Effect of Critical Illness Insurance on Household Catastrophic Health Expenditure: The Latest Evidence from the National Health Service Survey in China.

Anqi Li,Xue Yang,Zhonghua Wang,Yeliang Shi

doi:10.3390/ijerph16245086

Abstract

Background: China fully implemented the critical illness insurance (CII) program in 2016 to alleviate the economic burden of diseases and reduce catastrophic health expenditure (CHE). With an aging society, it is necessary to analyze the extent of CHE among Chinese households and explore the effect of CII and other associated factors on CHE. Methods: Data were derived from the Sixth National Health Service Survey (NHSS, 2018) in Jiangsu Province. The incidence and intensity of CHE were calculated with a sample of 3660 households in urban and rural areas in Jiangsu Province, China. Logistic regression and multiple linear regression models were used for estimating the effect of CII and related factors on CHE. Results: The proportion of households with no one insured by CII was 50.08% (1833). At each given threshold, from 20% to 60%, the incidence and intensity were higher in rural households than in urban ones. CII implementation reduced the incidence of CHE but increased the intensity of CHE. Meanwhile, the number of household members insured by CII did not affect CHE incidence but significantly decreased CHE intensity. Socioeconomic factors, such as marital status, education, employment, registered type of household head, household income and size, chronic disease status, and health service utilization, significantly affected household CHE. Conclusions: Policy effort should further focus on appropriate adjustments, such as dynamization of CII lists, medical cost control, increasing the CII coverage rate, and improving the reimbursement level to achieve the ultimate aim of using CII to protect Chinese households against financial risk caused by illness.

Highlights

In response to the call of the World Health Organization (WHO) and to promote population health status, many countries are exerting effort to achieve universal health coverage (UHC), which is a majorSustainable Development Goal
Policy effort should further focus on appropriate adjustments, such as dynamization of critical illness insurance (CII) lists, medical cost control, increasing the CII coverage rate, and improving the reimbursement level to achieve the ultimate aim of using CII to protect Chinese households against financial risk caused by illness
Regarding the associated factors of catastrophic health expenditure (CHE) in Jiangsu Province, we found that households with a low education householder, lower household income, members with ≥2 chronic diseases, and utilizing outpatient and inpatient services have a higher likelihood of CHE incidence, which is in accordance with other studies [3,31,32,33,34]

Summary

Introduction

In response to the call of the World Health Organization (WHO) and to promote population health status, many countries are exerting effort to achieve universal health coverage (UHC), which is a majorSustainable Development Goal. The BMI system consists of urban employee basic medical insurance, urban resident medical insurance (URMI), new rural cooperative medical scheme (NRCMS), and the urban and rural medical assistance system These basic medical insurance plans cover about 97% of the population (over 1.3 billion Chinese), which enabled China to achieve near UHC [2]. The number of household members insured by CII did not affect CHE incidence but significantly decreased CHE intensity. Socioeconomic factors, such as marital status, education, employment, registered type of household head, household income and size, chronic disease status, and health service utilization, significantly affected household CHE

Methods

Results

Discussion

Conclusion