies, Stanford University, Stanford, California, USA
- National Bureau of Economic Research, USA
| | - Kara Hanson
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Ming Wu
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
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Health-Related Quality of Life of People with Self-Reported Hypertension: A National Cross-Sectional Survey in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16101721. [PMID: 31100800 PMCID: PMC6572246 DOI: 10.3390/ijerph16101721] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 05/12/2019] [Accepted: 05/14/2019] [Indexed: 11/24/2022]
Abstract
This study aimed to determine the health-related quality of life (HRQoL) of people with self-reported diagnosed hypertension and its determinants in China. Data was obtained from the 5th National Health Services Survey. The HRQoL of the respondents who were 15 years or older was assessed with the EQ-5D-3L utility index and visual analogue scale (VAS), and compared between those with (n = 30,063) and without (n = 158,657) self-reported hypertension. Multivariate logistic regression, Tobit regression, and linear regression models were established to identify predictors of HRQoL. A difference of half standard deviation was deemed as minimal clinically important difference (MCID) for the utility index (0.03). The respondents with self-reported hypertension were more likely to report problems in the five dimensions (Adjusted Odds Ratio = 1.43–1.70) of the EQ-5D-3L, resulting in a significant lower utility index (β = −0.04) and VAS scores (β = −3.22) compared with those without self-reported hypertension, and the difference of the utility index exceeded MCID. In the respondents with self-reported hypertension, higher utility index and VAS scores were found in those who were female, younger, married, employed, smoking, drinking, exercising regularly, absent from comorbidity, resided in the eastern developed region, had normal body mass index, higher levels of education, and income. Hypertension management programs were associated with higher utility index (β = 0.01) and VAS scores (β = 1.02). Overall, hypertension is associated with lower HRQoL. Higher socioeconomic status and participation in management programs for chronic conditions are independent predictors of higher HRQoL of hypertensive people. This study provides a national representative estimate on the HRQoL of hypertensive people in China, which can be used for calculating the burden of hypertension.
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Si Y, Zhou Z, Su M, Wang X, Lan X, Wang D, Gong S, Xiao X, Shen C, Ren Y, Zhao D, Hong Z, Bian Y, Chen X. Decomposing inequality in catastrophic health expenditure for self-reported hypertension household in Urban Shaanxi, China from 2008 to 2013: two waves' cross-sectional study. BMJ Open 2019; 9:e023033. [PMID: 31076467 PMCID: PMC6528006 DOI: 10.1136/bmjopen-2018-023033] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Despite the latest wave of China's healthcare reform initiated in 2009 has achieved unprecedented progress in rural areas, little is known for specific vulnerable groups' catastrophic health expenditure (CHE) in urban China. This study aims to estimate the trend of incidence, intensity and inequality of CHE in hypertension households (households with one or more than one hypertension patient) in urban Shaanxi, China from 2008 to 2013. METHODS Based on the fourth and the fifth National Health Service Surveys of Shaanxi, we identified 460 and 1289 households with hypertension in 2008 and 2013, respectively for our analysis. We classified hypertension households into two groups: simplex households (with hypertension only) and mixed households (with hypertension plus other non-communicable diseases). CHE would be identified if out-of-pocket healthcare expenditure was equal to or higher than 40% of a household's capacity to pay. Concentration index and its decomposition based on Probit regressions were employed to measure the income-related inequality of CHE. RESULTS We find that CHE occurred in 11.2% of the simplex households and 22.1% of the mixed households in 2008, and the 21.5% of the simplex households and the 46.9% of mixed households incurred CHE in 2013. Furthermore, there were strong pro-poor inequalities in CHE in the simplex households (-0.279 and -0.283) and mixed households (-0.362 and -0.262) both in 2008 and 2013. The majority of observed inequalities in CHE could be associated with household economic status, household head's health status and having elderly members. CONCLUSION We find a sharp increase of CHE occurrence and the sustained strong pro-poor inequalities for simplex and mixed households in urban Shaanxi Province of China from 2008 to 2013. Our study suggests that more concerns are needed for the vulnerable groups such as hypertension households in urban areas of China.
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Affiliation(s)
- Yafei Si
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, China
| | - Zhongliang Zhou
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, China
- Global Health Institute, Xi’an Jiaotong University, Xi’an, China
| | | | - Xiao Wang
- International Business School, Xi’an Jiaotong-Liverpool University, Suzhou, China
| | - Xin Lan
- School of Public Health, Xi’an Jiaotong University School of Medicine, Xi’an, Shaanxi, China
| | - Dan Wang
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, China
| | - Shaoqing Gong
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, China
| | - Xiao Xiao
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, China
| | - Chi Shen
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, China
| | - Yangling Ren
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, China
| | - Dantong Zhao
- School of Public Health, Xi’an Jiaotong University School of Medicine, Xi’an, Shaanxi, China
| | - Zihan Hong
- International Business School, Xi’an Jiaotong-Liverpool University, Suzhou, China
| | - Ying Bian
- Institute of Chinese Medical Sciences, University of Macau, Taipa, Macao
| | - Xi Chen
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
- Department of Economics, Yale University, New Haven, CT, USA
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Xu Y, Garrib A, Zhou Z, Wang D, Gao J, Yang X, Fan X, Chen G. New Health Care Reform and Impoverishment among Chronic Households in China: A Random-Intercept Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E1074. [PMID: 30917496 PMCID: PMC6466394 DOI: 10.3390/ijerph16061074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 03/18/2019] [Accepted: 03/21/2019] [Indexed: 11/28/2022]
Abstract
High out-of-pocket (OOP) payments for chronic disease care often contribute directly to household poverty. Although previous studies have explored the determinants of impoverishment in China, few published studies have compared levels of impoverishment before and after the New Health Care Reform (NHCR) in households with members with chronic diseases (hereafter referred to as chronic households). Our study explored this using data from the fourth and fifth National Health Service Surveys conducted in Shaanxi Province. In total, 1938 households in 2008 and 7700 households in 2013 were included in the analysis. Rates of impoverishment were measured using a method proposed by the World Health Organization. Multilevel logistic modeling was used to explore the influence of the NHCR on household impoverishment. Our study found that the influence of NHCR on impoverishment varied by residential location. After the reform, in rural areas, there was a significant decline in impoverishment, although the impoverishment rate remained high. There was little change in urban areas. In addition, impoverishment in the poorest households did not decline after the NHCR. Our findings are important for policy makers in particular for evaluating reform effectiveness, informing directions for health policy improvement, and highlighting achievements in the efforts to alleviate the economic burden of households that have members with chronic diseases.
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Affiliation(s)
- Yongjian Xu
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an 710049, China.
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK.
| | - Anupam Garrib
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK.
| | - Zhongliang Zhou
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an 710049, China.
| | - Duolao Wang
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK.
| | - Jianmin Gao
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an 710049, China.
| | - Xiaowei Yang
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an 710049, China.
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK.
| | - Xiaojing Fan
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool L3 5QA, UK.
- School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an 710049, China.
| | - Gang Chen
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, VIC 3800, Australia.
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Azzani M, Roslani AC, Su TT. Determinants of Household Catastrophic Health Expenditure: A Systematic Review. Malays J Med Sci 2019; 26:15-43. [PMID: 30914891 PMCID: PMC6419871 DOI: 10.21315/mjms2019.26.1.3] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 07/03/2018] [Indexed: 01/07/2023] Open
Abstract
The World Health Organization estimates that annually 150 million people experience severe (catastrophic) financial difficulties as a result of healthcare payments. Therefore, a systematic review was carried out to identify the determinants of household catastrophic health expenditure (CHE) in low-to high-income countries around the world. Both electronic and manual searches were conducted. The main outcome of interest was the determinants of CHE due to healthcare payments. Thirty eight studies met the inclusion criteria for review. The analysis revealed that household economic status, incidence of hospitalisation, presence of an elderly or disabled household member in the family, and presence of a family member with a chronic illness were the common significant factors associated with household CHE. The crucial finding of the current study is that socioeconomic inequality plays an important role in the incidence of CHE all over the world, where low-income households are at high risk of financial hardship from healthcare payments. This suggests that healthcare financing policies should be revised in order to narrow the gap in socioeconomic inequality and social safety nets should be implemented and strengthened for people who have a high need for health care.
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Affiliation(s)
- Meram Azzani
- Community Medicine Department, Faculty of Medicine & Biomedical Sciences, MAHSA University, Saujana Putra Campus, 42610 Jenjarom, Selangor, Malaysia
| | - April Camilla Roslani
- University of Malaya Cancer Research Institute (UMCRI), Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
- Department of Surgery, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Tin Tin Su
- Centre for Population Health (CePH), Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
- South East Asia Community Observatory (SEACO), Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, 47500 Bandar Sunway, Selangor, Malaysia
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Wang Q, Xu L, Sun L, Li J, Qin W, Ding G, Zhang J, Zhu J, Xie S, Yu Z, Zhou C. Rural-urban difference in blood pressure measurement frequency among elderly with hypertension: a cross-sectional study in Shandong, China. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2018; 37:25. [PMID: 30466482 PMCID: PMC6249846 DOI: 10.1186/s41043-018-0155-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 11/06/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Blood pressure measurement is the first step in preventing and controlling hypertension. The objective of this study is to examine the rural-urban difference towards blood pressure measurement among elderly with hypertension. METHODS A total of 2007 elderly (65+) were selected from the fifth Health Service Survey of Shandong Province in 2013. A standardized questionnaire was used to investigate the demographic characters, socioeconomic status, self-rated health, and blood pressure related index. Three logistic regression models were used to examine the difference in blood pressure measurement between rural and urban elderly. Unadjusted and adjusted logistic regression models were used to explore the associated factors of blood pressure measurement in both rural areas and urban areas. RESULTS The prevalence of weekly blood pressure measurement in urban elderly was higher than that in rural elderly (63.9% vs 34.3%). The rural elderly had an odds ratio (OR) for weekly blood pressure measurement of 0.467 (95%CI = 0.380-0.575) compared with urban elderly. Binary logistic regression analysis showed that medication frequency and accepting health care professionals' guidance were common associated factors of blood pressure measurement among both rural and urban elderly; personal income was unique associated factor of blood pressure measurement among rural elderly; marital status, education level, self-rated health, and blood pressure level currently were unique associated factors of blood pressure measurement among urban elderly. CONCLUSIONS There is a big difference in blood pressure measurement between rural and urban elderly. Interventions targeting identified at-risk subgroups, especially for those rural elderly, should be made to reduce such a gap.
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Affiliation(s)
- Qian Wang
- School of Public Health, Shandong University, Jinan, 250012 China
| | - Lingzhong Xu
- School of Public Health, Shandong University, Jinan, 250012 China
- Collaborative Innovation Center of Social Risks Governance in Health, School of Public health, Fudan University, Shanghai, 200032 China
| | - Long Sun
- School of Public Health, Shandong University, Jinan, 250012 China
| | - Jiajia Li
- School of Public Health, Shandong University, Jinan, 250012 China
- Collaborative Innovation Center of Social Risks Governance in Health, School of Public health, Fudan University, Shanghai, 200032 China
| | - Wenzhe Qin
- School of Public Health, Shandong University, Jinan, 250012 China
| | - Gan Ding
- School of Public Health, Shandong University, Jinan, 250012 China
| | - Jiao Zhang
- School of Public Health, Shandong University, Jinan, 250012 China
| | - Jing Zhu
- School of Public Health, Shandong University, Jinan, 250012 China
| | - Su Xie
- School of Public Health, Shandong University, Jinan, 250012 China
| | - Zihang Yu
- School of Public Health, Shandong University, Jinan, 250012 China
| | - Chengchao Zhou
- School of Public Health, Shandong University, Jinan, 250012 China
- Collaborative Innovation Center of Social Risks Governance in Health, School of Public health, Fudan University, Shanghai, 200032 China
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Pandey A, Kumar GA, Dandona R, Dandona L. Variations in catastrophic health expenditure across the states of India: 2004 to 2014. PLoS One 2018; 13:e0205510. [PMID: 30346971 PMCID: PMC6197636 DOI: 10.1371/journal.pone.0205510] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 09/26/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Financial protection is a key dimension of universal health coverage. Catastrophic health expenditure (CHE) has increased in India over time. The overall figures mask the subnational heterogeneity crucial for designing insurance coverage for 1.3 billion population across India. We estimated CHE in every state of India and the changes over a decade. METHODS We used National Sample Survey data on health care utilisation in 2004 and 2014. The states were placed in four groups based on epidemiological transition level (ETL), defined on the basis of ratio of disability-adjusted life-years from communicable diseases to those from non-communicable diseases and injuries combined, with a low ratio denoting high ETL state group. CHE was defined as the proportion of households that had out-of-pocket payments for health care equalling or exceeding 10% of the household expenditure. We assessed variation in the magnitude and distribution of CHE between ETL state groups and between states of India. RESULTS In 2014, CHE was higher in the high (30.3%, 95% confidence interval: 28.5 to 32.1) and higher-middle (27.4%, 26.3 to 28.6) ETL state groups than the low (21.8%, 20.8 to 22.8) and lower-middle (19.0%, 17.1 to 21.0) groups. From 2004 to 2014, CHE increased only in the high and higher-middle ETL groups (1.19 and 1.34 times, respectively). However, the individual states with substantial increase in CHE were spread across all ETL groups. The gap between the highest CHE of an individual state and the lowest was 8-fold in 2014. CHE was disproportionately concentrated among the rich in 2004 for most of India, but in 2014 CHE was distributed equally among the rich and poor because of the substantial increase in CHE among the poor over time. CONCLUSIONS Better provision of quality health care should be accompanied by financial protection measures to safeguard the poor from increasing CHE in India. The state-specific CHE trends can provide useful input for the planning of the recently launched National Health Protection Mission such that it meets the requirement of each state.
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Affiliation(s)
- Anamika Pandey
- Public Health Foundation of India, National Capital Region, Gurugram, India
| | - G. Anil Kumar
- Public Health Foundation of India, National Capital Region, Gurugram, India
| | - Rakhi Dandona
- Public Health Foundation of India, National Capital Region, Gurugram, India
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States of America
| | - Lalit Dandona
- Public Health Foundation of India, National Capital Region, Gurugram, India
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States of America
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Analysis on Medical Expenses of Hypertensive Inpatients in Urban Areas from 2010 to 2013-Evidence from Two Provinces in South of China. Curr Med Sci 2018; 38:741-748. [PMID: 30128887 DOI: 10.1007/s11596-018-1939-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 05/20/2018] [Indexed: 02/04/2023]
Abstract
Along with the development of society and the rapid economic growth in the past decades, hypertension and other chronic diseases have become important reasons for people's poverty caused by illness in China. This study collected a total of 5857 people from 2010 to 2013 randomly from the database of the Medical Insurance Department (MID), including 3229 people in Hubei province and 2628 people in Guangdong province. One-way ANOVA was used to compare the total medical expense, out-of-pocket (OOP) expense and hospital stay between variables. A multiple linear regression analysis was done to identify possible risk factors of total medical expense. The results showed that the average total medical expense per capita was 5709.89 yuan, and the medical expense per capita was 7053.58 and 4555.97 yuan in Guangdong province and Hubei province, respectively. The medical expense of hypertensive inpatients decreased from 7222.32 yuan in 2012 to 4894.66 yuan in 2013. There were no significant differences in medical expenses between different genders of hypertensive patients (P>0.05). People of different ages, provinces, medical insurances and medical institution levels showed significant differences in medical expenses. The government should increase the investment in chronic disease management and treatment in the central and western regions to narrow the gap with the eastern region. Medical insurance fund payment should be improved to ensure the fairness of the use of medical services in different medical insurances. And measures should be taken to encourage chronic patients to visit primary medical institutions to effectively reduce medical expenses.
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Impact of hypertension on health-related quality of life among different age subgroups in Shanghai: the subpopulation treatment effect pattern plot analysis. J Hum Hypertens 2018; 33:78-86. [PMID: 30082691 DOI: 10.1038/s41371-018-0092-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 07/09/2018] [Accepted: 07/11/2018] [Indexed: 12/31/2022]
Abstract
The aim of our study was to investigate the effect of hypertension on health-related quality of life (HRQoL) among different age subgroups of people in Shanghai using subpopulation treatment effect pattern plot (STEPP) methodology. We utilized data from the fifth Health Service Survey of Shanghai, 2013, which utilizes a cross-sectional study design. The participants were selected into the survey by using a three-stage, stratified, random sampling method. HRQoL was evaluated by the EuroQol five-dimensional 3 level (EQ-5D-3L) questionnaire, and the EuroQol-visual analog scales (EQ-VAS) score was the main outcome. A generalized estimating equations (GEE) model adjusted for socio-demographic covariates was used to determine the effect of hypertension on HRQoL. STEPP analysis was performed to explore the effect of hypertension within overlapping age subpopulations. Subgroup analyses for gender were conducted for the main outcome. A total of 28,730 residents who were 18 years or older were included in our study. The results of the multivariate GEE model showed that hypertension negatively affected HRQoL in the study population (estimate = -1.85, p < 0.0001). According to the STEPP analysis, we found that the EQ-VAS score in the hypertension group was lower than that in non-hypertension group for every age group. Additionally, the results of subgroup analyses indicated that the difference of score between two groups was larger among young women. When compared to respondents without hypertension, respondents with hypertension experienced lower HRQoL regardless of gender or any range of age. Furthermore, the impact of hypertension on HRQoL of young women might be more obvious.
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Su M, Si Y, Zhou Z, Shen C, Dong W, Fan X, Wang X, Wei X. Comparing the income-related inequity of tested prevalence and self-reported prevalence of hypertension in China. Int J Equity Health 2018; 17:82. [PMID: 29907150 PMCID: PMC6003002 DOI: 10.1186/s12939-018-0796-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 06/04/2018] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Hypertension has become a global health challenge given its high prevalence and but low awareness and detection. Whether the actual prevalence of hypertension has been estimated is important, especially for the poor. This study aimed to measure tested prevalence and self-reported prevalence of hypertension and compare the inequity between them in China. METHODS Data were derived from China Health and Nutrition Survey (CHNS) conducted in 2011. By using the multistage, stratified, random sampling method, 12,168 respondents aged 18 or older were identified for analysis. Both tested prevalence (systolic blood pressure ≥ 140 mmHg or/and diastolic blood pressure ≥ 90 mmHg or /and current use any of antihypertensive medication) and self-reported prevalence (ever diagnosed with hypertension by a doctor) were used to measure the prevalence of hypertension. The concentration index was employed to measure the extent of inequality in tested prevalence and self-reported prevalence. A decomposition method, based on a Probit model, was used to analyze income-related horizontal inequity of tested prevalence and self-reported prevalence. RESULTS The tested prevalence and self-reported prevalence of total respondents were 28.8% [95% CI (28.0%, 29.6%)] and 15.7% [95% CI (15.0%, 16.3%)], and 26.4% [95% CI (25.1%, 27.6%)] and 19.0% [95% CI (17.9%, 20.1%)] in urban areas, and 30.3% [95% CI (29.3%, 31.4%)] and 13.5% [95% CI (12.7%, 14.3%)] in rural areas. The horizontal inequity indexes of mean tested prevalence and self-reported prevalence were - 0.0494 and 0.1203 of total respondents, - 0.0736 and 0.0748 in urban area, and - 0.0177 and 0.0466 in rural area respectively, indicating pro-poor inequity in tested prevalence and pro-rich inequity in self-reported prevalence of hypertension. Economic status, education attainment and age were key factors of the pro-poor inequity in tested prevalence. Economic status, area and age were key factors to explain the poor-rich inequity in self-reported prevalence. CONCLUSIONS This study revealed self-reported prevalence of hypertension was much lower than tested prevalence in China, while a larger gap between self-reported and tested prevalence was found in rural areas. Our study suggested social strategies aiming at narrowing economic gap and regional disparities, reducing educational inequity, and facilitating health conditions of the elderly should be implemented. Finally, awareness raising campaigns to test hypertension in rural area need be strengthened by health education programs and improving the access to public health service, especially for those who do not engage with regular health checkups.
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Affiliation(s)
- Min Su
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, China
| | - Yafei Si
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, China
| | - Zhongliang Zhou
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, China
| | - Chi Shen
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, China
| | - Wanyue Dong
- School of Public Health, Xi’an Jiaotong University, Xi’an, China
| | - Xiaojing Fan
- School of Public Health, Xi’an Jiaotong University, Xi’an, China
| | - Xiao Wang
- International Business School Suzhou, Xi’an Jiaotong-Liverpool University, Suzhou, China
| | - Xiaolin Wei
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Moradi T, Naghdi S, Brown H, Ghiasvand H, Mobinizadeh M. Decomposing inequality in financial protection situation in Iran after implementing the health reform plan: What does the evidence show based on national survey of households' budget? Int J Health Plann Manage 2018; 33:652-661. [PMID: 29573463 DOI: 10.1002/hpm.2517] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 02/20/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Lack of well-designed healthcare financing mechanisms and high level of out-of-pocket payments in Iran over the last decades led to implementing Health Transformation Plan, in 2014. This study aims to decompose inequality in financial protection of Iranian households after the implementation of the Health Transformation Plan. METHODS The data of Statistical Center of Iran (SCI) Survey on Rural and Urban Households Income-Expenditure in 2015 to 2016 were used. The headcount ratio of catastrophic health expenditures was calculated. The corrected concentration index was estimated. The role of contributors on inequality in the exposure to catastrophic health expenditures among poor and nonpoor households was calculated using Farelie's model. RESULTS The headcount ratio of the exposure to catastrophic health expenditures in urban and rural households was 2.5% (2.43% - 2.64%) and 3.6% (3.48% - 3.76%), respectively. The difference in households' income levels was the main contributor in explaining the inequality in facing catastrophic health expenditures between poor and nonpoor households. [Correction added on 02 June 2018, after first online publication: The "Results" section of the Abstract of the published article has been correctly updated on this version.] CONCLUSION: Even after implementing the HTP, the headcount ratios of catastrophic health expenditure are still considerable. The results show that income is the greatest determinant of inequality in facing catastrophic health expenditure and in urban households.
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Affiliation(s)
| | - Seyran Naghdi
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Heather Brown
- Institute of Health and Society, Newcastle University, Newcastle Upon Tyne, UK
| | - Hesam Ghiasvand
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Catastrophic health expenditure in households with chronic disease patients: A pre-post comparison of the New Health Care Reform in Shaanxi Province, China. PLoS One 2018; 13:e0194539. [PMID: 29547654 PMCID: PMC5856426 DOI: 10.1371/journal.pone.0194539] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 03/05/2018] [Indexed: 12/03/2022] Open
Abstract
Introduction In 2009, China officially launched the New Health Care Reform (NHCR). One important purpose of the reform was to reduce financial burden of health care through health insurance expansion and health care provider regulations. This study aimed to provide evidence on the effect of the NHCR reform on catastrophic health expenditure (CHE) by comparing the occurrence and inequality of CHE among households with chronic diseases patients before and after the reform. Methods This study used the subset of data from the 2008 and 2013 National Health Services Survey conducted in Shaanxi Province. Our sample included households with chronic diseases patients and excluded observations with key variables missing. The final sample size was 1942 households in 2008 and 7704 households in 2013. We defined CHE occurrence following the definition of the World Health Organization (WHO). The income-related inequality in CHE was measured by the concentration index. A multi-level logistic regression model was used in the study to explore the influence of the NHCR on CHE occurrence, controlling for important covariates. Results From 2008 to 2013, the occurrence rate of CHE in rural areas declined from 29.15% to 23.62%. However, the CHE rate in urban areas increased from 19.18% to 24.95%. The interaction term between year and rural/urban location was statistically significant, confirming that the influence of the NHCR on the CHE occurrence rates were heterogeneous between rural and urban areas. As for the CHE inequality, the concentration index in rural areas decreased from -0.4572 to -0.5499 with a p-value less than 0.05. This implied that the CHE occurrence inequality was increased after the implementation of the NHCR. Conclusion Our study suggested that the implementation of the NHCR might not have been effective in reducing the CHE occurrence for households with chronic disease patients. Although the occurrence of CHE of rural households had decreased, the occurrence of CHE in urban areas was higher than before. In addition, the income inequality of CHE occurrence was greater in 2013 compared to that in 2008 in rural areas. Although the reform resulted in higher insurance coverage and higher government expenditure in health care, the financial burden of health care on households did not necessarily improve. Further efforts on developing the current health insurance system and optimizing the hierarchical health care system are required to improve the protection against CHE.
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Su M, Zhou Z, Si Y, Wei X, Xu Y, Fan X, Chen G. Comparing the effects of China's three basic health insurance schemes on the equity of health-related quality of life: using the method of coarsened exact matching. Health Qual Life Outcomes 2018. [PMID: 29514714 PMCID: PMC5842629 DOI: 10.1186/s12955-018-0868-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND China has three basic health insurance schemes: Urban Employee Basic Medical Insurance (UEBMI), Urban Resident Basic Medical Insurance (URBMI) and New Rural Cooperative Medical Scheme (NRCMS). This study aimed to compare the equity of health-related quality of life (HRQoL) of residents under any two of the schemes. METHODS Using data from the 5th National Health Services Survey of Shaanxi Province, China, coarsened exact matching method was employed to control confounding factors. We included a matched sample of 6802 respondents between UEBMI and URBMI, 34,169 respondents between UEBMI and NRCMS, and 36,928 respondents between URBMI and NRCMS. HRQoL was measured by EQ-5D-3L based on the Chinese-specific value set. Concentration index was adopted to assess health inequality and was decomposed into its contributing factors to explain health inequality. RESULTS After matching, the horizontal inequity indexes were 0.0036 and 0.0045 in UEBMI and URBMI, 0.0035 and 0.0058 in UEBMI and NRCMS, and 0.0053 and 0.0052 in URBMI and NRCMS respectively, which were mainly explained by age, educational and economic statuses. The findings demonstrated the pro-rich health inequity was much higher for the rural scheme than that for the urban ones. CONCLUSION This study highlights the need to consolidate all three schemes by administrating uniformly, merging funds pooling and benefit packages. Based on the contributing factors, strategies aim to facilitate health conditions of the elderly, narrow economic gap, and reduce educational inequity, are essential. This study will provide evidence-based strategies on consolidating the fragmented health schemes towards reducing health inequity in both China and other developing countries.
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Affiliation(s)
- Min Su
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
| | - Zhongliang Zhou
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China.
| | - Yafei Si
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
| | - Xiaolin Wei
- Division of Clinical Public Health, and Institute of Health Policy Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Yongjian Xu
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
| | - Xiaojing Fan
- School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China
| | - Gang Chen
- Monash Business School, Monash University, Clayton, Australia
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