Does the medical insurance system play a real role in reducing catastrophic economic burden in elderly patients with cardiovascular disease in China? Implication for accurately targeting vulnerable characteristics

Meiyan Ma,Qi Xia,Qunhong Wu,Tao Sun,Heng Li,Linghan Shan,Han Gao,Ye Li,Jian Kang,Baoguo Shi,Xiyu Zhang,Yuze Li,Wenqing Miao,Yiyun Zhang,Yanhua Hao,Nianshi Wang,Xuelian Fu,Wanxin Tian

doi:10.1186/s12992-021-00683-7

Abstract

BackgroundThe vulnerability of cardiovascular disease (CVD) patients’ health abilities, combined with the severity of the disease and the overlapping risk factors, leads such people to bear the economic burden of the disease due to the medical services. We estimated the economic burden of CVD and identified the weak link in the design of the medical insurance.MethodsData from 5610 middle-aged and elderly with CVD were drawn from the 2015 wave of “China Health and Retirement Longitudinal Study” (CHARLS). The recommended method of the “World Health Organization” (WHO) was adopted to calculate “catastrophic health expenditure” (CHE), “impoverishment by medical expenses” (IME), and applied the treatment-effect model to analyze the determinants of CHE.ResultsThe incidence of CHE was 19.9% for the elderly families with CVD members, which was 3.6% higher than for uninsured families (16.3%). Families with CVD combined with > 3 other chronic diseases (38.88%) were the riskiest factor for the high CHE in the new rural cooperative medical system (NCMS). Moreover, families with members > 75 years old (33.33%), having two chronic disease (30.74%), and families having disabled members (33.33%), hospitalization members (32.41%) were identified as the high risky determinants for the high CHE in NCMS.ConclusionsElderly with physical vulnerabilities were more prone to CHE. The medical insurance only reduced barriers to accessing health resources for elderly with CVD; however it lacked the policy inclination for high-utilization populations, and had poorly accurate identification of the vulnerable characteristics of CVD, which in turn affects the economic protection ability of the medical insurance. The dispersion between the multiple medical security schemes leads to the existence of blind spots in the economic risk protection of individuals and families.

Highlights

Aging, rapid urbanization, and shifting disease patterns are causing cardiovascular disease (CVD) to become established as one of the primary diseases in the worl d[1, 2]
We found that as the family size increased for CVD patients, the risk of households being trapped in catastrophic health expenditure” (CHE) and impoverishment by medical expenses (IME) was reduced
With the inheritance of the traditional concept of supporting the elderly in China, the larger family size is the protective factor for CHE First, our results reveal that family size is a protective factor, that is, the larger the family size, the lower the risk of suffering catastrophic health expenditure

Summary

Introduction

Rapid urbanization, and shifting disease patterns are causing cardiovascular disease (CVD) to become established as one of the primary diseases in the worl d[1, 2]. As of 2015, 290 million people were suffering from CVD in China, including more than 9.5 million cases of heart disease [5]. Between 1990 and 2013, the total number of CVD deaths increased by 46% in China, mainly due to population aging [6]. The increasing trend of CVD has brought a heavy economic burden to the world at a global the population and householdlevel [7]. The vulnerability of cardiovascular disease (CVD) patients’ health abilities, combined with the severity of the disease and the overlapping risk factors, leads such people to bear the economic burden of the disease due to the medical services. We estimated the economic burden of CVD and identified the weak link in the design of the medical insurance

Methods

Results

Discussion

Conclusion