Catastrophic health expenditure incidence and its equity in China: a study on the initial implementation of the medical insurance integration system

Huan Liu,Baohua Liu,Zheng Kang,Linghan Shan,Jiahui Wang,Lijun Gao,Qunhong Wu,Mingli Jiao,Miaomiao Zhao,Ruohui Chen,Hong Zhu,Xinye Qi,Ning Ning,Lin Pan

doi:10.1186/s12889-019-8121-2

Abstract

BackgroundBy 2013, several regions in China had introduced health insurance integration policies. However, few studies addressed the impact of medical insurance integration in China. This study investigates the catastrophic health expenditure and equity in the incidence of catastrophic health expenditure by addressing its potential determinants in both integrated and non-integrated areas in China in 2013.MethodsThe primary data are drawn from the fifth China National Health Services Survey in 2013. The final sample comprises 19,788 households (38.4%) from integrated areas and 31,797 households (61.6%) from non-integrated areas. A probit model is employed to decompose inequality in the incidence of catastrophic health expenditure in line with the methodology used for decomposing the concentration index.ResultsThe incidence of catastrophic health expenditure in integrated areas is higher than in non-integrated areas (13.87% vs. 13.68%, respectively). The concentration index in integrated areas and non-integrated areas is − 0.071 and − 0.073, respectively. Average household out-of-pocket health expenditure and average capacity to pay in integrated areas are higher than those in non-integrated areas. However, households in integrated areas have lower share of out-of-pocket expenditures in the capacity to pay than households in non-integrated areas. The majority of the observed inequalities in catastrophic health expenditure can be explained by differences in the health insurance and householders’ educational attainment both in integrated areas and non-integrated areas.ConclusionsThe medical insurance integration system in China is still at the exploratory stage; hence, its effects are of limited significance, even though the positive impact of this system on low-income residents is confirmed. Moreover, catastrophic health expenditure is associated with pro-poor inequality. Medical insurance, urban-rural disparities, the elderly population, and use of health services significantly affect the equity of catastrophic health expenditure incidence and are key issues in the implementation of future insurance integration policies.

Highlights

By 2013, several regions in China had introduced health insurance integration policies
Catastrophic health expenditure At a 40% threshold, the poorest households face the highest proportion of catastrophic health expenditure (CHE) occurrence compared with other quintiles, both in Integrated area (IA) and Non-integrated area (NIA); the concentration index (CI) is negative both in IAs and NIAs, suggesting that inequality in CHE is biased toward low-income people
The absolute value of the CI is slightly lower for IA households than NIA households

Summary

Introduction

By 2013, several regions in China had introduced health insurance integration policies. Few studies addressed the impact of medical insurance integration in China. Catastrophic health expenditure (CHE) represents out-of-pocket (OOP) payments for health care exceeds a specified threshold of household’s income or household’s capacity to pay (CTP) [1,2,3]. OA et al defined CHE as direct OOP medical costs exceeding 10% of the monthly household income [2]. The World Health Organization (WHO) defined financial catastrophe as the OOP expenditure exceeding 40% of the household income net of subsistence needs [3]. Surveys in 89 countries, covering 89% of the world’s population, suggested that 150 million people globally suffer financial catastrophes every year due to OOP medical costs [4]. According to a cross-sectional study, in 2008, about 13% of families experienced CHE in China [9]

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Discussion

Conclusion