Abstract
China has achieved universal social health insurance coverage, but it is unclear whether this has alleviated the economic burden of disease for individuals. This was investigated in the present study by analyzing National Health Service Survey (2008–2018) data from Jiangsu province. Ordinary least squares and binary multivariate logistic regression of pooled cross-sectional data were carried out to evaluate the effect of universal health insurance coverage and other socioeconomic factors on the economic burden of disease. Total health expenses (THE) first increased and then decreased during the survey period while out-of-pocket health expenses (OOP) decreased except for urban residents, for whom OOP increased after 2013. Household catastrophic health expenditure (HCHE) was stable between 2008 and 2013 but increased after 2013. Social health insurance had a significant positive effect on the annual THE and OOP and a negative effect on HCHE, however, universal health insurance coverage could alleviated THE and the economic burden of disease on individuals (OOP) while it was insufficient to protect against the economic risk of diseases (HCHE), with greater benefits for urban as compared to rural residents. Other socioeconomic factors including age, marital status, education, income, and health status also influenced the economic burden of disease.
Highlights
In 2013, the World Health Organization (WHO) put forth the concept of universal health coverage, which aims to ensure that all people can access good quality health services without falling into poverty [1]
The effect was more pronounced in rural areas, possibly reflecting their inferior living conditions compared to urban residents
of-pocket health expenses (OOP) was significantly lower for respondents older than 60 years than for those aged ≤30 years, which differs from the results of another study [49]
Summary
In 2013, the World Health Organization (WHO) put forth the concept of universal health coverage, which aims to ensure that all people can access good quality health services without falling into poverty [1]. Medical expenses can directly affect the economic burden of disease on individuals, which can adversely impact their health status. Since the Decision on Establishing the Basic Medical Insurance System for Urban Workers in 1998, China’s social health insurance system has made great progress in terms of coverage rate, which increased from 21% in 2003 [6] to more than 95% in 2020 [7]. The current health insurance system framework in China consists of Urban Employees’ Medical Insurance, Urban Residents’ Medical Insurance (URMI), and New Rural Cooperative Medical Scheme (NCMS). In January 2016, the General Office of the State Council issued the Opinions on Integrating the Basic Medical Insurance System for Urban and Rural Residents, which proposed merging URMI and NCMS into Urban and Rural Residents’ Medical Insurance
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