Abstract
Background: Medical debt is a persistent global issue and a crucial and effective indicator of long-term family medical financial burden. This paper fills a research gap on the incidence and causes of medical debt in Chinese low- and middle-income households. Method: Data were obtained from the 2015 China Household Finance Survey, with medical debt measured as borrowings from families, friends and third parties. Tobit regression models were used to analyze the data. The concentration index was employed to measure the extent of socioeconomic inequality in medical debt incidence. Results: We found that 2.42% of middle-income families had medical debt, averaging US$6278.25, or 0.56 times average household yearly income and 3.92% of low-income families had medical debts averaging US$5419.88, which was equivalent to 2.49 times average household yearly income. The concentration index for low and middle-income families’ medical debt was significantly pro-poor. Medical debt impoverished about 10% of all non-poverty households and pushed poverty households deeper into poverty. While catastrophic health expenditure (CHE) was the single most important factor in medical debt, age, education, and health status of householder, hospitalization and types of medical insurance were also significant factors determining medical debt. Conclusions: Using a narrow definition of medical debt, the incidence of medical debt in Chinese low- and middle-income households was relatively low. But, once medical debt happened, it imposed a long-term financial burden on medical indebted families, tipping many low and middle-income households into poverty and imposing on households several years of debt repayments. Further studies need to use broader definitions of medical debt to better assess the long-term financial impact of medical debt on Chinese families. Policy makers need to modify China’s basic medical insurance schemes to manage out-of-pocket, medical debt and CHE and to take account of pre-existing medical debt.
Highlights
It is no secret that bad health and bad debts often coincide
There are few international studies on health insurance, medical debt and poverty. To address this gap in the Chinese medical debt-poverty literature, this paper explores the impact of medical debt on the financial welfare of middle- and low-income families across China
In addition to catastrophic health expenditure (CHE), we found that health status, working conditions, hospitalization and medical insurance of middle-aged people were crucial factors determining medical debt for middleand low-income families
Summary
It is no secret that bad health and bad debts often coincide. A large and growing worldwide problem, medical debt imposes financial hardship on household budgets. Ability to pay for that care, even among families with adequate health insurance coverage [2]. Large medical bills impose an additional sizable burden on those who are already economically fragile, where financially stretched households and households that are uninsured or underinsured can be pushed into long-term personal debt, bankruptcy and poverty [4]. One survey found that 44% of American families with medical debt exhausted their savings to service outstanding medical bills, and many of them traded medical debt for other types of debt [3]. Medical debt is a persistent global issue and a crucial and effective indicator of long-term family medical financial burden. Method: Data were obtained from the 2015 China Household Finance Survey, with medical debt measured as borrowings from families, friends and third parties. The concentration index was employed to measure the extent of socioeconomic inequality in medical debt incidence
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