Measurement and determinants of catastrophic health expenditure among elderly households in China using longitudinal data from the CHARLS

Abstract

Background Catastrophic health expenditure (CHE) among the Chinese elderly warrants attention. However, the incidence, intensity and determinants of CHE have not been fully investigated. This study explores the incidence, intensity and determinants of CHE among elderly Chinese citizens, i.e., those aged 60 years or older. Methods Data were obtained from three waves of the China Health and Retirement Longitudinal Study (CHARLS): 2011, 2013 and 2015. The cut-off points used in this study for CHE were 10% of the total expenditures and 40% of non-food expenditure. Under the guidance of Andersen’s model of health services utilization, this study used logistic regression analysis to explore the determinants of CHE. Results The incidence of CHE defined as more than 40% of non-food expenditure rose over the study period, 2011–2015, from 20.86% (95% CI: 19.35 to 22.37%) to 31.00% (95% CI: 29.28 to 32.72%). The intensity of CHE also increased. The overshoot (O) based on non-food expenditure rose from 3.12% (95% CI: 2.71 to 3.53%) to 8.75% (95% CI: 8.14 to 9.36%), while the mean positive overshoot (MPO) rose from 14.96% (95% CI: 12.99 to 16.92%) to 28.23% (95% CI: 26.26 to 30.19%). Thus, the problem of CEH was even more serious in 2015 than in 2011. Logistic regression revealed that households were more likely to face CHE if they had a spouse as a household member, reported an inpatient event in the last year, reported an outpatient visit in the last month, were disabled, were members of a poor expenditure quartile, lived in the middle and western zones or resided in an urban area. In contrast, CEH was not significantly affected by respondents being older than 75 years or having a chronic health condition, by household size or by insurance type. Conclusions Key policy recommendations include the gradual improvement of medical assistance and the expansion of the use of health insurance to reduce household liability for health expenditures.

Catastrophic Health Expenditure Associated With Frailty in Community-Dwelling Chinese Older Adults: A Prospective Cohort Analysis

“…In our sample, the incidence of CHE at the 40% threshold among community-dwelling older adults was 21.76% in 2011 and increased to 26.46% in 2013. The increasing trend of CHE prevalence was similarly observed in other Chinese studies, which may be partly explained by the rising OOP healthcare costs over time along with the absence of effective measures to cut down expenditures or share financial risks for individuals (3,23). Several important findings are drawn from this study as follows.…”

“…A considerable number of individuals are confronted with a huge economic burden due to out-of-pocket (OOP) healthcare expenditures worldwide, and consequently, often place their families under a situation of unanticipated financial catastrophe or impoverishment ( 1 ). Although health insurance arrangements in many countries including China have achieved unprecedented progress in recent decades, particularly by expanding medical insurance coverage and increasing reimbursement benefits, their role in protecting the individuals or households from being pushed into poverty remains a challenge ( 2 , 3 ). To help quantify and deal with the financial difficulties of households resulting from healthcare costs, researchers have generally agreed on a term called “catastrophic health expenditure (CHE),” which is defined as if healthcare spending exceeds a specified level of tolerance or threshold from the capacity of the household to pay ( 4 , 5 ).…”

“…The occurrence of CHE could absorb a large proportion of the household budget and leads to the sacrifice of the consumption of daily necessities, thereby affecting household living conditions and further deteriorating individual well-being ( 4 , 5 ). Meanwhile, CHE is highly pronounced among older people, who account for the high demand for healthcare services but have limited income ( 3 , 6 ). Along with the rapid and dramatic population aging, it is thus imperative to understand the CHE prevalence and its associated risk factors among elderly people.…”

Household financial burden associated with health care for older people in Viet Nam: A cross-sectional survey

“…These results are in agreement with those observed in prior studies in other countries where health insurance schemes are not well designed and do not protect their beneficiaries from economic hardship [32,51,52]. For example, studies have shown that Chinese health insurance programmes had undesirable outcomes and did not protect the insured from financial catastrophic and medical impoverishment, especially the older population [30,53]and those with NCDs [54,55]. There are several possible explanations for these findings.…”

“…Such findings imply that having older people in a household predispose it to financial catastrophe. This contention is widely supported by evidence from previous studies in Viet Nam [10,24,28] and low-and middle-income countries [29][30][31][32]. Using data from the Viet Nam Household Living Standards Survey, two studies concluded that the presence of older adults in a household was significantly correlated with higher rates of CHE [10,28].…”