Center for Policy and Management Research, School of Health Management, Harbin Medical University, No. 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China.
Department of Economics, School of Economics, Minzu University of China, Beijing, China.
BMC Med Res Methodol. 2022 May 25;22(1):151. doi: 10.1186/s12874-022-01630-9.
Middle-aged and older adults are more likely to suffer from chronic diseases because of their particular health characteristics, which lead to a high incidence of catastrophic health expenditure (CHE). This study plans to analyse the different factors affecting CHE in middle-aged and older adults with chronic diseases, target the vulnerable characteristics, and suggest groups that medical insurance policies should pay more attention to.
The data used in this study came from the 2018 China Health and Retirement Longitudinal Study (CHARLS) database. The method of calculating the CHE was adopted from the World Health Organization (WHO). The logistic regression was used to determine the family characteristics of chronic disease in middle-aged and older adults with a high probability of incurring CHE.
The incidence of CHE in middle-aged and older adults with chronic disease was highest in sub-poverty level families (26.20%) was lowest in wealthier level families (20.07%). Households with malignant tumours had the highest CHE incidence under any circumstances, especially if the householder had been using inpatient service in the past year. Among the comparison of CHE incidence in different types of medical insurance, the Urban and Rural Residents' Basic Medical Insurance (URRBMI) was the highest (27.46%). The incidence of CHE was 2.73 times (95% CI 2.30-3.24) and 2.16 times (95% CI 1.81-2.57) higher among people who had used inpatient services in the past year or outpatient services in the past month than those who had not used them.
Relatively wealthy economic conditions cannot significantly reduce the financial burden of chronic diseases in middle-aged and older adults. For this particular group with multiple vulnerabilities, such as physical and social vulnerability, the high demand and utilization of health services are the main reasons for the high incidence of CHE. After achieving the goal of lowering the threshold of universal access to health services, the medical insurance system in the next stage should focus on multiple vulnerable groups and strengthen the financial protection for middle-aged and older adults with chronic diseases, especially for patients with malignant tumours.
中老年人由于其特殊的健康特征，更容易患慢性病，导致灾难性医疗支出（CHE）的发生率较高。本研究计划分析影响患有慢性病的中老年人 CHE 的不同因素，针对弱势群体，并提出医疗保险政策应更加关注的群体。
本研究使用的数据来自 2018 年中国健康与养老追踪调查（CHARLS）数据库。采用世界卫生组织（WHO）的 CHE 计算方法。使用逻辑回归确定患有慢性病的中老年人家庭特征中 CHE 发生概率较高的因素。
患有慢性病的中老年人中，处于贫困线以下家庭的 CHE 发生率最高（26.20%），最富裕家庭的 CHE 发生率最低（20.07%）。在任何情况下，患有恶性肿瘤的家庭 CHE 发生率最高，特别是如果家庭主要成员在过去一年中使用过住院服务。在不同类型医疗保险的 CHE 发生率比较中，城乡居民基本医疗保险（URRBMI）最高（27.46%）。与未使用过住院服务或门诊服务的人相比，过去一年中使用过住院服务或门诊服务的人 CHE 发生率分别高出 2.73 倍（95%CI 2.30-3.24）和 2.16 倍（95%CI 1.81-2.57）。
相对富裕的经济条件并不能显著减轻中老年人慢性病的经济负担。对于这一具有身体和社会脆弱性等多种脆弱性的特定群体，对卫生服务的高需求和高利用率是 CHE 发生率较高的主要原因。在实现普遍获得卫生服务的目标后，下一阶段的医疗保险制度应关注多个弱势群体，并加强对患有慢性病的中老年人的经济保护，特别是对恶性肿瘤患者。
