Harbin Medical University, Harbin, China.
Department of Stomatology, Heilongjiang Provincial Hospital, Harbin, China.
Front Public Health. 2021 Sep 9;9:705488. doi: 10.3389/fpubh.2021.705488. eCollection 2021.
Non-communicable diseases (NCD) drag the NCD patients' families to the abyss of poverty. Medical insurance due to weak control over medical expenses and low benefits levels, may have actually contributed to a higher burden of out-of-pocket payments. By making a multi-dimensional calculation on catastrophic health expenditure (CHE) in Heilongjiang Province over 10 years, it is significant to find the weak links in the implementation of medical insurance to achieve poverty alleviation. A logistic regression was undertaken to predict the determinants of catastrophic health expenditure. The average CHE of households dropped from 18.9% in 2003 to 14.9% in 2013. 33.2% of the households with three or more NCD members suffered CHE in 2013, which was 7.2 times higher than the households without it (4.6%). The uninsured households with cardiovascular disease had CHE of 12.0%, which were nearly 10% points lower than insured households (20.4-22.4%). For Medical Insurance for Urban Employees Scheme enrolled households, the increasing number of NCD members raised the risk of impoverishment from 3.4 to 20.0% in 2003, and from 0.3 to 3.1% in 2008. Households with hospital in-patient members were at higher risk of CHE (OR: 3.10-3.56). Healthcare needs and utilization are one of the most significant determinants of CHE. Households with NCD and in-patient members are most vulnerable groups of falling into a poverty trap. The targeting of the NCD groups, the poorest groups, uninsured groups need to be primary considerations in prioritizing services that are contained in medical insurance and poverty alleviation.
非传染性疾病（NCD）将 NCD 患者家庭拖入贫困的深渊。由于对医疗费用控制不力和福利水平低，医疗保险实际上可能导致更高的自付费用负担。通过对黑龙江省 10 多年来灾难性卫生支出（CHE）进行多维计算，发现医疗保险扶贫实施中的薄弱环节具有重要意义。采用逻辑回归对灾难性卫生支出的决定因素进行预测。家庭平均 CHE 从 2003 年的 18.9%下降到 2013 年的 14.9%。2013 年，有 33.2%的有 3 个或更多 NCD 成员的家庭发生了 CHE，这是没有 NCD 成员的家庭的 7.2 倍（4.6%）。未参保的心血管疾病患者有 CHE 的比例为 12.0%，比参保家庭低近 10 个百分点（20.4-22.4%）。对于参加城镇职工医疗保险的家庭，2003 年 NCD 成员数量的增加使贫困风险从 3.4%上升到 20.0%，而 2008 年从 0.3%上升到 3.1%。有住院患者成员的家庭发生 CHE 的风险更高（OR：3.10-3.56）。医疗保健需求和利用是非传染性疾病致贫的最重要决定因素之一。有 NCD 和住院患者成员的家庭是最容易陷入贫困陷阱的弱势群体。在优先考虑医疗保险和扶贫服务时，应将 NCD 群体、最贫困群体和未参保群体作为首要考虑因素。
