Targeting vulnerable groups of health poverty alleviation in rural China— what is the role of the New Rural Cooperative Medical Scheme for the middle age and elderly population?

Wang, Nianshi; Xu, Jing; Ma, Meiyan; Shan, Linghan; Jiao, Mingli; Xia, Qi; Tian, Wanxin; Xi-yu, Zhang; Liu, Limin; Hao, Yanhua; Gao, Lijun; Wu, Qunhong; Li, Ye

doi:10.1186/s12939-020-01236-x

Cited by 22 publications

(20 citation statements)

References 27 publications

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“…Firstly, we did observe that the incidence of CHE in rural China displayed an upward trend. Although it was consistent with related literature [3,9,[21][22][23][24][25], it was unexpected because policies were implemented in this period to reduce the incidence of CHE. For instance, in 2013, China's central government launched the strategy of Targeted Poverty Alleviation (TPA) to prevent people from being reduced to poverty by health expenditure and other reasons.…”

Section: Discussionsupporting

confidence: 89%

“…For instance, in 2013, China's central government launched the strategy of Targeted Poverty Alleviation (TPA) to prevent people from being reduced to poverty by health expenditure and other reasons. TPA aimed to get 83 million rural poor people out of poverty, which was de ned as under the national absolute poverty line of 2,300 yuan per capita in 2010 by the end of 2020 [23,26]. TPA, therefore, was of great value to innovating the poverty alleviation methods for rural households.…”

Section: Discussionmentioning

confidence: 99%

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Catastrophic health expenditure and its inequality in rural China: evidence from 2013-2018 CHARLS

ZHang

Min

et al. 2022

Preprint

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Background: Catastrophic health expenditure (CHE) is an important indicator for measuring health inequality. Previous studies mainly focused on whole populations rather than specific vulnerable groups through the regional survey or cross-sectional data. China’s rural area is often associated with an underdeveloped economy and insufficient health resources. This study aims to update the information on the extent and trends in incidence and inequality of CHE among the households of rural China through CHARLS panel data. Methods：Data were obtained from three waves of the China Health and Retirement Longitudinal Study (CHARLS): 2013, 2015, and 2018. CHE was defined as the proportion of household health expenditures to the non-food expenditure more than 40% threshold. The inequality of CHE was measured by the concentration index. Decomposition methods were used to decompose the concentration index into its determining components. Results：The incidence of CHE was 23.41% (95% CI: 0.22, 0.25) in 2013, 21.36% (95% CI: 0.20, 0.23) in 2015 and 28.97% (95% CI: 0.27, 0.31) in 2018 in rural households. The concentration index was negative: -0.1528 (95% CI: -0.1941, -0.1115) in 2013, -0.1010 (95% CI: -0.1442, -0. 0577) in 2015 and -0.0819 (95% CI: -0.1170, -0.0467) in 2018. Economic status, age, and chronic disease were the main contributors to the inequality of CHE. Conclusions：The incidence of CHE in rural households of China displayed an upward trend. Furthermore, there existed a strong pro-poor inequality of CHE in rural China. Economic status, age, and chronic diseasewere the main contributors to the pro-poor inequality. Health policies to allocate resources and services are needed to satisfy the needs of rural households and provide more accessible and affordable health services. More concerns need to be directed toward households with chronic diseases and households with the elderly. Meanwhile, policymakers need to pay more attention to relieving the incidence of CHE and promoting health equality.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Catastrophic health expenditure and its inequality in rural China: evidence from 2013-2018 CHARLS

ZHang

Min

et al. 2022

Preprint

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“…However, we did not find any significant effects of the different insurance programs in their role of protecting households from CHE in comparison with those without any insurance. The new rural cooperative medical scheme has long been criticized for its limited role, if any, in alleviating household poverty induced by medical expenses ( 57 ). Although the integration of health insurance for urban and rural residents may help reduce the urban-rural disparity ( 53 , 58 ), the overall level of insurance entitlements remains to be low in comparison with the basic medical insurance for urban employees ( 26 ).…”

Section: Discussionmentioning

confidence: 99%

Multimorbidity and catastrophic health expenditure: Evidence from the China Health and Retirement Longitudinal Study

Chang

Zheng

et al. 2022

Front. Public Health

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BackgroundPopulation aging accompanied by multimorbidity imposes a great burden on households and the healthcare system. This study aimed to determine the incidence and determinants of catastrophic health expenditure (CHE) in the households of old people with multimorbidity in China.MethodsData were obtained from the China Health and Retirement Longitudinal Study (CHARLS) conducted in 2018, with 3,511 old people (≥60 years) with multimorbidity responding to the survey on behalf of their households. CHE was identified using two thresholds: ≥10% of out-of-pocket (OOP) health spending in total household expenditure (THE) and ≥40% of OOP health spending in household capacity to pay (CTP) measured by non-food household expenditure. Logistic regression models were established to identify the individual and household characteristics associated with CHE incidence.ResultsThe median values of THE, OOP health spending, and CTP reached 19,900, 1,500, and 10,520 Yuan, respectively. The CHE incidence reached 31.5% using the ≥40% CTP threshold and 45.6% using the ≥10% THE threshold. It increased by the number of chronic conditions reported by the respondents (aOR = 1.293–1.855, p < 0.05) and decreased with increasing household economic status (aOR = 1.622–4.595 relative the highest quartile, p < 0.001). Hospital admissions over the past year (aOR = 6.707, 95% CI: 5.186 to 8.674) and outpatient visits over the past month (aOR = 4.891, 95% CI: 3.822 to 6.259) of the respondents were the strongest predictors of CHE incidence. The respondents who were male (aOR = 1.266, 95% CI: 1.054 to 1.521), married (OR = 1.502, 95% CI: 1.211 to 1.862), older than 70 years (aOR = 1.288–1.458 relative to 60–69 years, p < 0.05), completed primary (aOR = 1.328 relative to illiterate, 95% CI: 1.079 to 1.635) or secondary school education (aOR = 1.305 relative to illiterate, 95% CI: 1.002 to 1.701), lived in a small (≤2 members) household (aOR = 2.207, 95% CI: 1.825 to 2.669), and resided in the northeast region (aOR = 1.935 relative to eastern, 95% CI: 1.396 to 2.682) were more likely to incur CHE.ConclusionMultimorbidity is a significant risk of CHE. Household CHE incidence increases with the number of reported chronic conditions. Socioeconomic and regional disparities in CHE incidence persist in China.

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“…Comorbidities, which are common for older adults 40 , 41 , may also complicate clinical symptoms of infection, leading to delays in seeking treatment and diagnosis 42 , 43 . Other possible explanations include loss of social connection and interaction 44 , 45 , ageism 46 and tendency of self-medication 47 , 48 .…”

Section: Discussionmentioning

confidence: 99%

Health-seeking and diagnosis delay and its associated factors: a case study on COVID-19 infections in Shaanxi Province, China

Zheng

Kämpfen

Huang

2021

Sci Rep

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This time-to-event study examines social factors associated with health-seeking and diagnosis of 165 COVID-19 cases in response to the pandemic spread in Shaanxi Province, China. In particular, we investigate the differential access to healthcare in terms of delayed time from symptom onset to first medical visit and subsequently to diagnosis by factors such as sex, age, travel history, and type of healthcare utilization. We show that it takes more time for patients older than 60 (against those under 30) to seek healthcare after developing symptoms (+ 2.5 days, $$p<0.01$$ p < 0.01 ), surveillance on people with living or travel history to Wuhan helps shorten the time to the first doctor visit (− 0.8 days) and diagnosis (− 2.2 days, $$p<0.01$$ p < 0.01 ). A delay cut is associated with the adoption of intermediary and large hospitals rather than community-based care as primary care choices (− 1.6 days, $$p<0.1$$ p < 0.1 and − 2.2 days, $$p<0.05$$ p < 0.05 ). One unit increase of healthcare workers per 1000 people saves patients 0.5 days ($$p<0.1$$ p < 0.1 ) for diagnosis from the first doctor visit and 0.6 days ($$p<0.05$$ p < 0.05 ) in total. Our analysis of factors associated with the time delay for diagnosis may provide a better understanding of the health-seeking behaviors of patients and the diagnosis capacity of healthcare providers during the COVID-19 pandemic.

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Targeting vulnerable groups of health poverty alleviation in rural China— what is the role of the New Rural Cooperative Medical Scheme for the middle age and elderly population?

Cited by 22 publications

References 27 publications

Catastrophic health expenditure and its inequality in rural China: evidence from 2013-2018 CHARLS

Catastrophic health expenditure and its inequality in rural China: evidence from 2013-2018 CHARLS

Multimorbidity and catastrophic health expenditure: Evidence from the China Health and Retirement Longitudinal Study

Health-seeking and diagnosis delay and its associated factors: a case study on COVID-19 infections in Shaanxi Province, China

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