scholarly journals Empirical Analysis of the Status and Influencing Factors of Catastrophic Health Expenditure of Migrant Workers in Western China

2019 ◽  
Vol 16 (5) ◽  
pp. 738 ◽  
Author(s):  
Li Liu ◽  
Xuewen Zhang ◽  
Longchao Zhao ◽  
Ningxiu Li
Keyword(s):  
Migrant Workers ◽  
Health Expenditure ◽  
Income Group ◽  
Catastrophic Health Expenditure ◽  
Western China ◽  
Annual Income ◽  
Education Group ◽  
Basic Medical Insurance ◽  
Per Capita ◽  
Basic Medical

Objective: To understand the current situation and influencing factors of catastrophic health expenditure (CHE) of migrant workers in Western China. Method: Sample data were obtained by cluster random sampling. Data were entered and sorted using Epidata 3.1 and SPSS 21.0. The statistical analysis involved a descriptive analysis, chi-square tests, multivariate unconditional logistic regression, and multiple correspondence analysis (MCA). Results: A total of 1271 households were surveyed, and the incidence of CHE was 12.5% (159/1271). The multivariate logistic regression showed that households with elderly people over 65 years old (0R = 2.05, 95% CI = 1.42–2.97), children under five years old (0R = 2.61, 95% CI = 1.53–4.48), at least one person with no basic medical insurance (0R = 2.96, 95% CI = 2.08–4.23), chronically ill patients (0R = 1.85, 95% CI = 1.23–2.77), and hospitalized patients (0R = 3.61, 95% CI = 2.31–5.62) contributed to the risk of CHE. Compared to migrant workers in the >30,000 Yuan household per capita annual income group, the 10,001–20,000 Yuan income group (0R = 2.35, 95% CI = 1.44–3.82) and ≤10,000 Yuan income group (0R = 3.72, 95% CI = 2.09–6.62) had a higher risk of CHE occurrence. Compared to migrant workers in the university and above head-of-household education group, those in the primary level or below education group (0R = 5.90, 95% CI = 3.02–11.5) had a higher risk of CHE occurrence. MCA revealed a strong interrelationship between the following risk factors and CHE: household per capita annual income ≤10,000 Yuan, primary school education level or below for the head of the household, and having at least one person in the household with no basic medical insurance. Conclusions: CHE incidence amongst migrant workers in Western China is a serious issue, and policymakers should pay more attention to these migrant workers’ households that are more prone to CHE than others, so as to decrease the incidence of CHE in this group.

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

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.

scholarly journals The Basic vs. Ability-to-Pay Approach: Evidence From China's Critical Illness Insurance on Whether Different Measurements of Catastrophic Health Expenditure Matter

2021 ◽  
Vol 9 ◽  
Author(s):  
Ying Zhang ◽  
Yongmei Guan ◽  
Ding Hu ◽  
Jacques Vanneste ◽  
Dongmei Zhu
Keyword(s):  
Critical Illness ◽  
Health Expenditure ◽  
Catastrophic Health Expenditure ◽  
World Health ◽  
Basic Approach ◽  
Ability To Pay ◽  
Basic Medical Insurance ◽  
The World ◽  
Health Organization ◽  
Basic Medical

Alleviating catastrophic health expenditure (CHE) is one of the vital objectives of health systems, as defined by the World Health Organization. However, no consensus has yet been reached on the measurement of CHE. With the aim of further relieving the adverse effects of CHE and alleviating the problem of illness-caused poverty, the Critical Illness Insurance (CII) program has been operational in China since 2012. In order to verify whether the different measurements of CHE matter under China's CII program, we compare the two-layer CII models built by using the basic approach and the ability-to-pay (ATP) approach at a range of thresholds. Exploiting the latest China family panel studies dataset, we demonstrate that the basic approach is more effective in relieving CHE for all insured households, while the ATP approach works better in reducing the severity of CHE in households facing it. These findings have meaningful implications for policymaking. The CII program should be promoted widely as a supplement to the current Social Basic Medical Insurance system. To improve the CII program's effectiveness, it should be based on the basic approach, and the threshold used to measure CHE should be determined by the goal pursued by the program.

scholarly journals A 15-Year Trend of Catastrophic Health Payment and its Inequality in China: Evidence from Longitudinal Data

2021 ◽  
Author(s):  
Yongjian Xu ◽  
Yiting Zhou ◽  
Andi Pramono
Keyword(s):  
Health Care ◽  
Decomposition Analysis ◽  
Medical Insurance ◽  
Catastrophic Health Expenditure ◽  
Chinese Government ◽  
Nutrition Survey ◽  
Basic Medical Insurance ◽  
Poor Households ◽  
Health Payment ◽  
Basic Medical

Abstract Background：The Chinese health care system has gone through two major cycles of reform since the 1980s. This study aims to comprehensively track the trends in the occurrence of catastrophic health payment and its inequality in the past 15 years, which may help better understand the influence of health system reforms on catastrophic health payment and its inequality. Methods：The study employed the subset of data from China Health and Nutrition Survey conducted from 1991 to 2015. Concentration index and decomposition analysis were used to measure the magnitude of income-related inequality in catastrophic health payment and decompose it into determinants respectively. Results: The incidence of catastrophic health expenditure in China increased from 3.10% in 1993 to 8.90% in 2004, and still maintained at a high level in the following years. The incidence gap of catastrophic health payment between the richest and poorest became increasingly wider over year. Moreover, the adjusted concentration indexes were all negative in each year, decreasing from -0.202 in 1991 to -0.613 in 2015. The basic medical insurance didn’t decrease the incidence of catastrophic health payment and showed the second largest contribution on the inequality in catastrophic health payment before 2004. However, this contribution began to decline after 2006. Conclusions: After the New Health Care Reform, although the Chinese government has taken many measures to protect poor households from catastrophic health payment, the incidence gap between the rich and poor has widened. China has nearly achieved universal coverage in recent years, however, the basic medical insurance in China was not enough to protect households from catastrophic health payment. Our study suggests that improving the generosity of existing basic medical insurance, and reforming the medical insurance payment system would be helpful to reduce the incidence of catastrophic health payment. The use of big data tools and techniques to effectively screen the poor households, and strengthening the social medical aid system would be helpful to decrease the pro-rich inequality in catastrophic health payment.

scholarly journals Inequity in healthcare needs, health service use and financial burden of medical expenditures in China: results from a consecutive household monitoring study in Jiangsu Province

2019 ◽  
Author(s):  
Weixi Jiang ◽  
Xiaolin Xu ◽  
Shenglan Tang ◽  
Ling Xu ◽  
Yaoguang Zhang ◽  
...  
Keyword(s):  
Health Expenditure ◽  
Service Use ◽  
Negative Binomial ◽  
Medical Insurance ◽  
Factors Associated ◽  
Logit Regression ◽  
Healthcare Needs ◽  
Basic Medical Insurance ◽  
Rural And Urban ◽  
Basic Medical

Abstract Background: Although public medical insurance covers over 95% of the population in China, disparities in health service use and out-of-pocket (OOP) health expenditure across income groups are still widely observed. This study aims to investigate the socio-economic disparities in perceived healthcare needs, informal care, formal care and payment for healthcare and explore their equity implication. Methods: We assessed healthcare needs, service use and payment in 400 households in rural and urban areas in Jiangsu, China, and included only the adult sample (N=925). One baseline survey and 10 follow-up surveys were conducted during the 7-month monitoring period, and the Affordability Ladder Program (ALP) framework was adopted for data analysis. Negative binomial/zero-inflated negative binomial and logit regression models were used to explore factors associated with perceived needs of care and with the use of self-treatment, outpatient and inpatient care respectively. Two-part model and logit regression modeling were conducted to explore factors associated with OOP health expenditure and with the likelihood of incurring catastrophic health expenditure (CHE). Results : After adjusting for covariates, rural residence was significantly associated with more perceived healthcare needs, more self-treatment, higher probability of using outpatient and inpatient service, more OOP health expenditure and higher likelihood of incurring catastrophic expenditure ( P <0.05). Compared to the Urban Employee Basic Medical Insurance (UEBMI), enrollment in the New Rural Cooperative Medical Scheme (NRCMS) or in the Urban Resident Basic Medical Insurance (URBMI) was correlated with lower probability of ever using outpatient services, but with more outpatient visits when people were at risk of using outpatient service ( P <0.05). NRCMS/URBMI enrollment was also associated with higher likelihood of incurring CHE compared to UEBMI enrollment (OR=2.02, P <0.05); in stratified analysis of the rural and urban sample this effect was only significant for the rural population. Conclusions: The rural population in Jiangsu perceived more healthcare needs, had a higher probability of using both informal and formal healthcare services, and had more OOP health expenditure and a higher likelihood of incurring CHE. The inequity mainly exists in health care financing, and may be partially addressed through improving the benefit packages of NRCMS/URBMI.

scholarly journals Empirical Analysis of Beneficial Equality of the Basic Medical Insurance for Migrants in China

2021 ◽  
Vol 2021 ◽  
pp. 1-11
Author(s):  
Jieying Gao ◽  
Dongxiao Chu ◽  
Tao Ye
Keyword(s):  
Low Income ◽  
Medical Insurance ◽  
Income Group ◽  
Floating Population ◽  
Dynamic Monitoring ◽  
Health Coverage ◽  
Heckman Model ◽  
Basic Medical Insurance ◽  
Income Groups ◽  
Basic Medical

The fairness of the benefits of basic medical insurance for the migrants is drawing increasing attention. This paper examined the beneficial equality of the basic medical insurance for the floating population in China using the “2014 National Internal Migrant Dynamic Monitoring Survey.” The Heckman model was employed due to selection bias among inpatients, and the random forest algorithm of machine learning was used to analyze the importance of factors affecting the hospitalization decision-making, hospitalization consumption, and reimbursement proportion of the floating population. The results show significant differences in the fairness of basic medical insurance benefits among different income groups, and the highest-income group benefits the most. In contrast, the higher-income group benefits the least. Further verification by introducing the commercial medical insurance indicated that the differences among different income groups did not disappear but reduced the degree of difference among the groups. Although China’s healthcare reform has progressed greatly, the study’s findings confirm that the government’s fair medical insurance can lead to unfair problems and the phenomena of low-income groups subsidizing high-income groups under the equalized basic medical insurance system. Adjusting the design of equalized medical insurance and allowing different income groups to pay different premium levels according to the payment level may be more conducive to the fairness of benefits based on achieving universal health coverage in China.

scholarly journals Inequity in healthcare needs, health service use and financial burden of medical expenditures in China: results from a consecutive household monitoring study in Jiangsu Province

2019 ◽  
Author(s):  
Weixi Jiang ◽  
Xiaolin Xu ◽  
Shenglan Tang ◽  
Ling Xu ◽  
Yaoguang Zhang ◽  
...  
Keyword(s):  
Health Expenditure ◽  
Service Use ◽  
Negative Binomial ◽  
Medical Insurance ◽  
Factors Associated ◽  
Logit Regression ◽  
Healthcare Needs ◽  
Basic Medical Insurance ◽  
Rural And Urban ◽  
Basic Medical

Abstract Background: Although public medical insurance covers over 95% of the population in China, disparities in health service use and out-of-pocket (OOP) health expenditure across income groups are still widely observed. This study aims to investigate the socio-economic disparities in perceived healthcare needs, informal care, formal care and payment for healthcare and explore their equity implication. Methods: We assessed healthcare needs, service use and payment in 400 households in rural and urban areas in Jiangsu, China, and included only the adult sample (N=925). One baseline survey and 10 follow-up surveys were conducted during the 7-month monitoring period, and the Affordability Ladder Program (ALP) framework was adopted for data analysis. Negative binomial/zero-inflated negative binomial and logit regression models were used to explore factors associated with perceived needs of care and with the use of self-treatment, outpatient and inpatient care respectively. Two-part model and logit regression modeling were conducted to explore factors associated with OOP health expenditure and with the likelihood of incurring catastrophic health expenditure (CHE). Results : After adjusting for covariates, rural residence was significantly associated with more perceived healthcare needs, more self-treatment, higher probability of using outpatient and inpatient service, more OOP health expenditure and higher likelihood of incurring catastrophic expenditure ( P <0.05). Compared to the Urban Employee Basic Medical Insurance (UEBMI), enrollment in the New Rural Cooperative Medical Scheme (NRCMS) or in the Urban Resident Basic Medical Insurance (URBMI) was correlated with lower probability of ever using outpatient services, but with more outpatient visits when people were at risk of using outpatient service ( P <0.05). NRCMS/URBMI enrollment was also associated with higher likelihood of incurring CHE compared to UEBMI enrollment (OR=2.02, P <0.05); in stratified analysis of the rural and urban sample this effect was only significant for the rural population. Conclusions: The rural population in Jiangsu perceived more healthcare needs, had a higher probability of using both informal and formal healthcare services, and had more OOP health expenditure and a higher likelihood of incurring CHE. The inequity mainly exists in health care financing, and may be partially addressed through improving the benefit packages of NRCMS/URBMI.

scholarly journals An Empirical Study on the Benefits Equity of the Medical Security Policy: the China Health and Nutrition Survey (CHNS)

2020 ◽  
Vol 17 (4) ◽  
pp. 1203 ◽  
Author(s):  
Huan Liu ◽  
Weidong Dai
Keyword(s):  
Health Care ◽  
Medical Insurance ◽  
Preventive Health Care ◽  
Income Group ◽  
Preventive Health ◽  
Medical Assistance ◽  
Middle Income ◽  
Basic Medical Insurance ◽  
Medical Security ◽  
Basic Medical

Background: One of the fundamental objectives of the basic medical security system is to provide institutional guarantees for the appropriate medical needs of different groups. Among them, achieving fairness of benefits is the first principle of the system. This study aims to explore the benefit equity of preventive health care for different groups and the specific path to promote fairness. Methods: Based on the 2015 CHNS survey data, through the theory construction of benefit fairness in the basic medical insurance and using the two-stage IV-Heckman model, the paper analyzes the benefit fairness of the basic medical insurance in urban and rural China. Results: This study indicates that (1) the results of empirical and theoretical models are not consistent with the sample of the insured population. (2) As private medical insurance and medical assistance are restricted in the model, the reimbursement ratio of medical insurance in other income groups is all higher than the highest one. However, the coefficient is getting larger, with the lowest income group having the largest coefficient. After controlling for variables of disease and severity, the results suggest that the main impact path is hospitalization costs. (3) Taking the highest income group as a reference, the compensation proportion of preventive health care in other groups is higher, respectively, than the reference group, while the groups below middle income have a significant relationship with compensation for preventive health care. Conclusions: Supplementary private medical insurance and medical assistance have important protection functions for low- and middle-income populations. However, owing to the actual income threshold, the two groups cannot benefit from the medical security system. This result is still valid in the field of preventive health care. The increase of preventive health care expenditure reduces the cost of individual hospitalization, but the high-income group has emerged with more preventive health care expenditures, creating new unfairness.

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

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.

scholarly journals Inequity in healthcare needs, health service use and financial burden of medical expenditures in China: results from a consecutive household monitoring study in Jiangsu Province

2019 ◽  
Author(s):  
Weixi Jiang ◽  
Xiaolin Xu ◽  
Shenglan Tang ◽  
Ling Xu ◽  
Yaoguang Zhang ◽  
...  
Keyword(s):  
Health Expenditure ◽  
Service Use ◽  
Negative Binomial ◽  
Medical Insurance ◽  
Factors Associated ◽  
Logit Regression ◽  
Healthcare Needs ◽  
Basic Medical Insurance ◽  
Rural And Urban ◽  
Basic Medical

Abstract Background: Although public medical insurance covers over 95% of the population in China, disparities in health service use and out-of-pocket (OOP) health expenditure across income groups are still widely observed. This study aims to investigate the socio-economic disparities in perceived healthcare needs, informal care, formal care and payment for healthcare and explore their equity implication. Methods: We assessed healthcare needs, service use and payment in 400 households in rural and urban areas in Jiangsu, China, and included only the adult sample (N=925). One baseline survey and 10 follow-up surveys were conducted during the 7-month monitoring period, and the Affordability Ladder Program (ALP) framework was adopted for data analysis. Negative binomial/zero-inflated negative binomial and logit regression models were used to explore factors associated with perceived needs of care and with the use of self-treatment, outpatient and inpatient care respectively. Two-part model and logit regression modeling were conducted to explore factors associated with OOP health expenditure and with the likelihood of incurring catastrophic health expenditure (CHE). Results : After adjusting for covariates, rural residence was significantly associated with more perceived healthcare needs, more self-treatment, higher probability of using outpatient and inpatient service, more OOP health expenditure and higher likelihood of incurring catastrophic expenditure ( P <0.05). Compared to the Urban Employee Basic Medical Insurance (UEBMI), enrollment in the New Rural Cooperative Medical Scheme (NRCMS) or in the Urban Resident Basic Medical Insurance (URBMI) was correlated with lower probability of ever using outpatient services, but with more outpatient visits when people were at risk of using outpatient service ( P <0.05). NRCMS/URBMI enrollment was also associated with higher likelihood of incurring CHE compared to UEBMI enrollment (OR=2.02, P <0.05); in stratified analysis of the rural and urban sample this effect was only significant for the rural population. Conclusions: The rural population in Jiangsu perceived more healthcare needs, had a higher probability of using both informal and formal healthcare services, and had more OOP health expenditure and a higher likelihood of incurring CHE. The inequity mainly exists in health care financing, and may be partially addressed through improving the benefit packages of NRCMS/URBMI.

scholarly journals Disparities in Dental Service Utilization among Adults in Chinese Megacities: Do Health Insurance and City of Residence Matter?

2020 ◽  
Vol 17 (18) ◽  
pp. 6851
Author(s):  
Xiaomin Qu ◽  
Xiang Qi ◽  
Bei Wu
Keyword(s):  
Health Insurance ◽  
Service Utilization ◽  
Dental Care ◽  
Medical Insurance ◽  
Dental Service ◽  
Gdp Per Capita ◽  
Dental Visits ◽  
Basic Medical Insurance ◽  
Per Capita ◽  
Basic Medical

The aims of the study were to present the prevalence of dental service utilization among adults (age between 18 and 65) in Chinese megacities and to examine the associations of health insurance and city of residence with dental visits. This study was a cross-sectional analysis of the 2019 New Era and Living Conditions in Megacities Survey data with a sample of 4835 participants aged 18–65 from 10 different megacities in China. The data including gross domestic product (GDP) per capita of each megacity obtained from the National Bureau of Statistics of China as a city-level characteristic. After adjusting sampling weights, approximately 24.28% of the participants had at least one dental visit per year. Findings from multilevel mixed-effects linear models showed that participants residing in megacities with higher GDP per capita (β = 0.07, p < 0.001) who had Urban Employee Basic Medical Insurance (β = 0.25, p < 0.001) or Urban Resident Basic Medical Insurance (β = 0.19, p < 0.01) had more frequent dental visits after adjusting demographic characteristics, socioeconomic status, health status, health behavior and attitude, and oral health indicators. Margins post-estimation model results demonstrated disparities in the predicted probability of having never visited a dentist by types of health insurance and city of residence. In conclusion, the prevalence of dental visits in China was found to be low. This study highlights socioeconomic inequalities in dental service utilization. There is a great need to develop more dental care programs and services and expand health insurance to cover dental care in China.

Sign in / Sign up

Export Citation Format

Share Document