scholarly journals Does the medical insurance system really achieved the effect of poverty alleviation for the elderly in China? Characteristics of vulnerable groups and failure links

2019 ◽  
Author(s):  
Meiyan Ma ◽  
Ye Li ◽  
Nianshi Wang ◽  
Qunhong Wu ◽  
Linghan Shan ◽  
...  
Keyword(s):  
Poverty Alleviation ◽  
Household Head ◽  
Medical Insurance ◽  
The Elderly ◽  
Catastrophic Health Expenditure ◽  
Health Needs ◽  
Vulnerable Groups ◽  
Outcome Variable ◽  
Weak Links ◽  
Maximum Point

Abstract Objective: We examined the physiological, household, and spatial agglomeration characteristics of the health poverty population in China. We identified weak links that affect the implementation of the medical insurance and further improve its effectiveness for health poverty alleviation. Methods: A national representative sample from the 2015 China Health and Pension Tracking Survey (CHARLS) was analyzed. The WHO recommended method was adopted to calculate catastrophic health expenditure (CHE) and impoverishment by medical expenses (IME). We created a binary indicator for IME as the outcome variable and applied the treatment-effect model to analyze the determinants of IME. Results： The incidence of IME was 7.2% of the overall population, compared to 20.3% of the sample households trapped in CHE. The incidence of IME enrolled in insurance schemes was 7.4% higher than that of uninsured families (4.8%). Economic level, living area, family size, age of household head, having hospitalized members, and participating in insurance were statistically significant for the occurrence of IME. Conclusion： The original poverty -promoting policies has not reached the maximum point of convergence with China ‘s current demand for health. The overlapped health vulnerabilities exacerbated the risk of poverty among the elderly and households with high health needs and utilization. In addition, the medical insurance schemes have proven to be insufficient for protection against economic burden of poor households. So, special health needs, age, and household capacity to pay should be comprehensively considered while strengthening the connection between the disease insurance scheme with supplementary insurance.

scholarly journals Does the medical insurance system really achieved the effect of poverty alleviation for the middle-aged and elderly people in China?Characteristics of vulnerable groups and failure links.

2020 ◽  
Author(s):  
Meiyan Ma ◽  
Ye Li ◽  
Nianshi Wang ◽  
Qunhong Wu ◽  
Linghan Shan ◽  
...  
Keyword(s):  
Poverty Alleviation ◽  
Health Expenditure ◽  
Household Head ◽  
Medical Insurance ◽  
Catastrophic Health Expenditure ◽  
Health Needs ◽  
Outcome Variable ◽  
Weak Links ◽  
Maximum Point ◽  
Medical Expenses

Abstract objective ： We examined the physiological, household, and spatial agglomeration characteristics of the health poverty population in China. We identified weak links that affect the implementation of the medical insurance and further improve its effectiveness for health poverty alleviation. Methods: A national representative sample from the 2015 China Health and Pension Tracking Survey (CHARLS) was analyzed. The WHO recommended method was adopted to calculate catastrophic health expenditure (CHE) and impoverishment by medical expenses (IME). We created a binary indicator for IME as the outcome variable and applied the treatment-effect model to analyze the determinants of IME. Results ： The rate of IME was 7.2% of the overall population, compared to 20.3% of the sample households trapped in CHE. The rate of IME enrolled in insurance schemes was 7.4% higher than that of uninsured families (4.8%). Economic level, living area, family size, age of household head, having hospitalized members, and participating in insurance were statistically significant for the rate of IME. Conclusion ： The original poverty -promoting policies has not reached the maximum point of convergence with China’s current demand for health. The overlapped health vulnerabilities exacerbated the risk of poverty among the elderly and households with high health needs and utilization. In addition, the medical insurance schemes have proven to be insufficient for protection against economic burden of poor households. So, special health needs, age, and household capacity to pay should be comprehensively considered while strengthening the connection between the disease insurance scheme with supplementary insurance. Keywords: medical insurance, poverty alleviation, healthy poverty, catastrophic health expenditure, impoverishment by medical expenses.

scholarly journals Does the medical insurance system really achieved the effect of poverty alleviation for the middle-aged and elderly people in China?Characteristics of vulnerable groups and failure links.

2020 ◽  
Author(s):  
Meiyan Ma ◽  
Ye Li ◽  
Nianshi Wang ◽  
Qunhong Wu ◽  
Linghan Shan ◽  
...  
Keyword(s):  
Poverty Alleviation ◽  
Health Expenditure ◽  
Household Head ◽  
Medical Insurance ◽  
Catastrophic Health Expenditure ◽  
Health Needs ◽  
Outcome Variable ◽  
Weak Links ◽  
Maximum Point ◽  
Medical Expenses

Abstract Objective ： We examined the physiological, household, and spatial agglomeration characteristics of the health poverty population in China. We identified weak links that affect the implementation of the medical insurance and further improve its effectiveness for health poverty alleviation. Methods: A national representative sample from the 2015 China Health and Pension Tracking Survey (CHARLS) was analyzed. The WHO recommended method was adopted to calculate catastrophic health expenditure (CHE) and impoverishment by medical expenses (IME). We created a binary indicator for IME as the outcome variable and applied the treatment-effect model to analyze the determinants of IME. Results ： The rate of IME was 7.2% of the overall population, compared to 20.3% of the sample households trapped in CHE. The rate of IME enrolled in insurance schemes was 7.4% higher than that of uninsured families (4.8%). Economic level, living area, family size, age of household head, having hospitalized members, and participating in insurance were statistically significant for the rate of IME. Conclusion ： The original poverty -promoting policies has not reached the maximum point of convergence with China’s current demand for health. The overlapped health vulnerabilities exacerbated the risk of poverty among the elderly and households with high health needs and utilization. In addition, the medical insurance schemes have proven to be insufficient for protection against economic burden of poor households. So, special health needs, age, and household capacity to pay should be comprehensively considered while strengthening the connection between the disease insurance scheme with supplementary insurance. Keywords: medical insurance, poverty alleviation, healthy poverty, catastrophic health expenditure, impoverishment by medical expenses.

scholarly journals Does the medical insurance system really achieved the effect of poverty alleviation for the middle-aged and elderly people in China?Characteristics of vulnerable groups and failure links.

2020 ◽  
Author(s):  
Meiyan Ma ◽  
Ye Li ◽  
Nianshi Wang ◽  
Qunhong Wu ◽  
Linghan Shan ◽  
...  
Keyword(s):  
Poverty Alleviation ◽  
Health Expenditure ◽  
Household Head ◽  
Medical Insurance ◽  
Catastrophic Health Expenditure ◽  
Health Needs ◽  
Outcome Variable ◽  
Weak Links ◽  
Maximum Point ◽  
Medical Expenses

Abstract Objective ： We examined the physiological, household, and spatial agglomeration characteristics of the health poverty population in China. We identified weak links that affect the implementation of the medical insurance and further improve its effectiveness for health poverty alleviation. Methods: A national representative sample from the 2015 China Health and Pension Tracking Survey (CHARLS) was analyzed. The WHO recommended method was adopted to calculate catastrophic health expenditure (CHE) and impoverishment by medical expenses (IME). We created a binary indicator for IME as the outcome variable and applied the treatment-effect model to analyze the determinants of IME. Results ： The rate of IME was 7.2% of the overall population, compared to 20.3% of the sample households trapped in CHE. The rate of IME enrolled in insurance schemes was 7.4% higher than that of uninsured families (4.8%). Economic level, living area, family size, age of household head, having hospitalized members, and participating in insurance were statistically significant for the rate of IME. Conclusion ： The original poverty -promoting policies has not reached the maximum point of convergence with China’s current demand for health. The overlapped health vulnerabilities exacerbated the risk of poverty among the elderly and households with high health needs and utilization. In addition, the medical insurance schemes have proven to be insufficient for protection against economic burden of poor households. So, special health needs, age, and household capacity to pay should be comprehensively considered while strengthening the connection between the disease insurance scheme with supplementary insurance. Keywords: medical insurance, poverty alleviation, healthy poverty, catastrophic health expenditure, impoverishment by medical expenses.

scholarly journals Ten-Year Poverty Alleviation Effect of the Medical Insurance System on Families With Members Who Have a Non-communicable Disease: Evidence From Heilongjiang Province in China

2021 ◽  
Vol 9 ◽  
Author(s):  
Qi Xia ◽  
Lichun Wu ◽  
Wanxin Tian ◽  
Wenqing Miao ◽  
Xiyu Zhang ◽  
...  
Keyword(s):  
Poverty Alleviation ◽  
Health Expenditure ◽  
Communicable Disease ◽  
Medical Insurance ◽  
Catastrophic Health Expenditure ◽  
Vulnerable Groups ◽  
Weak Links ◽  
Heilongjiang Province ◽  
Healthcare Needs ◽  
Out Of Pocket Payments

Aims: Non-communicable diseases (NCD) drag the NCD patients' families to the abyss of poverty. Medical insurance due to weak control over medical expenses and low benefits levels, may have actually contributed to a higher burden of out-of-pocket payments. By making a multi-dimensional calculation on catastrophic health expenditure (CHE) in Heilongjiang Province over 10 years, it is significant to find the weak links in the implementation of medical insurance to achieve poverty alleviation.Methods: A logistic regression was undertaken to predict the determinants of catastrophic health expenditure.Results: The average CHE of households dropped from 18.9% in 2003 to 14.9% in 2013. 33.2% of the households with three or more NCD members suffered CHE in 2013, which was 7.2 times higher than the households without it (4.6%). The uninsured households with cardiovascular disease had CHE of 12.0%, which were nearly 10% points lower than insured households (20.4–22.4%). For Medical Insurance for Urban Employees Scheme enrolled households, the increasing number of NCD members raised the risk of impoverishment from 3.4 to 20.0% in 2003, and from 0.3 to 3.1% in 2008. Households with hospital in-patient members were at higher risk of CHE (OR: 3.10–3.56).Conclusions: Healthcare needs and utilization are one of the most significant determinants of CHE. Households with NCD and in-patient members are most vulnerable groups of falling into a poverty trap. The targeting of the NCD groups, the poorest groups, uninsured groups need to be primary considerations in prioritizing services that are contained in medical insurance and poverty alleviation.

scholarly journals Targeting vulnerable groups of health poverty alleviation in rural China— what is the role of the New Rural Cooperative Medical Scheme for the elderly population?

2020 ◽  
Author(s):  
Nianshi Wang ◽  
Ye Li ◽  
Meiyan Ma ◽  
Mingli Jiao ◽  
Qunhong Wu ◽  
...  
Keyword(s):  
Poverty Alleviation ◽  
Elderly Population ◽  
Rural China ◽  
The Elderly ◽  
Catastrophic Health Expenditure ◽  
Rural Elderly ◽  
Vulnerable Groups ◽  
Medical Expense ◽  
Out Of Pocket Payments ◽  
Education Levels

Abstract BACKGROUND : Based on the health poverty alleviation policy, we explored whether the New Rural Cooperative Medical System (NRCMS) had effectively reduced the economic burden of the rural elderly population and impoverished vulnerable groups with regard to medical expenses, providing further evidence for increasing the medical insurance system. METHODS: Data were obtained from the 2015 China Health and Retirement Longitudinal Study. The method was adapted from WHO to calculate the catastrophic health expenditure (CHE) and impoverishment by medical expense (IME). The treatment effect model was used to identify the determinants of CHE in the rural elderly residents. RESULTS: The incidence of CHE in rural China for the elderly is 19.65%, and the impoverishment by medical expense has reached 6.94%. The households enrolled in NRCMS suffered higher CHE (21.9%) and IME (8.0%), than unenrolled households (20.6%, 7.7%). The NRCMS did not provide sufficient economic protection from CHE for households with 3 chronic diseases, inpatients, or adults over 65, Risk factors for CHE included education levels, households with inpatients, people over 65 years old, disabilities, and so on. CONCLUSIONS: Although the NRCMS had reduced barriers to the use of household health services while reducing their out of pocket payments, in some respects, it was still not effective to reduce the risk of residents falling into poverty. Our research identifies the characteristics of vulnerable groups that the NRCMS does not provide enough support for, and are at risk of falling into poverty through health impoverishment.

scholarly journals Minimizing the Risk of Catastrophic Health Expenditure in China: A Multi-Dimensional Analysis of Vulnerable Groups

2021 ◽  
Vol 9 ◽  
Author(s):  
Jiahui Wang ◽  
Xiao Tan ◽  
Xinye Qi ◽  
Xin Zhang ◽  
Huan Liu ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Health Insurance ◽  
Low Socioeconomic Status ◽  
Health Expenditure ◽  
Household Head ◽  
Catastrophic Health Expenditure ◽  
Two Dimensions ◽  
Medical Expenditure ◽  
Vulnerable Groups ◽  
Low Socioeconomic

Background: In moving toward universal health coverage in China, it is crucial to identify which populations should be prioritized for which interventions rather than blindly increasing welfare packages or capital investments. We identify the characteristics of vulnerable groups from multiple perspectives through estimating catastrophic health expenditure (CHE) and recommend intervention priorities.Methods: Data were from National Health Service Survey conducted in 2003, 2008, and 2013. According to the recommendation of WHO, this study adopted 40% as the CHE threshold. A binary regression was used to identify the determinants of CHE occurrence; a probit model was used to obtain CHE standardized incidence under the characteristics of single and two dimensions in 2013.Results: The total incidence of CHE in 2013 was 13.9%, which shows a general trend of growth from 2003 to 2013. Families in western and central regions and rural areas were more at risk. Factors related to social demography show that households with a female or an unmarried head of household or with a low socioeconomic status were more likely to experience CHE. Households with older adults aged 60 and above had 1,524 times higher likelihood of experiencing CHE. Among the health insurance schemes, the participants covered by the New Rural Cooperative Medical Scheme had the highest risk compared with the participants of all basic health insurance schemes. Households with several members seeking outpatient, inpatient care or with non-communicable diseases were more likely to experience CHE. Households with members not seeing a doctor or hospitalized despite the need for it were more likely to experience CHE. Characteristics such as a household head with characteristics related to low socioeconomic status, having more than two hospitalized family members, ranked high. Meanwhile, the combination of having illiterate household heads and with being covered by other health insurance plans or by none ranked the first place. Cancer notably caused a relatively high medical expenditure among households with CHE.Conclusion: In China, considering the vulnerability of the population across different dimensions is conducive to the alleviation of high CHE. Furthermore, people with multiple vulnerabilities should be prioritized for intervention. Identifying and targeting them to offer help and support will be an effective approach.

scholarly journals Does the medical insurance system play a real role in reducing catastrophic economic burden in elderly patients with cardiovascular disease in China? Implication for accurately targeting vulnerable characteristics

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Meiyan Ma ◽  
Wanxin Tian ◽  
Jian Kang ◽  
Yuze Li ◽  
Qi Xia ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Economic Burden ◽  
Weak Link ◽  
Health Resources ◽  
Medical Insurance ◽  
The Elderly ◽  
Catastrophic Health Expenditure ◽  
World Health ◽  
Accurate Identification ◽  
Health Organization

Abstract Background The vulnerability of cardiovascular disease (CVD) patients’ health abilities, combined with the severity of the disease and the overlapping risk factors, leads such people to bear the economic burden of the disease due to the medical services. We estimated the economic burden of CVD and identified the weak link in the design of the medical insurance. Methods Data from 5610 middle-aged and elderly with CVD were drawn from the 2015 wave of “China Health and Retirement Longitudinal Study” (CHARLS). The recommended method of the “World Health Organization” (WHO) was adopted to calculate “catastrophic health expenditure” (CHE), “impoverishment by medical expenses” (IME), and applied the treatment-effect model to analyze the determinants of CHE. Results The incidence of CHE was 19.9% for the elderly families with CVD members, which was 3.6% higher than for uninsured families (16.3%). Families with CVD combined with > 3 other chronic diseases (38.88%) were the riskiest factor for the high CHE in the new rural cooperative medical system (NCMS). Moreover, families with members > 75 years old (33.33%), having two chronic disease (30.74%), and families having disabled members (33.33%), hospitalization members (32.41%) were identified as the high risky determinants for the high CHE in NCMS. Conclusions Elderly with physical vulnerabilities were more prone to CHE. The medical insurance only reduced barriers to accessing health resources for elderly with CVD; however it lacked the policy inclination for high-utilization populations, and had poorly accurate identification of the vulnerable characteristics of CVD, which in turn affects the economic protection ability of the medical insurance. The dispersion between the multiple medical security schemes leads to the existence of blind spots in the economic risk protection of individuals and families.

scholarly journals Targeting vulnerable groups of health poverty alleviation in rural China— what is the role of the New Rural Cooperative Medical Scheme for the middle age and elderly population?

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Nianshi Wang ◽  
Jing Xu ◽  
Meiyan Ma ◽  
Linghan Shan ◽  
Mingli Jiao ◽  
...  
Keyword(s):  
Elderly People ◽  
Poverty Alleviation ◽  
Rural China ◽  
Catastrophic Health Expenditure ◽  
World Health ◽  
Vulnerable Groups ◽  
Middle Aged ◽  
Medical Expense ◽  
Out Of Pocket Payments ◽  
Health Organization

Abstract Background In light of the health poverty alleviation policy, we explore whether the New Rural Cooperative Medical System (NRCMS) has effectively reduced the economic burden of medical expenses on rural middle-aged and elderly people and other impoverished vulnerable groups. The study aims to provide evidence that can be used to improve the medical insurance system. Methods Data were obtained from the 2015 China Health and Retirement Longitudinal Study (CHARLS). The method of calculating the catastrophic health expenditure (CHE) and impoverishment by medical expense (IME) was adopted from the World Health Organization (WHO). The treatment effect model was used to identify the determinants of CHE for rural middle-aged and elderly people. Results The incidence of CHE in rural China for middle-aged and elderly people is 21.8%, and the IME is 8.0%. The households that had enrolled in the NRCMS suffered higher CHE (21.9%) and IME (8.0%), than those that had not enrolled (CHE: 20.6% and IME: 7.7%). The NRCMS did not provide sufficient economic protection from CHE for households with three or more chronic diseases, inpatients, or households with members aged over 65 years. Key risk factors for the CHE included education levels, households with inpatients, households with members aged over 65 years, and households with disabilities. Conclusions Although the NRCMS has reduced barriers to the usage of household health services by reducing people’s out-of-pocket payments, it has not effectively reduced the risk of these households falling into poverty. Our research identifies the characteristics of vulnerable groups that the NRCMS does not provide enough support for, and which puts them at a greater risk of falling into poverty due to health impoverishment.

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

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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