Abstract
BackgroundPolicy interventions have been taken to protect households from facing unpredictable economic changes that may cause catastrophe in China. This study aims to estimate the change of overall proportion of households incurring catastrophic health care expenditure (CHE) and its income-related inequality in the rural areas of Shaanxi Province from 2008 to 2013.MethodsThe data were drawn from the National Household Health Service Surveys of Shaanxi Province conducted in the years 2008 and 2013. In total, 3,217 households in 2008 and 13,085 households in 2013 were selected for analysis. A “Capacity to pay” approach was used to measure the incidence of CHE. The concentration index was employed to measure the extent of income-related inequality in CHE. A decomposition method, based on a logit model, was used to decompose the concentration index into its determining components.ResultsFrom 2008 to 2013, the overall proportion of households incurring CHE dropped from 17.19 % to 15.83 %, while conversely, the inequality in facing CHE strongly increased. The majority of observed inequalities in CHE were explained by household economic status and household size in 2013. In addition, the absence of commercial health insurance and having elderly members were also important contributors to inequality in CHE.ConclusionsEven though we used a conservative method to measure CHE, the overall proportion of households incurring CHE in Shaanxi Province is still considerably high in both years. Furthermore, there exists a strong pro-rich inequality of CHE in rural areas of Shaanxi Province. Our study suggests that narrowing the gap of household economic status, improving the anti-risk capability of small scale households, establishing prepayment mechanisms in health insurance, strengthening the depth of reimbursement and subsidising vulnerable households in Shaanxi Province are helpful for both reducing the probability of incurring CHE and the pro-rich inequality in CHE.
Highlights
IntroductionThis study aims to estimate the change of overall proportion of households incurring catastrophic health care expenditure (CHE) and its income-related inequality in the rural areas of Shaanxi Province from 2008 to 2013
Policy interventions have been taken to protect households from facing unpredictable economic changes that may cause catastrophe in China
The percentage of households with all members covered by social health insurance increased sharply from 88.13 % to 97.47 %; households with chronic disease members rose from 32.73 % to 40.89 %
Summary
This study aims to estimate the change of overall proportion of households incurring catastrophic health care expenditure (CHE) and its income-related inequality in the rural areas of Shaanxi Province from 2008 to 2013. The Chinese health care system has initiated several reforms designed to eliminate access barriers to health services, millions of people are still prevented from seeking and obtaining needed health care owing to financial difficulty [1]. This is especially true in western China where the per capita income is far behind the eastern areas of China [2]. Considering the serious consequences of CHE, protecting households from CHE has been widely considered as a desirable objective of many health policies [12,13,14,15]
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