Abstract
Background: To provide an updated estimate of the level and change in catastrophic health expenditure in China and examine the association between catastrophic health expenditure and family net income, we obtained data from four waves of the China Family Panel Studies conducted between 2010 and 2016. Method: We defined catastrophic health expenditure as out-of-pocket payments equaling or exceeding 40% of the household’s capacity to pay. The Poisson regression with robust variance and generalized estimated equation (Poisson-GEE) model was used to quantify the level and change of catastrophic health expenditure, as well as the association between catastrophic heath expenditure and family net income. Result: Overall, the incidence of catastrophic expenditure in China experienced a 0.70-fold change between 2010 (12.57%) and 2016 (8.94%). The incidence of catastrophic health expenditure (CHE) decreased more in the poorest income quintile than the richest income quintile (annual decrease of 1.17% vs. 0.24% in urban areas, p < 0.001; 1.64% vs. −0.02% in rural areas, p < 0.001). Every 100% increase in income was associated with a 14% relative-risk reduction in CHE (RR = 0.86, 95% CI: 0.85–0.88) after adjusting for demographics, health needs, and health utilization characteristics; this association was weaker in recent years. Conclusion: Our analysis found that China made progress to reduce catastrophic health expenditure, especially for poorer groups. Income growth is strongly associated with this change.
Highlights
Around the world, there is an increasing commitment to achieving universal health coverage (UHC) [1]
To provide a more complete perspective of catastrophic health expenditure, we reported CHE calculations based on total household expenditure (Table S1) and the of-pocket health expenditures (OOP) budget share (OOP as the proportion of total household expenditure, Table S2)
Between 2010 and 2016, the mean family net income in China increased by 63.7% from 33069.51
Summary
There is an increasing commitment to achieving universal health coverage (UHC) [1]. In the context of China, the world’s largest developing economy, the progress in access to health services co-occurs with the challenges of financial protection [6]. This phenomenon is consistent with findings from other developing countries [2,3]. Using data up to the first decade of the 21st century, China was listed as one of the bottom countries regarding catastrophic health expenditure (CHE)—the official Sustainable Development Goals(SDG) indicator of financial protection [7]—while being one of the upper–middle performers in health service coverage [4].
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