Department of Public Health, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
Appl Health Econ Health Policy. 2011;9(1):39-49. doi: 10.2165/11530730-000000000-00000.
within total health expenditure, the share of out-of-pocket health expenditure by individuals has increased in the past 25 years in China, from 20% in 1980 to 49% in 2006, with a peak of 59% in 2000. Medical issues have become a larger concern than any other issue for households.
to estimate the determinants of individual out-of-pocket health expenditure in China.
we used a subsample of 9860 adults aged ≥ 18 years from the 2004 China Health and Nutrition Survey. To control for potential sample selection bias, the Heckman selection model was used to analyse individuals' health expenditure decisions, which is based on a sample that excludes individuals who do not report paying for healthcare.
of the sampled population, 24.6% reported recent illness, 80.6% of whom sought care; 82.3% of those who sought care reported the amount of health spending. The average out-of-pocket health expenditure was Chinese Yuan (Y) 502 (Y100 = $US12.2 in 2004). Illness perceived as 'quite serious' and self-reported poor health status had the highest coefficients (2.012 [p < 0.01] and 3.351 [p < 0.01], respectively). People spent more on healthcare with increasing age, especially over the age of 65 years, with a coefficient of 1.171 (p < 0.01). Those who had chronic disease, earned higher incomes, resided in urban areas, lived in the middle or eastern region, or lived in a household with a head having a middle school or higher education paid more for healthcare. In the model examining disaggregated effects of insurance programmes, the coefficients were positive, except for commercial insurance, and the coefficient for labour insurance was significant.
perceived severity of illness and self-reported health status are the most important factors when determining out-of-pocket health expenditure. The effect of aging is substantial. China should develop appropriate medical relief policies for the elderly to help them gain access to necessary healthcare services. Certain types of insurance programmes tend to increase out-of-pocket health expenditures, which highlights the need to continuously monitor and rigorously evaluate the impact of ongoing health insurance reform in China.
在过去的 25 年中，中国个人在总卫生支出中自付卫生支出的比例有所增加，从 1980 年的 20%增加到 2006 年的 49%，2000 年达到峰值 59%。医疗问题已成为家庭最关心的问题。
估计中国个人自付卫生支出的决定因素。
我们使用了 2004 年中国健康与营养调查中 9860 名年龄≥18 岁成年人的一个子样本。为了控制潜在的样本选择偏差，我们使用 Heckman 选择模型分析了个人的卫生支出决策，该模型基于排除了未报告医疗费用的个人的样本。
在抽样人群中，24.6%报告最近患病，其中 80.6%寻求治疗；82.3%寻求治疗的人报告了医疗支出金额。平均自付卫生支出为人民币 502 元（2004 年为 100 元人民币=12.2 美元）。被认为“相当严重”的疾病和自我报告的健康状况不佳的疾病具有最高的系数（分别为 2.012（p<0.01）和 3.351（p<0.01））。人们随着年龄的增长而增加医疗保健支出，尤其是 65 岁以上的人，系数为 1.171（p<0.01）。患有慢性病、收入较高、居住在城市地区、居住在中部或东部地区或家庭主要成员具有中学或以上学历的人，医疗支出更高。在检查保险计划的分散影响的模型中，除商业保险外，系数均为正，而劳动保险的系数显著。
疾病严重程度和自我报告的健康状况是决定自付卫生支出的最重要因素。老龄化的影响是巨大的。中国应制定适当的老年人医疗救助政策，帮助他们获得必要的医疗服务。某些类型的保险计划往往会增加自付卫生支出，这突显了需要不断监测和严格评估中国正在进行的医疗保险改革的影响。
