Evaluation of current health expenditures of adolescents and its financial burdens in China: a quantitative analysis

Abstract

BackgroundAfter being neglected for decades, increasing international attention has been focused on adolescent health. Data for adolescent health financing is needed to inform policies to allocate adequate resources, set strategic priorities, and ensure sustainable funding for adolescent health programmes and strategies. To prepare and inform national adolescent health and development strategies in China, we aimed to quantify and describe adolescents' current health expenditures, and to determine the financial burden to provide a framework for policy discussion. MethodsWe did a quantitative analysis of current health expenditures of adolescents in China. We collected primary data for adolescent health expenditures and service provision from ad-hoc institution surveys, and secondary data, such as national aggregate expenditures and government programmes, over 2014. On the basis of the principles and definitions of the System of Health Accounts 2011, we used a top-down approach to estimate adolescent health expenditures in China, and examined it by multiple dimensions, including financing schemes, health providers, health functions, and diseases that were based on primary diagnosis. FindingsThe adolescents' current health expenditures amounted to CNY82·1 billion, or 2·6% of the current health expenditures for the whole population in China. In per capita terms, adolescent health expenditures were CNY525, which were less than the average amount of the whole population (CNY2349). The expenditures mainly occurred in hospitals (56·7%), whereas primary health-care institutions shared a smaller portion (10·5%). Curative care represented the largest share of the total adolescent health expenditures, approximately 73·1% of the total expenditures. Adolescent health expenditures was mainly financed by household out-of-pocket payment, accounting for 57·9%. Respiratory, digestive, and genitourinary diseases, injury and poisoning, and neoplasms accounted for 59·8% of adolescent curative care expenditures. InterpretationMedical financing burden on households was substantial; allocation of medical resources remained irrational. Health interventions targeting key diseases need to be intensified to avoid or decrease the occurrence of related health expenditures in adolescents. FundingHong Kong Committee for UNICEF.