Abstract
BackgroundThe prevalence of chronic non-communicable diseases (NCDs) challenges the Chinese health system reform. Little is known for the differences in catastrophic health expenditure (CHE) between urban and rural households with NCD patients. This study aims to measure the differences above and quantify the contribution of each variable in explaining the urban-rural differences.MethodsUnbalanced panel data were obtained from the China Family Panel Studies (CFPS) conducted between 2012 and 2018. The techniques of Fairlie nonlinear decomposition and Blinder-Oaxaca decomposition were employed to measure the contribution of each independent variable to the urban-rural differences.ResultsThe CHE incidence and intensity of households with NCD patients were significantly higher in rural areas than in urban areas.The urban-rural differences in CHE incidence increased from 8.07% in 2012 to 8.18% in 2018, while the urban-rural differences in CHE intensity decreased from 2.15% in 2012 to 2.05% in 2018. From 2012 to 2018, the disparity explained by household income and self-assessed health status of household head increased to some extent. During the same period, the contribution of education attainment to the urban-rural differences in CHE incidence decreased, while the contribution of education attainment to the urban-rural differences in CHE intensity increased slightly.ConclusionsCompared with urban households with NCD patients, rural households with NCD patients had higher risk of incurring CHE and heavier economic burden of diseases. There was no substantial change in urban-rural inequality in the incidence and intensity of CHE in 2018 compared to 2012. Policy interventions should give priority to improving the household income, education attainment and health awareness of rural patients with NCDs.
Highlights
The prevalence of chronic non-communicable diseases (NCDs) challenges the Chinese health system reform
In terms of the coverage of basic medical insurance, the proportion of household head with Urban Employee Basic Medical Insurance (UEBMI) and Urban Residents Basic Medical Insurance (URBMI) was higher in urban areas than in rural areas, while the proportion of household head with New Rural Cooperative Medical Scheme (NRCMS) was higher in rural areas than in urban areas
We found that the catastrophic health expenditure (CHE) incidence of households with NCD patients in urban and rural areas were 17.96 and 26.14%, respectively, which are much higher than the results of another study on the overall proportion of households incurring CHE in China [17]
Summary
The prevalence of chronic non-communicable diseases (NCDs) challenges the Chinese health system reform. Little is known for the differences in catastrophic health expenditure (CHE) between urban and rural households with NCD patients. With the prevalence of chronic non-communicable diseases (NCDs) accompanied by accelerated population aging, increasing number of individuals worldwide will suffer from catastrophic health expenditure (CHE) in the future. A 2005 study estimated that NCDs had become the leading cause of death and disease burden in China, accounting for 80% of deaths and 70% of disability-adjusted life-years lost [4]. In 2015, NCDs contributed to 86.6% of all deaths and 70% of the total disease burden in China [5].
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