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Study of Catastrophic Health Expenditure in China’s Basic Health Insurance

Author(s): Zhongliang Zhou | Jianmin Gao

Journal: International Journal of Collaborative Research on Internal Medicine & Public Health
ISSN 1840-4529

Volume: 3;
Issue: 3;
Start page: 253;
Date: 2011;
Original page

Keywords: UEMS | URMS | NCMS | Catastrophic Health Expenditure | Logistic Regression Model

Background: The catastrophic health expenditure, which could result in impoverishment, is defined asthe health expenditure exceeds some fraction of “capacity to pay”. In order to protect households fromcatastrophic health spending, the Chinese government has implemented three basic health insuranceschemes (UEMS, URMS and NCMS) in the last decade. However, as only parts of residents’ medicalexpense are reimbursed by these health insurance schemes, the insured households might still have highchance of suffering catastrophic health expenditure.Aim & Objectives: The purpose of our study is to investigate the extent of catastrophic healthexpenditure for the households enrolled in UEMS, URMS and NCMS, and to identify factors associatedwith catastrophic health expenditure.Methods: The data came from China’s National Health Service Survey conducted in 2008 in Shaanxiprovince. In this survey, a four-stage stratified random sampling procedure was used to samplehouseholds in urban and rural areas. By using a questionnaire designed by the Health Ministry of China,5960 households were interviewed, from which 1215 households covered by UEMS or URMS and 2875households covered by NCMS were chosen. The indicators of incidence and intensity of catastrophicexpenditure were employed to measure catastrophic health expenditure with different thresholds levels(10, 15, 25 and 40%), and two logistic regression models were used to estimate the factors of theprobability of catastrophic expenditure for the households enrolled in urban and rural health insuranceschemes.Results: There were 16.87 to 68.07% households covered by UEMS or URMS that suffered catastrophichealth expenditure and the average degree by which payment exceeds the thresholds varied from 2.68 to13.36%. For the households covered by NCMS, the incidence and intensity of catastrophic expenditurewere 19.62 to 75.86% and 3.12 to 15.51% respectively. Poor health, families comprised of seniors, smallfamily size and low economic status were significantly led to catastrophic health expenditure forhouseholds enrolled in both of urban and rural health insurance schemes.Study Limitations: As indirect costs of health care and the patients’ earnings losses were not included inthe health expenditure, the catastrophic health expenditure might be under-estimated in this study.Conclusion: In order to reduce catastrophic expenditure, we recommend the Chinese government toexpand the health insurance schemes for covering outpatient service as well as improve thereimbursement rates, meanwhile, strengthen illness prevention and subsidize low-income households.
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