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.

Because of economic reform, dietary pattern in China changed rapidly during the past two decades. Meanwhile, the changes of income and nutrients intake had the same trend. This study aims to measure the income-related inequality in daily nutrients intake and its health-related income mobility over time. Data was sourced from four waves of China Health and Nutrition Survey. Concentration indexes and health-related income mobility indexes were employed to measure the income-related inequality of nutrients intake and its change over time. This study found that the daily protein intake, daily fat intake, daily energy intake, and proportion of energy from fat over 30% were more concentrated on the rich, whereas daily carbohydrates intake among the poor. The income-related inequalities were more severe than the cross-sectional perspective in the long run. The dynamic change of urbanisation indexes has resulted that over 30% of energy from fat was more concentrated among the rich and carbohydrates intake among the poor. The nutrition transition may bring about more severe disease economic burden to the poor in the future. This study recommends an approach to minimize gaps between rural and city areas by promoting rural revitalization to reduce the income-related inequality in daily nutrient intake.

Background：The Chinese health care system has gone through two major cycles of reform since the 1980s. This study aims to comprehensively track the trends in the occurrence of catastrophic health payment and its inequality in the past 15 years, which may help better understand the influence of health system reforms on catastrophic health payment and its inequality. Methods：The study employed the subset of data from China Health and Nutrition Survey conducted from 1991 to 2015. Concentration index and decomposition analysis were used to measure the magnitude of income-related inequality in catastrophic health payment and decompose it into determinants respectively. Results: The incidence of catastrophic health expenditure 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 catastrophic health payment between the richest and poorest became increasingly wider over year. Moreover, the adjusted concentration indexes were all negative in each year, decreasing from -0.202 in 1991 to -0.613 in 2015. The basic medical insurance didn’t decrease the incidence of catastrophic health payment and showed the second largest contribution on the inequality in catastrophic health payment before 2004. However, this contribution began to decline after 2006. Conclusions: After the New Health Care Reform, although the Chinese government has taken many measures to protect poor households from catastrophic health payment, the incidence gap between the rich and poor has widened. China has nearly achieved universal coverage in recent years, however, the basic medical insurance in China was not enough to protect households from catastrophic health payment. Our study suggests that improving the generosity of existing basic medical insurance, and reforming the medical insurance payment system would be helpful to reduce the incidence of catastrophic health payment. 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 pro-rich inequality in catastrophic health payment.

Background：The Chinese health care system has gone through two major cycles of reform since the 1980s.This study aims to comprehensively track the trends in the occurrence of catastrophic health payment and its inequality in the past 15 years, which may help better understand the influence of health system reforms on catastrophic health payment and its inequality. Methods：The study employed the subset of data from China Health and Nutrition Survey conducted from 1991 to 2015. Concentration index and decomposition analysis were used to measure the magnitude of income-related inequality in catastrophic health payment and decompose it into determinants respectively. Results:The incidence of catastrophic health expenditure 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 catastrophic health payment between the richest and poorest became increasingly wider over year. Moreover, the adjusted concentration indexes were all negative in each year, decreasing from -0.202 in 1991 to -0.613 in 2015. The basic medical insurance didn't decrease the incidence of catastrophic health payment and showed the second largest contribution on the inequality in catastrophic health payment before 2004. However, this contribution began to decline after 2006. Conclusions:After the New Health Care Reform, although the Chinese government has taken many measures to protect poor households from catastrophic health payment, the incidence gap between the rich and poor has widened. China has nearly achieved universal coverage in recent years, however, the basic medical insurance in China was not enough to protect households from catastrophic health payment. Our study suggests that improving the generosity of existing basic medical insurance, and reforming the medical insurance payment system would be helpful to reduce the incidence of catastrophic health payment. 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 pro-rich inequality in catastrophic health payment.

Background:This study aimed to investigate the income-related inequality of food preference and its mobility in the long run, and to quantify the determinants’ contributions of socioeconomic inequality mobility in food preference in China.Methods:The data were sourced from the China Health and Nutrition Survey (CHNS) conducted in 2006, 2009, 2011 and 2015, respectively. A study sample of 3940 adults were included for analysis. Five preselected questions were used to construct a summary food preference index. Cross-sectional and longitudinal concentration indices were used to measure the income-related inequality in food preference at a certain time and for a period, respectively. Health-related income mobility index was used to measure the gap between cross-sectional and longitudinal income-related health inequality concentration indices. Decomposition analysis was used to decompose income mobility index into its determinants.Results:The mean scores of food preference increased from 17.641 in 2006 to 18.881 in 2015. The richest people had the highest mean scores of food preference compared to other income groups in each year. Age, gender, income, education, and dietary knowledge score were positively associated with healthy food preference. The concentration indices of food preference score on income in each year were all positive, indicating that there was pro-rich inequality in food preference score with the rich having higher preference scores in each period. The income mobility index of food preference was -0.1426 after 4 periods, indicating that the degree of pro-rich inequality in food preference was larger than that at the baseline in the long run. Decomposition analysis showed that being married and living in Western China made healthy food preference more concentrated among the rich in the long run. Whereas increasing age and dietary knowledge contributed to making healthy food preference behavior less concentrated among the rich in the long run.Conclusions:The cross-sectional measure of food preference score inequality was underestimated in the long run. Our study suggests that people with decreased income could be taken as targeted population in future public intervention measures, and narrowing the regional gap between Eastern and Western China could be strengthened in future Chinese policies.