Abstract
BackgroundAlthough numerous studies examine catastrophic health expenditures (CHE) worldwide, most focus on whole populations rather than specific vulnerable groups. This study analyzes the extent, associated factors and inequality of CHE in elderly household with chronic disease patients in China.MethodsData were obtained from a nationally representative elderly household survey—the China Health and Retirement Longitudinal Study—that was conducted by the National School of Development of Peking University in 2011. An elderly household with chronic disease patients is defined by ≥ 1 chronic disease patient who is ≥ 45 years of age. CHE was measured according to the proportion of out-of-pocket health payments to non-food household expenditures. The associated factors of CHE were estimated using ordinary least square and logistic regression modeling. CHE inequality was measured according to the concentration index (CI) and its decomposition.ResultsCHE incidence and intensity were relatively high among elderly households with chronic disease patients. The main associated factors of CHE include household size, having members > 65 years, having members with ≥ 2 chronic diseases, per capita income, and elderly household members demonstrating healthcare-seeking behaviors. Healthcare insurance did not significantly affect CHE risk. Disproportionate concentration of CHE was noted among elderly households, and poor elderly households demonstrated a higher probability of experiencing CHE. Factors such as household size, per capita income, having members > 65 years, and having members with ≥ 2 chronic diseases are major and positive contributors to CHE inequality. Some inpatient and outpatient services are negatively contributed to CHE inequality,suggesting that the unequal usage of such services reduces CHE inequality among elderly households with chronic disease patients.ConclusionPolicy efforts should focus on improving financial protection and relieving the economic burden of disease in elderly households. The government should increase income subsidies and optimize social health insurance programs, thereby reducing CHE and alleviating CHE inequality among elderly households in China.
Highlights
The fundamental role of a healthcare system is to improve population health outcomes and protect households from illness-associated financial catastrophe [1]
As the threshold increased from 20% to 60% of non-food household expenditures, catastrophic health expenditures (CHE) incidence fell dramatically
CHE incidence and intensity were the greatest among rural elderly households with chronic disease patients at any given threshold, and CHE was significantly greater among elderly households with chronic disease patients in comparison with elderly households without chronic disease
Summary
The fundamental role of a healthcare system is to improve population health outcomes and protect households from illness-associated financial catastrophe [1]. Developed high-income countries, such as the United States, Germany, and Switzerland, have advanced social insurance or tax-funded health systems that protect households from catastrophic spending and reduce catastrophic incidence to < 1% (according to the 40% threshold). In many developing low- or middle-income countries, such as Vietnam and Brazil, > 10% of households experience CHE (according to the 40% threshold) because of high rates of poverty and groups that are excluded from financial risk-protection mechanisms [13]. China is facing high disease burden [14], OOP payments remain relatively high, and the overall incidence of catastrophic health expenses is about 13% (according to the 40% threshold) [15]. This study analyzes the extent, associated factors and inequality of CHE in elderly household with chronic disease patients in China
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