Measuring financial protection for health in families with chronic conditions in Rural China

Abstract

BackgroundAs the world’s largest developing country, China has entered into the epidemiological phase characterized by high life expectancy and high morbidity and mortality from chronic diseases. Cardiovascular diseases, chronic obstructive pulmonary diseases, and malignant tumors have become the leading causes of death since the 1990s. Constant payments for maintaining the health status of a family member who has chronic diseases could exhaust household resources, undermining fiscal support for other necessities and eventually resulting in poverty. The purpose of this study is to probe to what degree health expenditure for chronic diseases can impoverish rural families and whether the New Cooperative Medical Scheme can effectively protect families with chronic patients against catastrophic health expenditures.MethodsWe used data from the 4th National Health Services Survey conducted in July 2008 in China. The rural sample we included in the analysis comprised 39,054 households. We used both households suffering from medical impoverishment and households with catastrophic health expenditures to compare the financial protection for families having a chronic patient with different insurance coverage statuses. We used a logistic regression model to estimate the impact of different benefit packages on health financial protection for families having a chronic patient.ResultsAn additional 10.53% of the families with a chronic patient were impoverished because of healthcare expenditure, which is more than twice the proportion in families without a chronic patient. There is a higher catastrophic health expenditure incidence in the families with a chronic patient. The results of logistic regression show that simply adding extra benefits did not reduce the financial risks.ConclusionsThere is a lack of effective financial protection for healthcare expenditures for families with a chronic patient in rural China, even though there is a high coverage rate with the New Cooperative Medical Schemes. Given the coming universal coverage by the New Cooperative Medical Scheme and the increasing central government funds in the risk pool, effective financial protection for families should be possible through systematic reform of both financing mechanisms and payment methods.

The economic burden of chronic non-communicable diseases in rural Malawi: an observational study

“…These findings, which rely on direct costs for CNCDs aggregated at the household level, support findings from our previous work, which pointed at the regressivity of individual out-of-pocket expenditure on CNCDs [45]. These findings are also consistent with prior analyses of catastrophic spending, which included chronic conditions as an explanatory variable in models targeting the overall economic burden due to ill health in SSA [14, 15] and in LMICs more in general [28, 39, 42, 50, 51]. These studies had already indicated how suffering from a chronic condition represented an important determinant of catastrophic spending.…”

Medical security and catastrophic health expenditures among households containing persons with disabilities in Korea: a longitudinal population-based study

“…Health-related factors affecting CHE in our study included self-rated health and chronic those, similar to the results of previous studies on persons with no disability [24, 25] and persons with a disability and chronic diseases [26–28]. If a household includes a person with chronic diseases, they would be likely to continually incur medical expenses that may be increased by expenses not covered by health insurance.…”

Protecting patients with cardiovascular diseases from catastrophic health expenditure and impoverishment by health finance reform

“…NCMS plus NEMS was a protective factor of CHE and impoverishment. Similar to households with hospitalised members, households with income below the poverty line had significantly higher odds of CHE, and having household members aged over 60 was significant risk factor of incurring impoverishment, as demonstrated in prior studies .…”

“…Nowadays, health finance reform is implemented in many countries to minimise OOP payments, especially for poor people or those with chronic diseases [8,9]. Due to limited financial budgets, most health insurances provide protection against healthcare expenditures of inpatient services only [9,10]. However, those who have chronic diseases need frequent outpatient services and medication; thus, well-planned health financial reform is important [9,11,12].…”