Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China.
International Research Center for Medicinal Administration, Peking University, Beijing, China.
Eur J Health Econ. 2021 Apr;22(3):463-471. doi: 10.1007/s10198-021-01267-3. Epub 2021 Feb 13.
The Chinese government has made great progress in establishing the universal medical insurance system. This study aimed to analyze whether the universal medical insurance system protected middle-aged and elderly households from catastrophic health expenditure (CHE).
The data were obtained from the China Health and Retirement Longitudinal Study. We used household as our unit of analysis and CHE was measured as out-of-pocket expenditures ≥ 40% of nonfood household expenditures. Univariate analysis was deployed to examine the impacts of different medical insurance schemes on CHE, and the factors associated with CHE were estimated using a random-effects logit regression model.
We identified 10,005, 10,370, and 11,567 households in 2011, 2013, and 2015, respectively, and found 12.9% (2011), 26.6% (2013) and 27.9% (2015) of the households experienced CHE. When compared with no insurance, households enrolled in New Rural Cooperative Medical Insurance Scheme (P = 0.023) were associated with a lower incidence of CHE, but other insurance schemes were not significant. Households with members older than 65 years (P < 0.001), members with chronic diseases (P < 0.001), members with poor self-reported health conditions (P < 0.001), and members receiving health care (P < 0.001) had a higher risk of CHE. Large household size (P < 0.001) and high household income per capita (P < 0.001) were major protective factors to CHE incidence.
Despite China's great stride in the medical insurance coverage, it fell short to provide financial protection against medical expenditure burden. To reduce the risk of CHE, an integrated poverty and elderly-oriented medical insurance system could be put in place to address these problems.
中国政府在建立全民医疗保险制度方面取得了巨大进展。本研究旨在分析全民医疗保险制度是否保护了中年和老年家庭免受灾难性卫生支出（CHE）的影响。
数据来自中国健康与养老追踪调查。我们以家庭为分析单位，将 CHE 定义为自付支出超过非食品家庭支出的 40%。采用单变量分析来检验不同医疗保险方案对 CHE 的影响，使用随机效应 logit 回归模型来估计与 CHE 相关的因素。
我们分别在 2011 年、2013 年和 2015 年识别了 10005、10370 和 11567 户家庭，发现分别有 12.9%（2011 年）、26.6%（2013 年）和 27.9%（2015 年）的家庭发生了 CHE。与没有保险相比，参加新型农村合作医疗制度（P=0.023）的家庭 CHE 发生率较低，但其他保险方案则不显著。65 岁以上的家庭成员（P<0.001）、患有慢性病的家庭成员（P<0.001）、自我报告健康状况较差的家庭成员（P<0.001）和接受医疗保健的家庭成员（P<0.001）的家庭 CHE 风险更高。大家庭规模（P<0.001）和人均家庭收入较高（P<0.001）是 CHE 发生率的主要保护因素。
尽管中国在医疗保险覆盖范围方面取得了巨大进展，但在提供医疗支出负担的经济保护方面仍有不足。为了降低 CHE 风险，可以建立一个综合的扶贫和老年医疗保险制度来解决这些问题。
