Catastrophic health expenditure incidence and its equity in China: a study on the initial implementation of the medical insurance integration system

Abstract Background By 2013, several regions in China had introduced health insurance integration policies. However, few studies addressed the impact of medical insurance integration in China. This study investigates the catastrophic health expenditure and equity in the incidence of catastrophic health expenditure by addressing its potential determinants in both integrated and non-integrated areas in China in 2013. Methods The primary data are drawn from the fifth China National Health Services Survey in 2013. The final sample comprises 19,788 households (38.4%) from integrated areas and 31,797 households (61.6%) from non-integrated areas. A probit model is employed to decompose inequality in the incidence of catastrophic health expenditure in line with the methodology used for decomposing the concentration index. Results The incidence of catastrophic health expenditure in integrated areas is higher than in non-integrated areas (13.87% vs. 13.68%, respectively). The concentration index in integrated areas and non-integrated areas is − 0.071 and − 0.073, respectively. Average household out-of-pocket health expenditure and average capacity to pay in integrated areas are higher than those in non-integrated areas. However, households in integrated areas have lower share of out-of-pocket expenditures in the capacity to pay than households in non-integrated areas. The majority of the observed inequalities in catastrophic health expenditure can be explained by differences in the health insurance and householders’ educational attainment both in integrated areas and non-integrated areas. Conclusions The medical insurance integration system in China is still at the exploratory stage; hence, its effects are of limited significance, even though the positive impact of this system on low-income residents is confirmed. Moreover, catastrophic health expenditure is associated with pro-poor inequality. Medical insurance, urban-rural disparities, the elderly population, and use of health services significantly affect the equity of catastrophic health expenditure incidence and are key issues in the implementation of future insurance integration policies.

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Catastrophic Health Expenditure Incidence and Its Equity in China: A Study on the Initial Implementation of the Medical Insurance Integration System

10.21203/rs.2.11043/v2 ◽

2019 ◽

Author(s):

huan liu ◽

hong zhu ◽

jiahui wang ◽

xinye qi ◽

miaomiao zhao ◽

...

Keyword(s):

Health Insurance ◽

Health Services ◽

Low Income ◽

Health Expenditure ◽

Concentration Index ◽

Medical Insurance ◽

Catastrophic Health Expenditure ◽

Integration System ◽

Integration Policies ◽

The Impact

Abstract Introduction: By 2013, several regions in China had introduced health insurance integration policies. However, few studies addressed the impact of medical insurance integration in China. This study investigates the catastrophic health expenditure and equity in the incidence of catastrophic health expenditure by addressing its potential determinants in both integrated and non-integrated areas in China in 2013. Methods: The primary data are drawn from the fifth China National Health Services Survey in 2013. The final sample comprises 19,788 households (38.4%) from integrated areas and 31,797 households (61.6%) from non-integrated areas. A probit model is employed to decompose inequality in the incidence of catastrophic health expenditure in line with the methodology used for decomposing the concentration index. Results: The incidence of catastrophic health expenditure in integrated areas is higher than in non-integrated areas (13.87% vs. 13.68%, respectively). The concentration index in integrated areas and non-integrated areas is -0.071 and -0.073, respectively. Average household out-of-pocket health expenditure and average capacity to pay in integrated areas are higher than those in non-integrated areas. However, households in integrated areas have lower share of out-of-pocket expenditures in the capacity to pay than households in non-integrated areas. The majority of the observed inequalities in catastrophic health expenditure can be explained by differences in the health insurance and householders’ educational attainment both in integrated areas and non-integrated areas. Conclusions: The medical insurance integration system in China is still at the exploratory stage; hence, its effects are of limited significance, even though the positive impact of this system on low-income residents is confirmed. Moreover, catastrophic health expenditure is associated with pro-poor inequality. Medical insurance, urban-rural disparities, the elderly population, and use of health services significantly affect the equity of catastrophic health expenditure incidence and are key issues in the implementation of future insurance integration policies. Keywords: Catastrophic health expenditure, Medical insurance integration system, Equity, Influencing factors

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Catastrophic Health Expenditure Incidence and Its Equity in China: A Study on the Initial Implementation of the Medical Insurance Integration System

10.21203/rs.2.11043/v1 ◽

2019 ◽

Author(s):

huan liu ◽

hong zhu ◽

jiahui wang ◽

xinye qi ◽

miaomiao zhao ◽

...

Keyword(s):

Health Insurance ◽

Health Services ◽

Health Expenditure ◽

Concentration Index ◽

Medical Insurance ◽

The Elderly ◽

Catastrophic Health Expenditure ◽

Primary Data ◽

Integration System ◽

The Impact

Abstract Introduction: By 2013, several regions in China have introduced health insurance integration policies. However, few studies have addressed the impact of medical insurance integration in China. This study investigates catastrophic health expenditure and equity in the incidence of catastrophic health expenditure by addressing its potential determinants in both integrated areas and non-integrated areas in China in 2013. Methods: The primary data are drawn from the fifth China National Health Services Survey in 2013. The final sample comprises 19,788 households (38.4%) from integrated areas and 31,797 households (61.6%) from non-integrated areas. A probit model is employed to decompose the inequality of the incidence of catastrophic health expenditure in line with the methodology used for decomposing the concentration index. Results: The incidence of catastrophic health expenditure in integrated areas is higher than in non-integrated areas (13.87% vs. 13.68%, respectively). The concentration index in integrated areas and non-integrated areas is -0.071 and -0.073, respectively. Average household out-of-pocket health expenditure and average capacity to pay in integrated areas are higher than in non-integrated areas. However, households in integrated areas have lower out-of-pocket expenditures share in capacity to pay than households in non-integrated areas. The majority of the observed inequalities in catastrophic health expenditure can be explained by differences in the health insurance and householders’ educational attainment both in integrated areas and non-integrated areas. However, compared with non-integrated areas, the inequity caused by integrated medical insurance has been significantly reduced in integrated areas. Conclusions: The medical insurance integration system in China is still at the exploring stage; hence, its effects are of limited significance. Regardless of the area, catastrophic health expenditure is associated with pro-poor inequality. Medical insurance, urban-rural disparities, the elderly population, and the use of health services significantly affect the equity of catastrophic health expenditure incidence. Keywords: Catastrophic health expenditure, Medical insurance integration system, Equity, Influencing factors

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Changes in Catastrophic Health Expenditures Depending on Health Policies in Turkey

Frontiers in Public Health ◽

10.3389/fpubh.2020.614449 ◽

2021 ◽

Vol 8 ◽

Author(s):

Guvenc Kockaya ◽

Gülpembe Oguzhan ◽

Zafer Çalşkan

Keyword(s):

Health Services ◽

Health Expenditure ◽

Positive Impact ◽

Health Expenditures ◽

Catastrophic Health Expenditure ◽

Health Policies ◽

World Health ◽

Positive Health ◽

Catastrophic Health Expenditures ◽

The Impact

Without any financial protection out of pocket health expenses are essential both because their increase causes difficulties in accessing higher quality health services for households and more importantly because it complicates access to most basic health services. As a result of the Health Transformation Program in practice in the Turkish healthcare system since 2003, significant changes have been done in all layers of the health system. Turkish Statistics Institute (TurkStat) publishes the ratio of households that bear catastrophic health expenditures since 2002. According to TurkStat data, the ratio of households with catastrophic expenditure has fallen from 0.81% in 2002 to 0.17% in 2011 with the health transformation project. However, it has started to rise since 2012 and has reached 0.31% in 2014. This study aims to evaluate the expenditure items that may have caused the rise of the ratio of households with catastrophic health expenditures since 2012, which had previously dropped with the Health Transformation Program that has caused fundamental changes in health policies. Methodology and definitions presented in the article named “Distribution of health payments and catastrophic expenditures: Methodology” by Ke Xu published by the World Health Organization in 2005 have been used. Percentages of health expenditure items among the total expenditure of households with positive health expenditure and households with catastrophic health expenditure between 2007 and 2014 have been evaluated using descriptive analysis. Findings have been interpreted in light of the health policies in practice between 2007 and 2014. An overview of the impact of the health policies reveals that medicine expenditures have decreased both for household and public health expenditures. Despite the impact of policies on the pharmaceutical industry was criticized by the industry, the positive impact can be seen by the decrease in the spending on medicine for households spending on health. Hospital service with positive health expenditure is seen to decrease health expenditure. The reasons for the increase in households with catastrophic health expenditure need further research. As a result, the study strives to discuss the possible policy reasons for the observed effects.

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Unmet Healthcare Needs, Catastrophic Health Expenditure, and Health in South Korea’s Universal Healthcare System: Progression Towards Improving Equity by NHI Type and Income Level

Healthcare ◽

10.3390/healthcare8040408 ◽

2020 ◽

Vol 8 (4) ◽

pp. 408 ◽

Cited By ~ 1

Author(s):

Minsung Sohn ◽

Xianhua Che ◽

Hee-Jung Park

Keyword(s):

Health Insurance ◽

Health Status ◽

Low Income ◽

Health Expenditure ◽

Income Level ◽

Catastrophic Health Expenditure ◽

Poor Health ◽

Medical Aid ◽

Healthcare Needs ◽

Unmet Healthcare Needs

This study examined the effects of healthcare inequality on personal health. It aimed to determine how health insurance type and income level influence catastrophic health expenditure and unmet healthcare needs among South Koreans. Unbalanced Korean Health Panel data from 2011 to 2015, including 33,374 adults, were used. A time-trend and panel regression analysis were performed. The first to identify changes in the main variables and, the second, mediating effects of unmet healthcare needs and catastrophic health expenditure on the relationship between health insurance type, income level, and health status. The independent variables were: high-, middle-, low-income employee insured, high-, middle-, low-income self-employed insured, and medical aid. The dependent variable was health status, and the mediators were unmet needs and catastrophic health expenditure. The medical aid beneficiaries and low-income self-employed insured groups demonstrated a higher probability of reporting poor health status than the high-income, insured group (15.6%, 2.2%, and 2.3%, respectively). Participants who experienced unmet healthcare needs or catastrophic health expenditure were 10.7% and 5.6% higher probability of reporting poor health, respectively (Sobel test: p < 0.001). National policy reforms could improve healthcare equality by integrating insurance premiums based on income among private-sector employees and self-employed individuals within the health insurance network.

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Are People Enrolled in NCMS and CURBMI Susceptible in Catastrophic Health Expenditure? Evidence From China

INQUIRY The Journal of Health Care Organization Provision and Financing ◽

10.1177/0046958020919282 ◽

2020 ◽

Vol 57 ◽

pp. 004695802091928

Author(s):

Xinpeng Xu ◽

Hai Gu ◽

Hua You ◽

Lan Bai ◽

Decheng Li ◽

...

Keyword(s):

Low Income ◽

Health Expenditure ◽

Medical Insurance ◽

Catastrophic Health Expenditure ◽

New Cooperative Medical Scheme ◽

Basic Medical Insurance ◽

Medical Institutions ◽

Significant Difference ◽

Cooperative Medical Scheme ◽

Basic Medical

This study investigated associations between different types of medical insurance and the incidence of catastrophic health expenditure among middle-aged and the aged in China. The data came from the China Health and Retirement Longitudinal Survey implemented in 2013, with 9782 individuals analyzed. Probit regression models and multiple linear regressions were employed to explore the relationship mentioned above and potential mechanisms behind it. It was found that compared with participants in Urban Resident Basic Medical Insurance, individuals participating in New Cooperative Medical Scheme and Coordinating Urban and Rural Basic Medical Insurance was less likely to undergo catastrophic health expenditure ( P < .001, P = .008), especially for low-income and middle-income group. Participants in New Cooperative Medical Scheme and Coordinating Urban and Rural Basic Medical Insurance were more likely to utilize inpatient medical service ( P < .001, P = .020) and choose low-level medical institutions for treatment ( P = .003, P = .006). And individuals participating in New Cooperative Medical Scheme had lower out-of-pocket expenditure ( P = .034). The study showed the significant difference in the incidence of catastrophic health expenditure among participants in different medical insurances. Efforts should be made to improve the service quality of grassroots medical institutions except for the increase of reimbursement ratio, so that rural residents can enjoy high-quality medical services.

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The Impact of i-PUSH on Maternal and Child Health Outcomes, Health Care Utilization and Financial Protection: A Cluster Randomised Controlled Trial Based on Financial and Health Diaries Data

10.21203/rs.3.rs-62882/v1 ◽

2020 ◽

Author(s):

Amanuel Abajobir ◽

Richard de Groot ◽

Caroline Wainaina ◽

Anne Njeri ◽

Daniel Maina ◽

...

Keyword(s):

Health Care ◽

Health Insurance ◽

Health Services ◽

Low Income ◽

Health Knowledge ◽

Care Utilization ◽

Quality Health ◽

Randomised Controlled ◽

The Impact ◽

Quality Health Services

Abstract Background: Universal Health Coverage (UHC) ensures access to quality health services for all, with no financial hardship when accessing the needed services. Nevertheless, access to quality health services is marred by substantial resource shortages creating service delivery gaps in low-and middle-income countries (LMICs), including Kenya. The Innovative Partnership for Universal Sustainable Healthcare (i-PUSH) program, developed by AMREF Health Africa and PharmAccess Foundation (PAF), aims to empower low-income women of reproductive age and their families through innovative digital tools. This study aims to evaluate the impact of i-PUSH on maternal and child health care utilization, women’s health including their knowledge, behavior and uptake of respective services, as well as women’s empowerment and financial protection. It also aims to evaluate the impact of the LEAP training tool on empowering and enhancing CHVs’ health literacy and to evaluate the impact of the M-TIBA health wallet on savings for health and health insurance uptake.Methods: This is a cluster randomised controlled trial (RCT) study that uses a four-pronged approach –including year-long weekly financial and health diaries interviews, baseline and endline surveys, a qualitative study and behavioral lab-in-the-field experiments–in Kakemega County, Kenya. In total, 240 households from 24 villages in Kakamega will be followed to capture their health, health knowledge, health-seeking behavior, health expenditures and enrolment in health insurance over time. A random half of the households live in villages assigned to the treatment group where i-PUSH will be implemented after the baseline, while the other half of the households live in control village where i-PUSH will not be implemented until after the endline. The study protocol was reviewed and approved by the AMREF Ethical and Scientific Review Board (AMREF-ESRC). Research permits were obtained from the National Commission for Science, Technology and Innovation (NACOSTI) agency of Kenya. Discussion: People in LMICs often suffer from high out-of-pocket healthcare expenditures, which in turn, impedes access to quality health services. Saving for healthcare as well as enrolment in health insurance can improve access to healthcare by building capacities at all levels–individuals, families and communities. Notable, i-PUSH fosters savings for health care through the mobile-phone based “health wallet”, it enhances enrolment in subsidized health insurance through the mobile platform–M-TIBA–developed by PAF, and it seeks to improve health knowledge and behavior through Community Health Volunteers (CHVs) who are trained using the LEAP tool–AMREF’s mHealth platform. The findings will inform stakeholders to formulate better strategies to ensure access to UHC in general, and for a highly vulnerable segment of the population in particular, including low-income mothers and their children. Trial registration history: Registered with Protocol Registration and Results System (Protocol ID: AfricanPHRC; Trial ID: NCT04068571: AEARCTR-0006089; Date: 29 August 2019) and The American Economic Association's registry for randomised controlled trials (Trial ID: AEARCTR-0006089; Date: 26 June 2020).

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The impact of National Health Insurance upon accessibility of health services and financial protection from catastrophic health expenditure: a case study of Savannakhet province, the Lao People’s Democratic Republic

Health Research Policy and Systems ◽

10.1186/s12961-019-0493-3 ◽

2019 ◽

Vol 17 (1) ◽

Cited By ~ 1

Author(s):

Somdeth Bodhisane ◽

Sathirakorn Pongpanich

Keyword(s):

Health Insurance ◽

Health Service ◽

Health Expenditure ◽

Democratic Republic ◽

Catastrophic Health Expenditure ◽

Health Service Utilisation ◽

Service Utilisation ◽

Financial Protection ◽

The Government ◽

The Impact

Abstract Introduction Many schemes have been implemented by the government of the Lao People’s Democratic Republic to provide equity in health service utilisation. Initially, health service utilisations were fully supported by the government and were subsequently followed by the Revolving Drug Fund. In the 2000s, four health financing schemes, namely the Social Security Organization, the State Authority for Social Security, the Health Equity Fund and Community-Based Health Insurance (CBHI), were introduced with various target groups. However, as these voluntary schemes have suffered from a very low enrolment rate, the government decided to pilot the National Health Insurance (NHI) scheme, which offers a flat, co-payment system for health service utilisation. This study aims to assess the effectiveness of the NHI in terms of its accessibility and in providing financial protection from catastrophic health expenditure. Methods The data collection process was implemented in hospitals of two districts of Savannakhet province. A structured questionnaire was used to retrieve all required information from 342 households; the information comprised of the socioeconomics of the household, accessibility to health services and financial payment for both outpatient and inpatient department services. Binary logistic regression models were used to discover the impact of NHI in terms of accessibility and financial protection. The impact of NHI was then compared with the outcomes of the preceding, voluntary CBHI scheme, which had been the subject of earlier studies. Results Under the NHI, it was found that married respondents, large households and the level of income significantly increased the probability of accessibility to health service utilisation. Most importantly, NHI significantly improved accessibility for the poorest income quantile. In terms of financial protection, households with an existing chronic condition had a significantly higher chance of suffering financial catastrophe when compared to households with healthy members. As probability of catastrophic expenditure was not affected by income level, it was indicated that NHI is able to provide equity in financial protection. Conclusion The models found that the NHI significantly enhances accessibility for poor income households, improving health service distribution and accessibility for the various income levels when compared to the CBHI coverage. Additionally, it was also found that NHI had enhanced financial protection since its introduction. However, the NHI policy requires a dramatically high level of government subsidy; therefore, there its long-term sustainability remains to be determined.

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The impact of health insurance on poverty among rural older adults: an evidence from nine counties of western China

International Journal for Equity in Health ◽

10.1186/s12939-021-01379-5 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Shaoguo Zhai ◽

Shuiping Yuan ◽

Quanfang Dong

Keyword(s):

Older Adults ◽

Health Insurance ◽

Health Expenditure ◽

Financial Burden ◽

Catastrophic Health Expenditure ◽

Western China ◽

Cooperative Medical Scheme ◽

The Impact ◽

The Relationship ◽

Rural Older Adults

Abstract Background Older adults are more prone to various diseases. Health insurance becomes effective mechanism to relieve financial burden when the insured is sick. In China, most older adults live in the countryside, and New Rural Cooperative Medical Scheme is a kind of health insurance system in rural areas. The relationship between New Rural Cooperative Medical Scheme and financial burden due to health expenditure of older adults in China was investigated. This paper aims at the impact of New Rural Cooperative Medical Scheme on the poverty among rural older adults. Methods This study employs Probit model and Tobit model to assess the impact of New Rural Cooperative Medical Scheme on alleviating poverty among rural older adults based on a survey in nine representative counties in western China. Results The findings show that diseases have significantly negative impact on rural elderly poverty. New Rural Cooperative Medical Scheme has impact on alleviating of the health-payment poverty due to catastrophic health expenditure, but the impact is limited. The impact of health insurance on poverty alleviation is greater for men, older adults aged between 60 to 69 and households in in economically poorer area than their counterparts. Conclusions This study show the relationship between New Rural Cooperative Medical Scheme and catastrophic health expenditure of older adults in China. The results draw policy attention to introduce different reimbursement expense ratios for different groups to alleviate them from poverty based on more comprehensive insurance packages.

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The impact of i-PUSH on maternal and child health care utilization, health outcomes, and financial protection: study protocol for a cluster randomized controlled trial based on financial and health diaries data

Trials ◽

10.1186/s13063-021-05598-7 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Amanuel Abajobir ◽

Richard de Groot ◽

Caroline Wainaina ◽

Anne Njeri ◽

Daniel Maina ◽

...

Keyword(s):

Health Care ◽

Health Insurance ◽

Health Services ◽

Study Protocol ◽

Low Income ◽

Health Knowledge ◽

Randomized Controlled ◽

Quality Health ◽

The Impact ◽

Quality Health Services

Abstract Background Universal Health Coverage ensures access to quality health services for all, with no financial hardship when accessing the needed services. Nevertheless, access to quality health services is marred by substantial resource shortages creating service delivery gaps in low-and middle-income countries, including Kenya. The Innovative Partnership for Universal Sustainable Healthcare (i-PUSH) program, developed by AMREF Health Africa and PharmAccess Foundation (PAF), aims to empower low-income women of reproductive age and their families through innovative digital tools. This study aims to evaluate the impact of i-PUSH on maternal and child health care utilization, women’s health including their knowledge, behavior, and uptake of respective services, as well as women’s empowerment and financial protection. It also aims to evaluate the impact of the LEAP training tool on empowering and enhancing community health volunteers’ health literacy and to evaluate the impact of the M-TIBA health wallet on savings for health and health insurance uptake. Methods This is a study protocol for a cluster randomized controlled trial (RCT) study that uses a four-pronged approach—including year-long weekly financial and health diaries interviews, baseline and endline surveys, a qualitative study, and behavioral lab-in-the-field experiments—in Kakemega County, Kenya. In total, 240 households from 24 villages in Kakamega will be followed to capture their health, health knowledge, health-seeking behavior, health expenditures, and enrolment in health insurance over time. Half of the households live in villages randomly assigned to the treatment group where i-PUSH will be implemented after the baseline, while the other half of the households live in control village where i-PUSH will not be implemented until after the endline. The study protocol was reviewed and approved by the AMREF Ethical and Scientific Review Board. Research permits were obtained from the National Commission for Science, Technology and Innovation agency of Kenya. Discussion People in low-and middle-income countries often suffer from high out-of-pocket healthcare expenditures, which, in turn, impede access to quality health services. Saving for healthcare as well as enrolment in health insurance can improve access to healthcare by building capacities at all levels—individuals, families, and communities. Notably, i-PUSH fosters savings for health care through the mobile-phone based “health wallet,” it enhances enrolment in subsidized health insurance through the mobile platform—M-TIBA—developed by PAF, and it seeks to improve health knowledge and behavior through community health volunteers (CHVs) who are trained using the LEAP tool—AMREF’s mHealth platform. The findings will inform stakeholders to formulate better strategies to ensure access to Universal Health Coverage in general, and for a highly vulnerable segment of the population in particular, including low-income mothers and their children. Trial registration Registered with Protocol Registration and Results System (protocol ID: AfricanPHRC; trial ID: NCT04068571: AEARCTR-0006089; date: 29 August 2019) and The American Economic Association’s registry for randomized controlled trials (trial ID: AEARCTR-0006089; date: 26 June 2020).

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Free access to antiretroviral treatment and protection against the risk of catastrophic health expenditure in people living with HIV: evidence from Cameroon

BMC Health Services Research ◽

10.1186/s12913-021-06331-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Marwân-al-Qays Bousmah ◽

Marie Libérée Nishimwe ◽

Christopher Kuaban ◽

Sylvie Boyer

Keyword(s):

Socioeconomic Status ◽

Health Expenditure ◽

Antiretroviral Treatment ◽

Catastrophic Health Expenditure ◽

Hiv Care ◽

Free Access ◽

People Living With Hiv ◽

Art Policy ◽

Living With Hiv ◽

The Impact

Abstract Background To foster access to care and reduce the burden of health expenditures on people living with HIV (PLHIV), several sub-Saharan African countries, including Cameroon, have adopted a policy of removing HIV-related fees, especially for antiretroviral treatment (ART). We investigate the impact of Cameroon’s free antiretroviral treatment (ART) policy, enacted in May 2007, on catastrophic health expenditure (CHE) risk according to socioeconomic status, in PLHIV enrolled in the country’s treatment access program. Methods Based on primary data from two cross-sectional surveys of PLHIV outpatients in 2006–2007 and 2014 (i.e., before and after the policy’s implementation, respectively), we used inverse propensity score weighting to reduce covariate imbalances between participants in both surveys, combined with probit regressions of CHE incidence. The analysis included participants treated with ART in one of the 11 HIV services common to both surveys (n = 1275). Results The free ART policy was associated with a significantly lower risk of CHE only in the poorest PLHIV while no significant effect was found in lower-middle or upper socioeconomic status PLHIV. Unexpectedly, the risk of CHE was higher in those with middle socioeconomic status after the policy’s implementation. Conclusions Our findings suggest that Cameroon’s free ART policy is pro-poor. As it only benefitted PLHIV with the lowest socioeconomic status, increased comprehensive HIV care coverage is needed to substantially reduce the risk of CHE and the associated risk of impoverishment for all PLHIV.

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