Catastrophic Health Expenditure Incidence and Its Equity in China: A Study on the Initial Implementation of the Medical Insurance Integration System

Abstract

Introduction: By 2013, several regions in China have introduced health insurance integration policies. However, few studies have addressed the impact of medical insurance integration in China. This study investigates catastrophic health expenditure and equity in the incidence of catastrophic health expenditure by addressing its potential determinants in both integrated areas and non-integrated areas in China in 2013. Methods: The primary data are drawn from the fifth China National Health Services Survey in 2013. The final sample comprises 19,788 households (38.4%) from integrated areas and 31,797 households (61.6%) from non-integrated areas. A probit model is employed to decompose the inequality of the incidence of catastrophic health expenditure in line with the methodology used for decomposing the concentration index. Results: The incidence of catastrophic health expenditure in integrated areas is higher than in non-integrated areas (13.87% vs. 13.68%, respectively). The concentration index in integrated areas and non-integrated areas is -0.071 and -0.073, respectively. Average household out-of-pocket health expenditure and average capacity to pay in integrated areas are higher than in non-integrated areas. However, households in integrated areas have lower out-of-pocket expenditures share in capacity to pay than households in non-integrated areas. The majority of the observed inequalities in catastrophic health expenditure can be explained by differences in the health insurance and householders’ educational attainment both in integrated areas and non-integrated areas. However, compared with non-integrated areas, the inequity caused by integrated medical insurance has been significantly reduced in integrated areas. Conclusions: The medical insurance integration system in China is still at the exploring stage; hence, its effects are of limited significance. Regardless of the area, catastrophic health expenditure is associated with pro-poor inequality. Medical insurance, urban-rural disparities, the elderly population, and the use of health services significantly affect the equity of catastrophic health expenditure incidence. Keywords: Catastrophic health expenditure, Medical insurance integration system, Equity, Influencing factors

Catastrophic health expenditure: a community-based study in Sarawak, Malaysia

“…Our study found that catastrophic health expenditure was more likely to be high among males than females, which is consistent with Moradhvaj et al and Liu et al 28,30 The possible explanation might be the type of illness like chronic disease and duration of hospitalisation. A similar finding was reported in Iran, with a significant relationship between chronic disease and catastrophic health expenditure.…”

“…Those having family members of 5 or fewer were more likely to incur catastrophic health expenditures. [25][26][27][28] Li et al in China reported that a large family with at least one young member appeared to be a protective factor. 8 However, our study found a likelihood of CHE with a family size five and above at the 10% level.…”

“…Our finding is consistent with Kang et al in Korea and Liu et al in China. 28,32 Although the study was designed with a large sample size covering most of the ethnic groups in Sarawak still, most of the ethnic groups in the study were from rural areas, and the urban and Chinese populations were under-reported. Thus, the results might have limited generalisability.…”

The Impact of Catastrophic Medical Insurance in China: A five-year patient-level panel study

“…Despite such policy changes, prior research has been inconclusive about the impact of CMI on out-of-pocket spending. [4] , [5] , [6] , [7] , [8] , [9] Such mixed impacts may be expected when patients with improved insurance choose to seek care at higher-level providers, with an ambiguous impact of higher utilization on their out-of-pocket share of expenditures.…”