Abstract
ObjectiveTo examine the association of health insurances on catastrophic health expenditure (CHE), and compares that among different health insurances in the last two decades in China.MethodsThe systematic review was conducted according to the Cochrane Handbook and reported according to PRISMA. We searched English and Chinese literature databases including PubMed, EM base, web of science, CNKI, Wan fang, VIP and CBM (Sino Med) for empirical studies on the association between health insurance and CHE from January 2000 to June 2020. Study selection, data extraction and quality appraisal were conducted by two reviewers. The secular trend of CHE rate and comparisons between population with different health insurances were conducted using meta-analysis, subgroup analysis and meta-regression.ResultsA total of 4874 citations were obtained, and finally 30 eligible studies with 633917 participants were included. The overall CHE rate was 13.6% (95% CI: 13.1% - 14.0%) from Jan 2000 to June 2020, 12.8% (95% CI: 12.2% - 13.3%) for people with health insurance compared with 16.2% (95% CI:15.4% - 16.9%) for people without health insurance. For types of insurance, the CHE rate was 13.0% (95% CI: 12.4% - 13.6%) for people with new rural cooperative medical scheme (NCMS), 11.9% (95% CI: 9.3% - 14.5%) for urban employees health insurance (UEBMI), 12.0% (95% CI: 8.3% - 15.6%) for urban residents health insurance (URBMI), and 18.0% (95% CI: - 4.5% - 31.5%) for commercial insurance. However, the CHE rate in China has increased in the past 20 years, even adjusted for other factors. The CHE rate of people with NCMS has increased significantly more than people with UEBMI and URBMI.ConclusionIn the past 20 years, the basic health insurance plan has reduce the rate of CHE to a certain extent, but due to the rapid increase in medical costs and the release of health needs in recent years, it masks the role of health insurance. More efforts are needed to control unreasonable medical demand and rising costs.
Highlights
Every year, about 150 million people in the world spend heavily on health care, and 100 million people are pushed below the poverty line [1]
The overall catastrophic health expenditure (CHE) rate was 13.6% from Jan 2000 to June 2020, 12.8% for people with health insurance compared with 16.2% for people without health insurance
The CHE rate was 13.0% for people with new rural cooperative medical scheme (NCMS), 11.9% for urban employees health insurance (UEBMI), 12.0% for urban residents health insurance (URBMI), and 18.0% for commercial insurance
Summary
About 150 million people in the world spend heavily on health care, and 100 million people are pushed below the poverty line [1]. "it is difficult and expensive to seek medical adviser", has become public concern in the Chinese society [2]. Research found that in 2003, 2008 and 2013, 13.6%,15.1% and 13.8% of households had catastrophic health expenditure (CHE) in China, respectively, of which the poverty rate due to illness was 8.6%. The households with CHE spent an average of 64% of their non-survival expenditure on medical expenses, suggesting the severity of this problem [3]. In order to solve this problem, the Chinese government has made unremitting efforts and made a series of policies involving three basic health insurance schemes, increasing the proportion of reimbursement, making national essential drug lists system, and expanding reimbursement scope of health insurance of new treatments to improve the level of financial protection
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