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Panda HS, Rout HS, Jakovljevic M. Catastrophic health expenditure of inpatients in emerging economies: evidence from the Indian subcontinent. Health Res Policy Syst 2024; 22:104. [PMID: 39135065 PMCID: PMC11318257 DOI: 10.1186/s12961-024-01202-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Accepted: 07/29/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND Catastrophic health expenditures condensed the vital concern of households struggling with notable financial burdens emanating from elevated out-of-pocket healthcare expenditures. In this regard, this study investigated the nature and magnitude of inpatient healthcare expenditure in India. It also explored the incidence and determinants of inpatient catastrophic health expenditure. METHODOLOGY The study used the micro-level data collected in the 75th Round of the National Sample Survey on 93 925 households in India. Descriptive statistics were used to examine the nature, magnitude and incidence of inpatient healthcare expenditure. The heteroscedastic probit model was applied to explore the determinants of inpatient catastrophic healthcare expenditure. RESULTS The major part of inpatient healthcare expenditure was composed of bed charges and expenditure on medicines. Moreover, results suggested that Indian households spent 11% of their monthly consumption expenditure on inpatient healthcare and 28% of households were grappling with the complexity of financial burden due to elevated inpatient healthcare. Further, the study explored that bigger households and households having no latrine facilities and no proper waste disposal plans were more vulnerable to facing financial burdens in inpatient healthcare activity. Finally, the result of this study also ensure that households having toilets and safe drinking water facilities reduce the chance of facing catastrophic inpatient health expenditures. CONCLUSIONS A significant portion of monthly consumption expenditure was spent on inpatient healthcare of households in India. It was also conveyed that inpatient healthcare expenditure was a severe burden for almost one fourth of households in India. Finally, it also clarified the influence of socio-economic conditions and sanitation status of households as having a strong bearing on their inpatient healthcare.
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Affiliation(s)
- Himanshu Sekhar Panda
- Department of Humanities and Social Sciences, Indian Institute of Technology Kharagpur, Kharagpur, India
| | - Himanshu Sekhar Rout
- Department of Analytical and Applied Economics and RUSA Centre for Public Policy and Governance, Utkal University, Bhubaneswar, India.
| | - Mihajlo Jakovljevic
- UNESCO-The World Academy of Sciences (TWAS), Trieste, Italy
- Shaanxi University of Technology, Hantai District, Hanzhong, 723099, Shaanxi, China
- Department of Global Health Economics and Policy, University of Kragujevac, Kragujevac, Serbia
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Cao W, Feng H, Yang Y, Wang L, Wang X, Ma Y, Zhao D, Hu X. Trends in antidiabetic drug use and expenditure in public hospitals in Northwest China, 2012-21: a case study of Gansu Province. BMC Health Serv Res 2024; 24:415. [PMID: 38570849 PMCID: PMC10988802 DOI: 10.1186/s12913-024-10917-0] [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: 08/16/2023] [Accepted: 03/27/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Since the twenty-first century, the prevalence of diabetes has risen globally year by year. In Gansu Province, an economically underdeveloped province in northwest China, the cost of drugs for diabetes patients accounted for one-third of their total drug costs. To fundamentally reduce national drug expenditures and the burden of medication on the population, the relevant departments of government have continued to reform and improve drug policies. This study aimed to analyse long-term trends in antidiabetic drug use and expenditure in Gansu Province from 2012 to 2021 and to explore the role of pharmaceutical policy. METHODS Data were obtained from the provincial centralised bidding and purchasing (CBP) platform. Drug use was quantified using the anatomical therapeutic chemistry/defined daily dose (ATC/DDD) method and standardised by DDD per 1000 inhabitants per day (DID), and drug expenditure was expressed in terms of the total amount and defined daily cost (DDC). Linear regression was used to analyse the trends and magnitude of drug use and expenditure. RESULTS The overall trend in the use and expenditure of antidiabetic drugs was on the rise, with the use increasing from 1.04 in 2012 to 16.02 DID in 2021 and the expenditure increasing from 48.36 in 2012 to 496.42 million yuan in 2021 (from 7.66 to 76.95 million USD). Some new and expensive drugs changed in the use pattern, and their use and expenditure shares (as the percentage of all antidiabetic drugs) increased from 0 to 11.17% and 11.37%, but insulins and analogues and biguanides remained the most used drug class. The DDC of oral drugs all showed a decreasing trend, but essential medicines (EMs) and medical insurance drugs DDC gradually decreased with increasing use. The price reduction of the bid-winning drugs was over 40%, and the top three drugs were glimepiride 2mg/30, acarbose 50mg/30 and acarbose 100mg/30. CONCLUSIONS The implementation of pharmaceutical policies has significantly increased drug use and expenditure while reducing drug prices, and the introduction of novel drugs and updated treatment guidelines has led to changes in use patterns.
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Affiliation(s)
- Wenxuan Cao
- School of Public Health, Lanzhou University, 222# Tianshui South Road, Lanzhou, 730000, China
| | - Hu Feng
- School of Public Health, Lanzhou University, 222# Tianshui South Road, Lanzhou, 730000, China
| | - Yaya Yang
- School of Public Health, Lanzhou University, 222# Tianshui South Road, Lanzhou, 730000, China
| | - Lei Wang
- School of Public Health, Lanzhou University, 222# Tianshui South Road, Lanzhou, 730000, China
| | - Xuemei Wang
- School of Public Health, Lanzhou University, 222# Tianshui South Road, Lanzhou, 730000, China
| | - Yongheng Ma
- Division of Pharmaceutical Procurement, Gansu Public Resources Trading Center, 68# Yanxing Road, Lanzhou, 730000, China
| | - Defang Zhao
- Division of Pharmaceutical Procurement, Gansu Public Resources Trading Center, 68# Yanxing Road, Lanzhou, 730000, China
| | - Xiaobin Hu
- School of Public Health, Lanzhou University, 222# Tianshui South Road, Lanzhou, 730000, China.
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Wang Y, Deng H, Gao S, Li T, Wang F. A Fresh Perspective on Examining Population Emotional Well-Being Trends by Internet Search Engine: An Emerging Composite Anxiety and Depression Index. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:202. [PMID: 38397692 PMCID: PMC10888063 DOI: 10.3390/ijerph21020202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 02/03/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024]
Abstract
Traditional assessments of anxiety and depression face challenges and difficulties when it comes to understanding trends in-group psychological characteristics. As people become more accustomed to expressing their opinions online, location-based online media and cutting-edge algorithms offer new opportunities to identify associations between group sentiment and economic- or healthcare-related variables. Our research provides a novel approach to analyzing emotional well-being trends in a population by focusing on retrieving online information. We used emotionally enriched texts on social media to build the Public Opinion Dictionary (POD). Then, combining POD with the word vector model and search trend, we developed the Composite Anxiety and Depression Index (CADI), which can reflect the mental health level of a region during a specific time period. We utilized the representative external data by CHARLS to validate the effectiveness of CADI, indicating that CADI can serve as a representative indicator of the prevalence of mental disorders. Regression and subgroup analysis are employed to further elucidate the association between public mental health (measured by CADI) with economic development and medical burden. The results of comprehensive regression analysis show that the Import-Export index (-16.272, p < 0.001) and average cost of patients (4.412, p < 0.001) were significantly negatively associated with the CADI, and the sub-models stratificated by GDP showed the same situation. Disposable income (-28.389, p < 0.001) became significant in the subgroup with lower GDP, while the rate of unemployment (2.399, p < 0.001) became significant in the higher subgroup. Our findings suggest that an unfavorable economic development or unbearable medical burden will increase the negative mental health of the public, which was consistent across both the full and subgroup models.
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Affiliation(s)
- Yu Wang
- Center for Applied Statistics, Renmin University of China, Beijing 100872, China;
- School of Statistics, Renmin University of China, Beijing 100872, China; (H.D.); (S.G.); (T.L.)
| | - Heming Deng
- School of Statistics, Renmin University of China, Beijing 100872, China; (H.D.); (S.G.); (T.L.)
| | - Sunan Gao
- School of Statistics, Renmin University of China, Beijing 100872, China; (H.D.); (S.G.); (T.L.)
| | - Tongxu Li
- School of Statistics, Renmin University of China, Beijing 100872, China; (H.D.); (S.G.); (T.L.)
| | - Feifei Wang
- Center for Applied Statistics, Renmin University of China, Beijing 100872, China;
- School of Statistics, Renmin University of China, Beijing 100872, China; (H.D.); (S.G.); (T.L.)
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Li X, Mohanty I, Zhai T, Chai P, Niyonsenga T. Catastrophic health expenditure and its association with socioeconomic status in China: evidence from the 2011-2018 China Health and Retirement Longitudinal Study. Int J Equity Health 2023; 22:194. [PMID: 37735440 PMCID: PMC10515247 DOI: 10.1186/s12939-023-02008-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 09/09/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND An increase in healthcare utilization in response to universal health coverage may leave massive economic burden on individuals and households. Identifying catastrophic health expenditure helps us understand such burden. This study aims to examine the incidence of catastrophic health expenditure at various thresholds, explore its trend over years, and investigate whether it varies across socioeconomic status (SES). METHODS Data used in this study were from four waves of the China Health and Retirement Longitudinal Study (CHARLS): 2011, 2013, 2015, and 2018. SES was measured by annual per-capita household expenditure, which was then divided into quintiles (Quintile 1 (Q1): the poorest - Quintile 5 (Q5): the wealthiest). Catastrophic health expenditure was measured at both a fixed threshold (40%) and a set of variable thresholds, where the thresholds for other quintiles were estimated by multiplying 40% by the ratio of average food expenditure in certain quintile to that in the index quintile. Multilevel mixed-effects logistic regression models were used to analyze the determinants of catastrophic health expenditure at various thresholds. RESULTS A total of 6,953 households were included in our study. The incidence of catastrophic health expenditure varied across the thresholds set. At a fixed threshold, 10.90%, 9.46%, 13.23%, or 24.75% of households incurred catastrophic health expenditure in 2011, 2013, 2015, and 2018, respectively, which were generally lower than those at variable thresholds. Catastrophic health expenditure often decreased from 2011 to 2013, and an increasing trend occurred afterwards. Compared to households in Q5, those in lower quintiles were more likely to suffer catastrophic health expenditure, irrespective of the thresholds set. Similarly, having chronic diseases and healthcare utilization increased the odds of catastrophic health expenditure. CONCLUSIONS The financial protection against catastrophic health expenditure shocks remains a challenge in China, especially for the low-SES and those with chronic diseases. Concerted efforts are needed to further expand health insurance coverage across breadth, depth, and height, optimize health financing mechanism, redesign cost-sharing arrangements and provider payment methods, and develop more efficient expenditure control strategies.
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Affiliation(s)
- Xi Li
- Health Research Institute, Faculty of Health, University of Canberra, Building 23, 26 University Drive Street, Bruce, Canberra, 2617, Australia.
| | - Itismita Mohanty
- Health Research Institute, Faculty of Health, University of Canberra, Building 23, 26 University Drive Street, Bruce, Canberra, 2617, Australia
| | - Tiemin Zhai
- Department of Health Economics and National Health Accounts Research, China National Health Development Research Center, Beijing, China
| | - Peipei Chai
- Department of Health Economics and National Health Accounts Research, China National Health Development Research Center, Beijing, China
| | - Theo Niyonsenga
- Health Research Institute, Faculty of Health, University of Canberra, Building 23, 26 University Drive Street, Bruce, Canberra, 2617, Australia
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Wang Y, Liang W, Liu M, Liu J. Association of Catastrophic Health Expenditure With the Risk of Depression in Chinese Adults: Population-Based Cohort Study. JMIR Public Health Surveill 2023; 9:e42469. [PMID: 37581926 PMCID: PMC10466147 DOI: 10.2196/42469] [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: 09/05/2022] [Revised: 05/18/2023] [Accepted: 05/26/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Depression is one of the most common mental illnesses, and it may have a lasting effect on one's whole life. As a form of financial hardship, catastrophic health expenditure (CHE) may be associated with depression. However, current evidence about the relationship between CHE and the risk of depression is insufficient. OBJECTIVE This study aimed to explore the relationship between CHE and the risk of depression among Chinese adults. METHODS In this study, we used 3 waves of the China Family Panel Studies (CFPS) from 2012, 2016, and 2018. The CFPS are a nationally representative study covering 25 of 31 provinces in Chinese mainland and representing nearly 94.5% of the total population. We selected eligible household heads as participants, divided them into 2 groups by CHE events at baseline (exposed group: with CHE; unexposed group: without CHE), and followed them up. Households with CHE were defined as having out-of-pocket medical expenditures exceeding 40% of the total household nonfood expenditure, and people with depression were identified by the 8-item Centre for Epidemiological Studies Depression Scale (CES-D). We first described the baseline characteristics and used logistical regression to estimate their effects on CHE events. Then, we used Cox proportional hazard models to estimate adjusted hazard ratios and 95% CIs of depression among participants with CHE compared with those without CHE. Finally, we analyzed the subgroup difference in the association between CHE and depression. RESULTS Of a total of 13,315 households, 9629 were eligible for analysis. Among them, 6824 (70.9%) were men. The mean age was 50.15 (SD 12.84) years. Only 987 (10.3%) participants had no medical insurance. The prevalence of CHE at baseline was 12.9% (1393/9629). Participants with a higher family economic level (adjusted odds ratio [aOR] 1.15, 95% CI 1.02-1.31) and with the highest socioeconomic development level (aOR 1.18, 95% CI 1.04-1.34) had a higher prevalence of CHE than reference groups. During a median of 71 (IQR 69-72) person-months of follow-up, the depression incidence of participants with CHE (1.41 per 1000 person-months) was higher than those without CHE (0.73 per 1000 person-months). Multivariable models revealed that the adjusted hazard ratio for the incidence of depression in participants with CHE was 1.33 (95% CI 1.08-1.64), and this association appeared to be greater in participants without outpatient services (for interaction, P=.048). CONCLUSIONS CHE was significantly associated with increased risk of depression among Chinese adults. Concentrated work should be done to monitor CHE, and more efforts to ensure financial protection need to be made to prevent depression, especially for people with high health care needs.
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Affiliation(s)
- Yaping Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Wannian Liang
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Institute for Healthy China, Tsinghua University, Beijing, China
| | - Min Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Key Laboratory of Epidemiology of Major Diseases, Peking University, Ministry of Education, Beijing, China
| | - Jue Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Key Laboratory of Epidemiology of Major Diseases, Peking University, Ministry of Education, Beijing, China
- Institute for Global Health and Development, Peking University, Beijing, China
- Peking University Health Science Center-Weifang Joint Research Center for Maternal and Child Health, Peking University, Beijing, China
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Macabeo B, Wilson L, Xuan J, Guo R, Atanasov P, Zheng L, François C, Laramée P. Access to innovative drugs and the National Reimbursement Drug List in China: Changing dynamics and future trends in pricing and reimbursement. JOURNAL OF MARKET ACCESS & HEALTH POLICY 2023; 11:2218633. [PMID: 37325810 PMCID: PMC10266112 DOI: 10.1080/20016689.2023.2218633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND AND OBJECTIVES Multiple reforms aimed at improving the Chinese population's health have been introduced in recent years, including several designed to improve access to innovative drugs. We sought to review current factors affecting access to innovative drugs in China and to anticipate future trends. METHODS Targeted reviews of published literature and statistics on the Chinese healthcare system, medical insurance and reimbursement processes were conducted, as well as interviews with five Chinese experts involved in the reimbursement of innovative drugs. RESULTS Drug reimbursement in China is becoming increasingly centralized due to the removal of provincial pathways, the establishment of the National Healthcare Security Administration and the implementation of the National Reimbursement Drug List (NRDL), which is now the main route for drug reimbursement in China. There is also an increasing number of other channels via which patients may access innovative treatments, including various types of commercial insurance and special access. Health technology assessment (HTA) and health economic evidence are becoming pivotal elements of the NRDL decision-making process. Alongside the optimization of HTA decision making, innovative risk-sharing agreements are anticipated to be increasingly leveraged in the future to optimize access to highly specialized technologies and encourage innovation while safeguarding limited healthcare funds. CONCLUSIONS Drug public reimbursement in China continues to align more closely with approaches widely used in Europe in terms of HTA, health economics and pricing. Centralization of decision-making processes for public reimbursement of innovative drugs allows consistency in assessment and access, which optimizes the improvement of the Chinese population's health.
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Affiliation(s)
- Bérengère Macabeo
- Aix-Marseille Université, Marseille, France
- Pierre Fabre Group, Paris, France
| | - Liam Wilson
- Health Economics and Market Access, Amaris Consulting, Shanghai, China
| | - Jianwei Xuan
- Health Economic Research Institute, Sun Yat-Sen University, Guangzhou, China
| | - Ruichen Guo
- Institute of Clinical Pharmacology, Qilu Hospital of Shandong University, Jinan, China
| | - Petar Atanasov
- Health Economics and Market Access, Amaris Consulting, Barcelona, Spain
| | | | - Clement François
- Aix-Marseille Université, Marseille, France
- Putnam Associates, Paris, France
| | - Philippe Laramée
- Aix-Marseille Université, Marseille, France
- Pierre Fabre Group, Paris, France
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Zhai X, Zhang Q, Li X, Zhao X. Association between multimorbidity patterns and catastrophic health expenditure among Chinese older adults living alone. Arch Gerontol Geriatr 2023; 106:104892. [PMID: 36502679 DOI: 10.1016/j.archger.2022.104892] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 11/26/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Multimorbidity is prevalent among older adults and may result in catastrophic health expenditures (CHEs) on older adults' households. However, whether older adults living alone suffer such a financial burden is unknown. We aimed to investigate the association between multimorbidity patterns and CHE in Chinese older adults living alone. METHODS We included 884 participants aged 60 years and over and living alone from the 2018 wave of the China Health and Retirement Longitudinal Study (CHARLS). Latent class analysis was performed to identify multimorbidity patterns based on 14 self-reported chronic diseases. The logit model and Tobit model were adopted to analyze the association of multimorbidity patterns with the incidence and intensity of CHE, respectively. RESULTS Approximately 20.2% of the older adults living alone experienced CHE. Among the four multimorbidity groups (minimal disease, cardiovascular, lung and asthma, and multisystem), the multisystem group and cardiovascular group had significantly higher incidence and intensity of CHE than the minimal disease group. CONCLUSIONS Older adults living alone had high risks of CHE, especially those belonging to the multisystem pattern and cardiovascular pattern. Integrated care should be adopted in the treatment of multimorbidity to reduce health costs. More elder services and social assistance should be provided to solitary older adults with certain patterns of multimorbidity.
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Affiliation(s)
- Xinjia Zhai
- School of Health Humanities, Peking University, No. 38 Xueyuan Road, Beijing, China; Shanghai Advanced Institute of Finance, Shanghai Jiao Tong University, Shanghai, China
| | - Quan Zhang
- National School of Development, Peking University, Beijing, China
| | - Xinxuan Li
- School of Health Humanities, Peking University, No. 38 Xueyuan Road, Beijing, China
| | - Xinyi Zhao
- School of Health Humanities, Peking University, No. 38 Xueyuan Road, Beijing, China.
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Rahman T, Gasbarro D, Alam K. Financial risk protection from out-of-pocket health spending in low- and middle-income countries: a scoping review of the literature. Health Res Policy Syst 2022; 20:83. [PMID: 35906591 PMCID: PMC9336110 DOI: 10.1186/s12961-022-00886-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 07/05/2022] [Indexed: 11/26/2022] Open
Abstract
Background Financial risk protection (FRP), defined as households’ access to needed healthcare services without experiencing undue financial hardship, is a critical health systems target, particularly in low- and middle-income countries (LMICs). Given the remarkable growth in FRP literature in recent times, we conducted a scoping review of the literature on FRP from out-of-pocket (OOP) health spending in LMICs. The objective was to review current knowledge, identify evidence gaps and propose future research directions. Methods We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines to conduct this scoping review. We systematically searched PubMed, Scopus, ProQuest and Web of Science in July 2021 for literature published since 1 January 2015. We included empirical studies that used nationally representative data from household surveys to measure the incidence of at least one of the following indicators: catastrophic health expenditure (CHE), impoverishment, adoption of strategies to cope with OOP expenses, and forgone care for financial reasons. Our review covered 155 studies and analysed the geographical focus, data sources, methods and analytical rigour of the studies. We also examined the level of FRP by disease categories (all diseases, chronic illnesses, communicable diseases) and the effect of health insurance on FRP. Results The extant literature primarily focused on India and China as research settings. Notably, no FRP study was available on chronic illness in any low-income country (LIC) or on communicable diseases in an upper-middle-income country (UMIC). Only one study comprehensively measured FRP by examining all four indicators. Most studies assessed (lack of) FRP as CHE incidence alone (37.4%) or as CHE and impoverishment incidence (39.4%). However, the LMIC literature did not incorporate the recent methodological advances to measure CHE and impoverishment that address the limitations of conventional methods. There were also gaps in utilizing available panel data to determine the length of the lack of FRP (e.g. duration of poverty caused by OOP expenses). The current estimates of FRP varied substantially among the LMICs, with some of the poorest countries in the world experiencing similar or even lower rates of CHE and impoverishment compared with the UMICs. Also, health insurance in LMICs did not consistently offer a higher degree of FRP. Conclusion The literature to date is unable to provide a reliable representation of the actual level of protection enjoyed by the LMIC population because of the lack of comprehensive measurement of FRP indicators coupled with the use of dated methodologies. Future research in LMICs should address the shortcomings identified in this review. Supplementary Information The online version contains supplementary material available at 10.1186/s12961-022-00886-3.
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Affiliation(s)
- Taslima Rahman
- Murdoch Business School, Murdoch University, Perth, WA, 6150, Australia. .,Institute of Health Economics, University of Dhaka, Dhaka, 1000, Bangladesh.
| | - Dominic Gasbarro
- Murdoch Business School, Murdoch University, Perth, WA, 6150, Australia
| | - Khurshid Alam
- Murdoch Business School, Murdoch University, Perth, WA, 6150, Australia
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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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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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Pu X, Wang Y, Zhang W, Zeng M. Can Basic Medical Insurance Reduce Elderly Family Income Inequality in China? Front Public Health 2022; 10:838733. [PMID: 35242735 PMCID: PMC8885622 DOI: 10.3389/fpubh.2022.838733] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 01/14/2022] [Indexed: 11/13/2022] Open
Abstract
Basic medical insurance is the critical medical security system to realize common prosperity in China. This study explores the impact of basic medical insurance on elderly family income inequality in China using the China Family Panel Studies (CFPS) data in 2018. Our finding shows that basic medical insurance is significantly negatively correlated with elderly family income inequality, indicating basic medical insurance has a positive impact on narrowing the elderly family income inequality. The heterogeneity analysis shows that basic medical insurance has a more significant reduction effect among the eastern elderly and the younger elderly family. The results also suggest that health performance significantly mediates the relationship between basic medical insurance and elderly family income inequality. This study implies that the Chinese government should increase the proportion of basic medical insurance reimbursement and expand the scope of reimbursement for basic medical insurance to realize income fairness among elderly families.
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Affiliation(s)
- Xiaohong Pu
- School of Public Administration, Sichuan University, Chengdu, China
| | - Yilong Wang
- School of Public Administration, Sichuan University, Chengdu, China
- School of Management, Northwest Minzu University, Lanzhou, China
| | - Weike Zhang
- School of Public Administration, Sichuan University, Chengdu, China
- *Correspondence: Weike Zhang
| | - Ming Zeng
- School of Public Administration, Sichuan University, Chengdu, China
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12
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Catastrophic health expenditure and its determinants in households with lung cancer patients in China: a retrospective cohort study. BMC Cancer 2021; 21:1323. [PMID: 34893037 PMCID: PMC8665572 DOI: 10.1186/s12885-021-09030-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 11/17/2021] [Indexed: 12/28/2022] Open
Abstract
Background Numerous studies have examined catastrophic health expenditures (CHE) worldwide, mostly focusing on general or common chronic populations, rather than particularly vulnerable groups. This study assessed the medical expenditure and compensation of lung cancer, and explored the extent and influencing factors of CHE among households with lung cancer patients in China. Methods During 2018–2019, a hospital-based multicenter retrospective survey was conducted in seven provinces/municipalities across China as a part of the Cancer Screening Program of Urban China. CHE was measured according to the proportion of out-of-pocket (OOP) health payments of households on non-food expenditures. Chi-square tests and logistic regression analysis was adjusted to determine the factors that significantly influenced the likelihood of a household with lung cancer patient to incur in CHE. Results In total, 470 households with lung cancer patients were included in the analysis. Health insurance was shown to protect some households from the impact of CHE. Nonetheless, CHE incidence (78.1%) and intensity (14.02% for average distance and 22.56% for relative distance) were still relatively high among households with lung cancer patients. The incidence was lower in households covered by the Urban Employee Basic Medical Insurance (UEMBI) insurance, with higher income level and shorter disease course. Conclusion More attention is needed for CHE incidence among vulnerable populations in China. Households with lung cancer patients were shown to be more likely to develop CHE. Therefore, policy makers should focus on improving the financial protection and reducing the economic burden of this disease.
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Wei N, Huang W, Zhou LL. Impact of Catastrophic Health Expenditures on Chinese Household Consumption. Front Public Health 2021; 9:646494. [PMID: 34858912 PMCID: PMC8631299 DOI: 10.3389/fpubh.2021.646494] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 10/04/2021] [Indexed: 11/13/2022] Open
Abstract
China has built a social medical insurance system that covers the entire population so as to reduce the impact of diseases on individuals and families. Although the decline in the incidence of catastrophic health expenditures (CHEs) in China is encouraging, this issue remains important. On the basis of considering selectivity bias and heterogeneity, we applied propensity score matching (PSM) to analyze the 2018 data from the China Family Panel Studies. We assigned CHE households and non-CHE households to the treatment group and the control group, respectively, and used non-random data to simulate a randomized trial to investigate the impact of CHE on household consumption in China. The results of this study indicate that, when the threshold is set at 40%, the consumption of households experiencing CHEs (CHE household) is significantly lower than that of households not experiencing CHEs (non-CHE households) and that CHEs have a significant negative impact on other household consumption and a significant impact on the household property and debt. This effect still exists when the threshold is set lower, with household essential consumption most affected. The occurrence of CHEs leads to a reduction in household consumption and a significantly worsening financial situation for the CHE households, impacting the basic quality of life of the families. Therefore, it is necessary to further reform the medical and health system to reduce the high medical expenses.
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Affiliation(s)
- Ning Wei
- School of Management, Jiangsu University, Zhenjiang, China
| | - Wenhao Huang
- School of Management, Xuzhou Medical University, Xuzhou, China
| | - Lü-Lin Zhou
- School of Management, Jiangsu University, Zhenjiang, China
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Haldar J, Kamath R, Stallone D'lima K, Nazareth J. An Assessment of the Economic Feasibility of Selected Surgeries in the Obstetrics and Gynaecology Department under Community-Based Health Insurance (CBHI) in a Tertiary Care Hospital in South India. Glob Health Epidemiol Genom 2021; 2021:1158533. [PMID: 34631112 PMCID: PMC8487842 DOI: 10.1155/2021/1158533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/15/2021] [Accepted: 09/16/2021] [Indexed: 11/17/2022] Open
Abstract
Community-Based Health Insurance (CBHI) is a form of micro health insurance targeted at low-income groups that permits for grouping of assets to tackle the expenses of future, uncertain, health-related circumstances. According to the International Labour Organisation, more than 80% of India's employed nonagricultural population is in the informal sector, implying that they are possibly excluded from receiving health insurance benefits. This is where CBHI comes into play, wherein groups of people belonging to a community define the demand and benefits and pool their resources to provide financial protection to all their members. This study aims to scrutinize the package prices sanctioned by these schemes and compare them with the cost incurred by the hospital. The expense pattern of three surgeries in the Department of Obstetrics and Gynaecology was analysed under three insurance schemes: Arogya Bhagya Yojana, Arogya Karnataka, and Employees' State Insurance Scheme. Methodology. A retrospective study was conducted in a 2,032-bedded tertiary care hospital in South India. Patients of abdominal hysterectomy, vaginal hysterectomy, and caesarean section surgeries covered by any of the insurance schemes mentioned above were a part of the inclusion criteria. The patient records were examined from the hospital's Medical Records Department (MRD). The patients' bills were assembled from the inpatient billing department to scrutinize all the expenses associated with each surgery. The variable costs include consumables, medicine, electricity and AC, diagnostics, blood bank materials, doctor's fee, package differences, and others. In contrast, fixed costs include bed cost, equipment cost (purchase + annual maintenance cost), manpower cost-OT, manpower cost-nursing, and allocated indirect costs associated with the medical treatment. These were computed and compared with the package price of respective insurance schemes to determine if the schemes are profit-yielding schemes or loss-yielding schemes, using the data from the finance department. Results and Conclusion. It has been observed that the operating loss of the hospital for abdominal hysterectomy, vaginal hysterectomy, and caesarean section under CBHI schemes ranges between 7% and 36%. The highest loss was observed in Arogya Karnataka Scheme for caesarean section surgery (BPL patients). The amount received through these schemes is insufficient to cover the costs acquired by the hospital, let alone make a profit. However, under Arogya Bhagya and ESI Schemes, the hospital has made a profit in covering the variable costs for these surgeries. The study concludes that the hospital is running under loss due to the three Community-Based Health Insurance (CBHI) schemes.
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Affiliation(s)
- Jatoveda Haldar
- Prasanna School of Public Health (PSPH), Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Rajesh Kamath
- Department of Health Innovation, Prasanna School of Public Health (PSPH), Manipal Academy of Higher Education, Manipal, Karnataka, India
| | | | - Jossil Nazareth
- Prasanna School of Public Health (PSPH), Manipal Academy of Higher Education, Manipal, Karnataka, India
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Yu M, Zhong J, Hu R, Chen X, Wang C, Xie K, Guzman M, Gui X, Kong STJ, Qu T, Eggleston K. The Impact of Catastrophic Medical Insurance in China: A five-year patient-level panel study. LANCET REGIONAL HEALTH-WESTERN PACIFIC 2021; 13:100174. [PMID: 34527979 PMCID: PMC8358690 DOI: 10.1016/j.lanwpc.2021.100174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 04/18/2021] [Accepted: 05/11/2021] [Indexed: 11/02/2022]
Abstract
Background: In an effort to provide greater financial protection from the risk of large medical expenditures, China has gradually added catastrophic medical insurance (CMI) to the various basic insurance schemes. Tongxiang, a rural county in Zhejiang province, China, has had CMI since 2000 for their employee insurance scheme, and since 2014 for their resident insurance scheme. Methods: Compiling and analysing patient-level panel data over five years, we use a difference-in-difference approach to study the effect of the 2014 introduction of CMI for resident insurance beneficiaries in Tongxiang. In our study design, resident insurance beneficiaries are the treatment group, while employee insurance beneficiaries are the control group. Findings: We find that availability of CMI significantly increases medical expenditures among resident insurance beneficiaries, including for both inpatient and outpatient spending. Despite the greater financial protection, out-of-pocket expenditures increased, in part because patients accessed treatment more often at higher-level hospitals. Interpretation: Better financial coverage for catastrophic medical expenditures led to greater access and expenditures, not only for inpatient admissions-the category that most often leads to catastrophic expenditures-but for outpatient visits as well. These patterns of expenditure change with CMI may reflect both enhanced access to a patient's preferred site of care as well as the influence of incentives encouraging more care under fee-for-service payment. Funding: Stanford University's Freeman Spogli Institute for International Studies' Policy Implementation Lab and a Shorenstein Asia Pacific Research Center faculty research award provided funding for this project. Chinese translation of the abstract (Appendix 1).
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Affiliation(s)
- Min Yu
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Jieming Zhong
- Department of NCD Control and Prevention, Zhejiang CDC, Hangzhou, China
| | - Ruying Hu
- Department of NCD Control and Prevention, Zhejiang CDC, Hangzhou, China
| | - Xiangyu Chen
- Department of NCD Control and Prevention, Zhejiang CDC, Hangzhou, China
| | - Chunmei Wang
- Tongxiang Center for Disease Control and Prevention, Tongxiang, China
| | - Kaixu Xie
- Tongxiang Center for Disease Control and Prevention, Tongxiang, China
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Fu W, Shi J, Zhang X, Liu C, Sun C, Du Y, Wang H, Liu C, Lan L, Zhao M, Yang L, Bao B, Cao S, Zhang Y, Wang D, Li N, Chen W, Dai M, Liu G, He J. Effects of cancer treatment on household impoverishment: a multicentre cross-sectional study in China. BMJ Open 2021; 11:e044322. [PMID: 34193481 PMCID: PMC8246348 DOI: 10.1136/bmjopen-2020-044322] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To determine the incidence and intensity of household impoverishment induced by cancer treatment in China. DESIGN Average income and daily consumption per capita of the households and out-of-pocket payments for cancer care were estimated. Household impoverishment was determined by comparing per capita daily consumption against the Chinese poverty line (CPL, US$1.2) and the World Bank poverty line (WBPL, US$1.9) for 2015. Both pre-treatment and post-treatment consumptions were calculated assuming that the households would divert daily consumption money to pay for cancer treatment. PARTICIPANTS Cancer patients diagnosed initially from 1 January 2015 to 31 December 2016 who had received cancer treatment subsequently. Those with multiple cancer diagnoses were excluded. DATA SOURCES A household questionnaire survey was conducted on 2534 cancer patients selected from nine hospitals in seven provinces through two-stage cluster/convenience sampling. FINDINGS 5.89% (CPL) to 12.94% (WBPL) households were impoverished after paying for cancer treatment. The adjusted OR (AOR) of post-treatment impoverishment was higher for older patients (AOR=2.666-4.187 for ≥50 years vs <50 years, p<0.001), those resided in central region (AOR=2.619 vs eastern, p<0.01) and those with lower income (AOR=0.024-0.187 in higher income households vs the lowest 20%, p<0.001). The patients without coverage from social health insurance had higher OR (AOR=1.880, p=0.040) of experiencing post-treatment household impoverishment than those enrolled with the insurance for urban employees. Cancer treatment is associated with an increase of 5.79% (CPL) and 12.45% (WBPL) in incidence of household impoverishment. The median annual consumption gap per capita underneath the poverty line accumulated by the impoverished households reached US$128 (CPL) or US$212 (WBPL). US$31 170 395 (CPL) or US$115 238 459 (WBPL) were needed to avoid household impoverishment induced by cancer treatment in China. CONCLUSIONS The financial burden of cancer treatment imposes a significant risk of household impoverishment despite wide coverage of social health insurance in China.
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Affiliation(s)
- Wenqi Fu
- Department of Health Economics, School of Health Management/Public Health, Harbin Medical University, Harbin, China
| | - Jufang 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
| | - Xin Zhang
- Department of Health Economics, School of Health Management/Public Health, Harbin Medical University, Harbin, China
| | - Chengcheng Liu
- 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
| | - Chengyao Sun
- Department of Health Economics, School of Health Management/Public Health, Harbin Medical University, Harbin, China
| | - Yupeng Du
- Department of Health Economics, School of Health Management/Public Health, Harbin Medical University, Harbin, China
| | - Hong Wang
- Department of Health Economics, School of Health Management/Public Health, Harbin Medical University, Harbin, China
| | - Chaojie Liu
- Department of Public Health, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Li Lan
- Department for Prevention and Control of Chronic Non-communicable Diseases, Harbin Center for Disease Control and Prevention, Harbin, China
| | - Min Zhao
- Department of Medical Administration, Yunnan Provincial Cancer Hospital, Kunming, China
| | - Li Yang
- Department of Preventive Medicine, School of Public Health, Guangxi Medical University, Nanning, China
| | - Burenbatu Bao
- Department of Hematology and Oncology, Affiliated Hospital of Inner Mongolia University for Nationalities, Tongliao, China
| | - Sumei Cao
- Department of Cancer Prevention, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yongzhen Zhang
- Department of Epidemiology, Shanxi Provincial Cancer Hospital, Taiyuan, China
| | - DeBin Wang
- Health Management College, Anhui Medical University, Hefei, China
| | - Ni Li
- 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
| | - Wanqing 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
| | - Min Dai
- 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
| | - Guoxiang Liu
- Department of Health Economics, School of Health Management/Public Health, Harbin Medical University, Harbin, China
| | - Jie He
- 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
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Lin H, Chen M, Zheng Y, Yun Q, Chang C. The association of workplace health education with smoking-related behaviour and unequal gains by job position in China: ABWMC programme findings. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2021; 16:56. [PMID: 34193205 PMCID: PMC8247140 DOI: 10.1186/s13011-021-00392-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/15/2021] [Indexed: 11/21/2022]
Abstract
Background Although the Chinese government has introduced a series of regulations to promote tobacco-related health education in workplaces, their implementation has been far from satisfactory. The aim of the present study was to explore the association of company-level tobacco-related health education and employee smoking behaviour. Methods Data from the 2018 Asia Best Workplace Mainland China programme were used to address these aims. This was a cross-sectional study that included 14,195 employees from 79 companies in mainland China. Spearman correlation tests were used to examine unadjusted correlations between the study variables, and binary logistic regression was used for multivariable analysis. The dependent variables included smoking-related variables or health information-seeking behaviour. The explanatory variable was the company-level tobacco-related health education. Results Tobacco-related health education was associated with better smoking harm awareness (OR = 2.23; 95% CI = 1.94–2.56), lower second-hand smoke exposure (OR = 0.73; 95% CI = 0.66–0.81), better perception of the workplace environment (OR = 2.04; 95% CI = 1.84–2.26) and positive health information-seeking behaviour (OR = 2.07; 95% CI = 1.86–2.30). Job position interacted with health education, suggesting that the positive association of health education was lower for general employees than employees who held an administrative position. Conclusions Tobacco-related health education is not only associated with lower SHS exposure but also related to more positive environmental perceptions and health attitudes, and these effects are significant for higher-ranking employees. Policy makers should recognize and reduce these potential health disparities.
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Affiliation(s)
- Haoxiang Lin
- Department of Social Medicine and Health Education, School of Public Health, Peking University Health Science Center, 38 Xueyuan Rd, Haidian District, Beijing, China
| | - Meijun Chen
- Department of Social Medicine and Health Education, School of Public Health, Peking University Health Science Center, 38 Xueyuan Rd, Haidian District, Beijing, China
| | - Yunting Zheng
- Department of Social Medicine and Health Education, School of Public Health, Peking University Health Science Center, 38 Xueyuan Rd, Haidian District, Beijing, China
| | - Qingping Yun
- Department of Social Medicine and Health Education, School of Public Health, Peking University Health Science Center, 38 Xueyuan Rd, Haidian District, Beijing, China
| | - Chun Chang
- Department of Social Medicine and Health Education, School of Public Health, Peking University Health Science Center, 38 Xueyuan Rd, Haidian District, Beijing, China.
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Qin VM, Zhang Y, Chia KS, McPake B, Zhao Y, Hulse ESG, Legido-Quigley H, Lee JT. Temporal trends and variation in out-of-pocket expenditures and patient cost sharing: evidence from a Chinese national survey 2011-2015. Int J Equity Health 2021; 20:143. [PMID: 34147106 PMCID: PMC8214288 DOI: 10.1186/s12939-021-01480-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 05/25/2021] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES This study aims to examine: (1) temporal trends in the percentage of cost-sharing and amount of out-of-pocket expenditure (OOPE) from 2011 to 2015; (2) factors associated with cost-sharing and OOPE; and (3) the relationships between province-level economic development and cost-sharing and OOPE in China. SETTING A total of 10,316 adults aged ≥45 years from China followed-up from 2011 to 2015 were included in the analysis. We measured two main outcome variables: (1) patient cost sharing, measured by the percentage of OOPE as total healthcare expenditure, and (2) absolute amount of OOPE. RESULTS Based on self-reported data, we did not find substantial differences in the percentage of cost sharing, but a significant increase in the absolute amount of OOPE among the middle-aged and older Chinese between 2011 and 2015. The percentage of cost-sharing was considerably higher for outpatient than inpatient care, and the majority paid more than 80% of the total cost for prescription drugs. Provinces with higher GDP per capita tend to have lower cost-sharing and a higher OOPE than their counterparts, but the relationship for OOPE became insignificant after adjusting for individual factors. CONCLUSION Reducing out-of-pocket expenditure and patient cost sharing is required to improve financial protection from illness, especially for those with those with chronic conditions and reside in less developed regions in China. Ongoing monitoring of financial protection using data from various sources is warranted.
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Affiliation(s)
- Vicky Mengqi Qin
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
| | - Yuting Zhang
- Melbourne Institute, Applied Economic & Social Research, Faculty of Business and Economics, University of Melbourne, Melbourne, Victoria, Australia
| | - Kee Seng Chia
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Barbara McPake
- Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Yang Zhao
- Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Emily S G Hulse
- Centre for Health Policy, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Helena Legido-Quigley
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - John Tayu Lee
- Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Public Health Policy Evaluation Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
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Liu C, Liu ZM, Nicholas S, Wang J. Trends and determinants of catastrophic health expenditure in China 2010-2018: a national panel data analysis. BMC Health Serv Res 2021; 21:526. [PMID: 34051762 PMCID: PMC8164806 DOI: 10.1186/s12913-021-06533-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 05/13/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Catastrophic health expenditures (CHE) are out-of-pocket payments (OOP) that exceed a predefined percentage or threshold of a household's resources, usually 40 %, that can push households into poverty in China. We analyzed the trends in the incidence and intensity, and explored the determinants, of CHE, and proposed policy recommendation to address CHE. METHODS A unique 5-year national urban-rural panel database was constructed from the China Family Panel Studies (CFPS) surveys. CHE incidence was measured by calculating headcount (percentage of households incurring CHE to the total household sample) and intensity was measured by overshoot (degree by which an average out of pocket health expenditure exceeds the threshold of the total sample). A linear probability model was employed to assess the trend in the net effect of the determinants of CHE incidence and a random effect logit model was used to analyse the role of the characteristics of the household head, the household and household health utilization on CHE incidence. RESULTS CHE determinants vary across time and geographical location. From 2010 to 2018, the total, urban and rural CHE incidence all showed a decreasing tend, falling from 14.7 to 8.7 % for total households, 12.5-6.6 % in urban and 16.8-10.9 % in rural areas. CHE intensity decreased in rural (24.50-20.51 %) and urban (22.31-19.57 %) areas and for all households (23.61-20.15 %). Inpatient services were the most important determinant of the incidence of CHE. For urban households, the random effect logit model identified household head (age, education, self-rated health); household characteristics (members 65 + years, chronic diseases, family size and income status); and healthcare utilization (inpatient and outpatient usage) as determinants of CHE. For rural areas, the same variables were significant with the addition of household head's sex and health insurance. CONCLUSIONS The incidence and intensity of CHE in China displayed a downward trend, but was higher in rural than urban areas. Costs of inpatient service usage should be a key intervention strategy to address CHE. The policy implications include improving the economic level of poor households, reforming health insurance and reinforcing pre-payment hospital insurance methods.
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Affiliation(s)
- Cai Liu
- School of Management, Tianjin University of Traditional Chinese Medicine, 301617 Tianjin, China
| | - Zhao-min Liu
- Jining Medical University, 669 Xueyuan Road, Donggang District, 276826 Rizhao City, Shandong Province China
| | - Stephen Nicholas
- Australian National Institute of Management and Commerce, 1 Central Avenue Australian Technology Park, Eveleigh, NSW 2015 Sydney, Australia
- School of Economics and School of Management, Tianjin Normal University, West Bin Shui Avenue, 300074 Tianjin, China
- Research Institute for International Strategies, Guangdong University of Foreign Studies, Baiyun Avenue North, 510420 Guangzhou, China
- Newcastle Business School, University of Newcastle, University Drive, 2308 Newcastle, NSW Australia
| | - Jian Wang
- Dong Fureng Institute of Economic and Social Development, Wuhan University, No.54 Dongsi Lishi Hutong, Dongcheng District, 100010 Beijing, China
- Center for Health Economics and Management, School of Economics and Management, Wuhan University, 299 Bayi Road, Wuchang District, 430072 Wuhan, Hubei Province China
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20
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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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21
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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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Li F, Wu Y, Yuan Q, Zou K, Yang M, Chen D. Do health insurances reduce catastrophic health expenditure in China? A systematic evidence synthesis. PLoS One 2020; 15:e0239461. [PMID: 32970740 PMCID: PMC7514005 DOI: 10.1371/journal.pone.0239461] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Accepted: 09/08/2020] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To examine the association of health insurances on catastrophic health expenditure (CHE), and compares that among different health insurances in the last two decades in China. METHODS The systematic review was conducted according to the Cochrane Handbook and reported according to PRISMA. We searched English and Chinese literature databases including PubMed, EM base, web of science, CNKI, Wan fang, VIP and CBM (Sino Med) for empirical studies on the association between health insurance and CHE from January 2000 to June 2020. Study selection, data extraction and quality appraisal were conducted by two reviewers. The secular trend of CHE rate and comparisons between population with different health insurances were conducted using meta-analysis, subgroup analysis and meta-regression. RESULTS A total of 4874 citations were obtained, and finally 30 eligible studies with 633917 participants were included. The overall CHE rate was 13.6% (95% CI: 13.1% - 14.0%) from Jan 2000 to June 2020, 12.8% (95% CI: 12.2% - 13.3%) for people with health insurance compared with 16.2% (95% CI:15.4% - 16.9%) for people without health insurance. For types of insurance, the CHE rate was 13.0% (95% CI: 12.4% - 13.6%) for people with new rural cooperative medical scheme (NCMS), 11.9% (95% CI: 9.3% - 14.5%) for urban employees health insurance (UEBMI), 12.0% (95% CI: 8.3% - 15.6%) for urban residents health insurance (URBMI), and 18.0% (95% CI: - 4.5% - 31.5%) for commercial insurance. However, the CHE rate in China has increased in the past 20 years, even adjusted for other factors. The CHE rate of people with NCMS has increased significantly more than people with UEBMI and URBMI. CONCLUSION In the past 20 years, the basic health insurance plan has reduce the rate of CHE to a certain extent, but due to the rapid increase in medical costs and the release of health needs in recent years, it masks the role of health insurance. More efforts are needed to control unreasonable medical demand and rising costs.
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Affiliation(s)
- Furong Li
- Department of Health Policy and Management, West China school of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yuxuan Wu
- Department of Health Policy and Management, West China school of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
- West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qingqing Yuan
- 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, 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, Sichuan University, Chengdu, Sichuan, China
- Faculty of Health, Art and Design, Swinbune Technology University, Melbourne, Australia
| | - Dandi Chen
- Department of Health Policy and Management, West China school of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
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