- Title
- Trends and determinants of catastrophic health expenditure in China 2010–2018: a national panel data analysis
- Creator
- Liu, Cai; Liu, Zhao-min; Nicholas, Stephen; Wang, Jian
- Relation
- BMC Health Services Research Vol. 21, Issue 1, no. 526
- Publisher Link
- http://dx.doi.org/10.1186/s12913-021-06533-x
- Publisher
- BioMed Central
- Resource Type
- journal article
- Date
- 2021
- Description
- Background: Catastrophic health expenditures (CHE) are out-of-pocket payments (OOP) that exceed a predefined percentage or threshold of a household’s resources, usually 40 %, that can push households into poverty in China. We analyzed the trends in the incidence and intensity, and explored the determinants, of CHE, and proposed policy recommendation to address CHE. Methods: A unique 5-year national urban-rural panel database was constructed from the China Family Panel Studies (CFPS) surveys. CHE incidence was measured by calculating headcount (percentage of households incurring CHE to the total household sample) and intensity was measured by overshoot (degree by which an average out of pocket health expenditure exceeds the threshold of the total sample). A linear probability model was employed to assess the trend in the net effect of the determinants of CHE incidence and a random effect logit model was used to analyse the role of the characteristics of the household head, the household and household health utilization on CHE incidence. Results: CHE determinants vary across time and geographical location. From 2010 to 2018, the total, urban and rural CHE incidence all showed a decreasing tend, falling from 14.7 to 8.7 % for total households, 12.5–6.6 % in urban and 16.8–10.9 % in rural areas. CHE intensity decreased in rural (24.50–20.51 %) and urban (22.31–19.57 %) areas and for all households (23.61–20.15 %). Inpatient services were the most important determinant of the incidence of CHE. For urban households, the random effect logit model identified household head (age, education, self-rated health); household characteristics (members 65 + years, chronic diseases, family size and income status); and healthcare utilization (inpatient and outpatient usage) as determinants of CHE. For rural areas, the same variables were significant with the addition of household head’s sex and health insurance. Conclusions: The incidence and intensity of CHE in China displayed a downward trend, but was higher in rural than urban areas. Costs of inpatient service usage should be a key intervention strategy to address CHE. The policy implications include improving the economic level of poor households, reforming health insurance and reinforcing pre-payment hospital insurance methods.
- Subject
- catastrophic health expenditures; out-of-pocket expenses; health insurance; China; SDG 1; Sustainable Development Goals
- Identifier
- http://hdl.handle.net/1959.13/1457661
- Identifier
- uon:45365
- Identifier
- ISSN:1472-6963
- Rights
- © Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
- Language
- eng
- Full Text
- Reviewed
- Hits: 917
- Visitors: 976
- Downloads: 60
Collections
Goal 1: No Poverty
| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | ATTACHMENT02 | Publisher version (open access) | 984 KB | Adobe Acrobat PDF | View Details Download |