Abstract
Background: In moving toward universal health coverage in China, it is crucial to identify which populations should be prioritized for which interventions rather than blindly increasing welfare packages or capital investments. We identify the characteristics of vulnerable groups from multiple perspectives through estimating catastrophic health expenditure (CHE) and recommend intervention priorities.Methods: Data were from National Health Service Survey conducted in 2003, 2008, and 2013. According to the recommendation of WHO, this study adopted 40% as the CHE threshold. A binary regression was used to identify the determinants of CHE occurrence; a probit model was used to obtain CHE standardized incidence under the characteristics of single and two dimensions in 2013.Results: The total incidence of CHE in 2013 was 13.9%, which shows a general trend of growth from 2003 to 2013. Families in western and central regions and rural areas were more at risk. Factors related to social demography show that households with a female or an unmarried head of household or with a low socioeconomic status were more likely to experience CHE. Households with older adults aged 60 and above had 1,524 times higher likelihood of experiencing CHE. Among the health insurance schemes, the participants covered by the New Rural Cooperative Medical Scheme had the highest risk compared with the participants of all basic health insurance schemes. Households with several members seeking outpatient, inpatient care or with non-communicable diseases were more likely to experience CHE. Households with members not seeing a doctor or hospitalized despite the need for it were more likely to experience CHE. Characteristics such as a household head with characteristics related to low socioeconomic status, having more than two hospitalized family members, ranked high. Meanwhile, the combination of having illiterate household heads and with being covered by other health insurance plans or by none ranked the first place. Cancer notably caused a relatively high medical expenditure among households with CHE.Conclusion: In China, considering the vulnerability of the population across different dimensions is conducive to the alleviation of high CHE. Furthermore, people with multiple vulnerabilities should be prioritized for intervention. Identifying and targeting them to offer help and support will be an effective approach.
Highlights
Throughout the 40 years of “reform and opening up” of China, the country has progressed remarkably in terms of socioeconomic development
This study investigated and identified the high catastrophic health expenditure (CHE) incidence group from the perspective of the region, family structure, socioeconomic status, medical insurance, and needs and utilization of health services
Households located in western regions and rural areas were more vulnerable, and several provinces located in the eastern regions had a considerably high CHE incidence, owing to overutilization
Summary
Throughout the 40 years of “reform and opening up” of China, the country has progressed remarkably in terms of socioeconomic development. In addition to its economic progress, China has accelerated its goal of improved universal health coverage (UHC). The funding is from the contribution of an individual and the government; the Urban Resident Basic Medical Insurance (URBMI), launched 4 years after NCMS, was designed for urban residents not covered by UEBMI or NCMS, including primary and secondary school students, young children, and other unemployed urban residents. It is on a voluntary basis at the household level, and is sponsored by the government and an individual. We identify the characteristics of vulnerable groups from multiple perspectives through estimating catastrophic health expenditure (CHE) and recommend intervention priorities
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