Catastrophic Health Expenditures and its Inequality in Rural Poor Households in China

Abstract

Background：Catastrophic health expenditure (CHE) is an important indicator to measure health equity. Reducing risk of CHE and breaking vicious cycle between poverty and poor health are original intentions of medical security system design in various countries. This paper fulfills a research gap on CHE and its inequality in Chinese rural poor households.Methods：Based on 2018 China Health and Retirement Longitudinal Study Data (CHARLS), Logit and Tobit regression models were used to analyze CHE incidence and intensity among rural poor households, and its socioeconomic inequality.Results：The results showed that CHE incidence of rural poor households was 28.20%, and the average intensity was 0.076. For rural poor households, CHE incidence and intensity were higher than those in non-poor households at each given threshold from 20% to 60%. Socioeconomic factors including household size, chronic disease status, disability status, health service utilization, whether to have older adults ≥ 65 significantly associated with household CHE. Conclusions：Although China's social health insurance has almost achieved universal coverage, CHE incidence of rural poor households still remains high. A more refined health insurance policy with expanding current benefits packages, increasing reimbursement level is essential for protecting rural poor households from incurring CHE. Policy makers should also establish a new medical assistance system based on healthcare expenditure, which can effectively relieve medical economy burden of rural impoverished households.