scholarly journals Hospitalization Costs and Financial Burden on Families with Children with Depression: A Cross-Section Study in Shandong Province, China

Author(s):  
Yawei Guo ◽  
Jingjie Sun ◽  
Simeng Hu ◽  
Stephen Nicholas ◽  
Jian Wang

Background: Depression, one of the most frequent mental disorders, affects more than 350 million people of all ages worldwide, with China facing an increased prevalence of depression. Childhood depression is on the rise; globally, and in China. This study estimates the hospitalization costs and the financial burden on families with children suffering from depression and recommends strategies both to improve the health care of children with depression and to reduce their families’ financial burden. Methods: The data were obtained from the hospitalization information system of 297 general hospitals in six regions of Shandong Province, China. We identified 488 children with depression. The information on demographics, comorbidities, medical insurance, hospitalization costs and insurance reimbursements were extracted from the hospital’s information systems. Descriptive statistics were presented, and regression analyses were conducted to explore the factors associated with hospitalization costs. STATA14 software was used for analysis. Results: The mean age of children with depression was 13.46 ± 0.13 years old. The availability of medical insurance directly affected the hospitalization costs of children with depression. The children with medical insurance had average total hospitalization expenses of RMB14528.05RMB (US$2111.91) and length of stay in hospital of 38.87 days compared with the children without medical insurance of hospital with expenses of RMB10825.55 (US$1573.69) and hospital stays of 26.54 days. Insured children’s mean out-of-pocket expenses (6517.38RMB) was lower than the those of uninsured children (RMB10825.55 or US$1573.69), significant at 0.01 level. Insured children incurred higher treatment costs, drug costs, bed fees, check-up fees, test costs and nursing fees than uninsured patients (p < 0.01). Conclusions: Children suffering from depression with medical insurance had higher hospitalization costs and longer hospitalization stays than children without medical insurance. While uninsured inpatients experienced larger out-of-pocket costs than insured patients, out-of-pocket hospital expenses strained all family budgets, pushing many, especially low-income, families into poverty—insured or uninsured. The different hospital cost structures for drugs, treatment, bed fees, nursing and other costs, between insured and uninsured children with depression, suggest the need for further investigations of treatment regimes, including over-demand by parents for treatment of their children, over-supply of treatment by medical staff and under-treatment of uninsured patients. We recommend more careful attention paid to diagnosing depression in girls and further reform to China’s health insurance schemes—especially to allow migrant families to gain basic medical insurance.

Author(s):  
Jiajing Li ◽  
Chen Jiao ◽  
Stephen Nicholas ◽  
Jian Wang ◽  
Gong Chen ◽  
...  

Background: Medical debt is a persistent global issue and a crucial and effective indicator of long-term family medical financial burden. This paper fills a research gap on the incidence and causes of medical debt in Chinese low- and middle-income households. Method: Data were obtained from the 2015 China Household Finance Survey, with medical debt measured as borrowings from families, friends and third parties. Tobit regression models were used to analyze the data. The concentration index was employed to measure the extent of socioeconomic inequality in medical debt incidence. Results: We found that 2.42% of middle-income families had medical debt, averaging US$6278.25, or 0.56 times average household yearly income and 3.92% of low-income families had medical debts averaging US$5419.88, which was equivalent to 2.49 times average household yearly income. The concentration index for low and middle-income families’ medical debt was significantly pro-poor. Medical debt impoverished about 10% of all non-poverty households and pushed poverty households deeper into poverty. While catastrophic health expenditure (CHE) was the single most important factor in medical debt, age, education, and health status of householder, hospitalization and types of medical insurance were also significant factors determining medical debt. Conclusions: Using a narrow definition of medical debt, the incidence of medical debt in Chinese low- and middle-income households was relatively low. But, once medical debt happened, it imposed a long-term financial burden on medical indebted families, tipping many low and middle-income households into poverty and imposing on households several years of debt repayments. Further studies need to use broader definitions of medical debt to better assess the long-term financial impact of medical debt on Chinese families. Policy makers need to modify China’s basic medical insurance schemes to manage out-of-pocket, medical debt and CHE and to take account of pre-existing medical debt.


2019 ◽  
Author(s):  
Jiajing Li ◽  
Chen Jiao ◽  
Lizheng Xu ◽  
Stephen Nicholas ◽  
Jian Wang

Abstract Background Medical debt is a persistent global issue and a crucial and effective indicator of long-term family medical financial burden. This paper fills a research gap on the incidence and causes of medical debt in Chinese low and middle-income households.Method Data was obtained from the 2015 China Household Finance Survey and medical debt measured as borrowings from families, friends and third parties. Tobit regression models were used to analyze the data. The concentration index was employed to measure the extent of socioeconomic inequality in medical debt incidence.Results We found that 2.42% of middle-income families had a medical debt, averaging US$6278.25, or 0.56 times household yearly income; and 3.92% of low-income families had medical debts averaging US$5419.88, which was equivalent to 2.49 times household yearly income. The concentration index for low and middle-income families’ medical debt was significantly pro-poor. Medical debt impoverished about 10% of all non-poverty households and pushed poor households deeper into poverty. While catastrophic health expenditure was the single most important factor in medial debt, age, education, and health status of householder, hospitalization and types of medical insurance were also significant factors determining medical debt.Conclusions Using a narrow definition of medical debt, the incidence of medical debt in Chinese low and middle-income households was relatively low. But, once medical debt happened, it imposed a long-term financial burden on medical indebted families, tipping many low and middle-income households into poverty and imposing on households several years of debt repayments. Further studies need to use broader definitions of medical debt to better assess the long-term financial impact of medical debt on Chinese families. Policy makers need to modify basic medical insurance schemes to manage out-of-pocket medical expenses better and take account of pre-existing medical debt when addressing this problem.


PEDIATRICS ◽  
1991 ◽  
Vol 88 (5) ◽  
pp. 1051-1051
Author(s):  
STUDENT

The proportion of children in the United States without private or public health insurance increased from roughly 13 percent to 18 percent between 1977 and 1987, according to a new study by the Agency for Health Care Policy and Research (AHCPR). The growth in the proportion of uninsured children in poor and low-income families over the decade was even more dramatic—it rose from 21 percent to 31 percent.


POPULATION ◽  
2019 ◽  
Vol 22 (1) ◽  
pp. 106-121
Author(s):  
Vyacheslav Bobkov

The article deals with the theoretical, methodical and practical principles of forming a new model of targeted social support of low-income families with children on the basis of guaranteed minimum income. Approbation of the new approaches to targeted social support of low-income families with children was implemented in Vologda oblast. The target representative sample was 70 families. It has been found out that after the targeted social support under the current legislation (lump-sum payments excluded), basic income in these families averaged 35.3 per cent of the differentiated equivalent subsistence minimum, thus being evidence of the inefficient state social assistance. The author has substantiated introducing additional monthly targeted social payments to parents besides the set regular payments (additional family poverty benefit) that will enable families to improve their economic sustainability. He substantiated a number of threshold values of the guaranteed minimum income that would ensure current consumption ranging from the cost food basket up to the size of the differentiated equivalent living standards of families, depending on the financial capacity of the regional budget. The guaranteed minimum income of low-income families with children averaged 54.6 per cent of the regional differentiated equivalent subsistence minimum. There have been developed methodical recommendations for identifying untapped socio-economic potential of families as a source of raising income from employment, as well as criteria for removal of families from the recipients of targeted social assistance in the form of cash benefits. Proposals on correcting the current legislation on the state social support have been formulated.


2020 ◽  
Vol 94 (1) ◽  
pp. 129-168 ◽  
Author(s):  
Yoonsook Ha ◽  
Margaret M. C. Thomas ◽  
Thomas Byrne ◽  
Daniel P. Miller

2016 ◽  
Vol 22 (2) ◽  
pp. 77-92 ◽  
Author(s):  
Diana Hernández ◽  
Yang Jiang ◽  
Daniel Carrión ◽  
Douglas Phillips ◽  
Yumiko Aratani

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