Zhang Ying, Vanneste Jacques, Xu Jiaxin, Liu Xiaoxing
Department of Finance, School of Economics and Management, Southeast University, Nanjing, People's Republic of China.
Applied Economics Faculty, University of Antwerp, Antwerp, Belgium.
Int J Health Econ Manag. 2019 Jun;19(2):193-212. doi: 10.1007/s10754-018-9252-1. Epub 2018 Sep 21.
Currently, a high percentage of China's households face financial catastrophe as a direct result of excessive out-of-pocket (OOP) health expenditures. To alleviate this, China has set up the Critical Illness Insurance (CII) program since 2012. However, the current CII is still in an experimental phase and tested in 8 (out of 34) provinces, which has not been proved to be effective. This paper develops a health financing system for reducing catastrophic medical spending using a two-layer model for CII. This model partly compensates expenses exceeding the cap line of the Social Resident Basic Medical Insurance scheme to maintain the ratio of OOP expenses to total medical expenditure approximately at 20%. Adjustment coefficients based on individual net income across different regions are applied to increase fairness. The financial sustainability of the model is tested using a fund balance calculation. Finally, the two-layer model of the CII is empirically simulated with the latest provincial data from China Family Panel Studies. The results demonstrate that the model can effectively alleviate the incidence and severity of catastrophic health expenditures.
目前，中国很大比例的家庭因高额自付医疗费用而面临财务危机。为缓解这一状况，中国自2012年起设立了大病保险（CII）项目。然而，当前的大病保险仍处于试点阶段，仅在34个省份中的8个省份进行测试，其有效性尚未得到证实。本文利用大病保险的两层模型开发了一种用于减少灾难性医疗支出的健康融资系统。该模型对超出社会居民基本医疗保险计划封顶线的费用进行部分补偿，以使自付费用与总医疗支出的比例大致维持在20%。应用基于不同地区个人净收入的调整系数来提高公平性。通过基金余额计算对该模型的财务可持续性进行了测试。最后，利用中国家庭追踪调查的最新省级数据对大病保险的两层模型进行了实证模拟。结果表明，该模型能够有效缓解灾难性健康支出的发生率和严重程度。
