A 25-Year Trend of Catastrophic Health Expenditure and Its Inequality in China: Evidence from Longitudinal Data

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.

Understanding financial risk protection in China’s health system: a descriptive analysis using data from multiple national household surveys

“…These results remained robust when using other thresholds (results available upon request). Existing literature also found that residency, income, and household family size were correlated with the incidence of CHE and MI [ 9 , 13 , 26 ].…”

Provincial variations in catastrophic health expenditure and medical impoverishment in China: a nationwide population-based study

“…These results were comparable with findings from previous studies using other data sources. 8 , 39 Fig. 1 shows the provincial variations in the incidence of CHE and MI in 2017.…”

“… 8 Another study using data from the China Health and Nutrition Survey applied total net household income as the denominator, and showed that the incidence of CHE using the 40% threshold was around 9% in 2015. 39 All these estimates suggest large margins for improvements in financial protection in China, although China has achieved laudable progress during the past 20 years. More importantly, we found large variations in financial risk protection within the nation.…”

The Study of Catastrophic Health Expenditure (CHE) for Hospitalization in Urban Kerala

“…Thus, a potential solution to decrease the burden of paying for OOPE is to consider through universal health insurance [1,2]. The effect of health system nancing on the welfare of households, mainly those economically disadvantaged, has in uenced the development of health systems and insurance mechanisms in various countries, such as the USA, Australia, India, and Indonesia [25]. In order to achieve universal health coverage (UHC), it is essential to rely on prepaid health spending and pool nancial risks.…”