Multi-dimensional vulnerability analysis on catastrophic health expenditure among middle-aged and older adults with chronic diseases in China

Abstract

Objective Middle-aged and older adults are more likely to suffer from chronic diseases because of their particular health characteristics, which lead to a high incidence of catastrophic health expenditure (CHE). This study plans to analyse the different factors affecting CHE in middle-aged and older adults with chronic diseases, target the vulnerable characteristics, and suggest groups that medical insurance policies should pay more attention to. Methods The data used in this study came from the 2018 China Health and Retirement Longitudinal Study (CHARLS) database. The method of calculating the CHE was adopted from the World Health Organization (WHO). The logistic regression was used to determine the family characteristics of chronic disease in middle-aged and older adults with a high probability of incurring CHE. Results The incidence of CHE in middle-aged and older adults with chronic disease was highest in sub-poverty level families (26.20%) was lowest in wealthier level families (20.07%). Households with malignant tumours had the highest CHE incidence under any circumstances, especially if the householder had been using inpatient service in the past year. Among the comparison of CHE incidence in different types of medical insurance, the Urban and Rural Residents’ Basic Medical Insurance (URRBMI) was the highest (27.46%). The incidence of CHE was 2.73 times (95% CI 2.30–3.24) and 2.16 times (95% CI 1.81–2.57) higher among people who had used inpatient services in the past year or outpatient services in the past month than those who had not used them. Conclusions Relatively wealthy economic conditions cannot significantly reduce the financial burden of chronic diseases in middle-aged and older adults. For this particular group with multiple vulnerabilities, such as physical and social vulnerability, the high demand and utilization of health services are the main reasons for the high incidence of CHE. After achieving the goal of lowering the threshold of universal access to health services, the medical insurance system in the next stage should focus on multiple vulnerable groups and strengthen the financial protection for middle-aged and older adults with chronic diseases, especially for patients with malignant tumours.

Understanding variation in catastrophic health expenditure from socio-ecological aspect: a systematic review

“…For instance, type of illness. Studies from China, Bangladesh, Malaysia, and Kenya showed that patients having chronic disease, NCD and cancer face higher CHE [ 25 , 26 , 31 , 32 , 41 , 48 , 49 ].…”

“…Again, accessed care is another influential predictor of CHE. Studies from Iran, China, and Vietnam concluded that those who are taking inpatient care very likely face CHE [ 4 , 36 , 47 , 48 , 54 ]. Moreover, diseases for which the treatment cost is higher have higher CHE.…”

“…Again, the same study found that private facilities were unavailable in rural coastal areas, which made health care inaccessible to many. Health insurance has been identified as a protector against CHE in several studies from China, Bangladesh, Malaysia, Kenya, and Vietnam [ 4 , 20 , 24 , 48 ]. On the contrary, studies from China found that delayed or ignored inpatient treatment coverage often fails to protect patients from CHE [ 43 ].…”

Disease characteristics and hospitalization burden among older inpatients with hypertension in tertiary general hospitals in Jiangsu Province, China: a retrospective analysis

“…With the increased aging in the global population, comorbidities in older adults will become a common problem [19] that societies of all countries will face. Therefore, strategies to reduce the disease burden of older patients with comorbidities have become the focus of the governments, scienti c community, and industry [20]. The input-output research of chronic disease health management in China indicated that the input-output ratio of disease prevention is 1:11.72 [21]; especially, disease prevention can not only effectively reduce the burden of disease, but also signi cantly improve the quality of life of patients [22].…”

How to Make Primary Healthcare More Popular: Evidence from the Middle-Aged and Elderly in China

“…Among them, the number of PCIs (ρ31), the number of beds (ρ32), and the number of personnel (ρ33) characterized the capabilities of PCIs. Physical characteristics are fundamental factors that promote the use of medical resources [ 50 , 51 ], while chronic diseases and activities of daily living (ADL) are often proxy variables [ 52 , 53 ]. For hypertension, patients tend to choose PCIs [ 54 ].…”