Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing 210008, China.
Center for Health Policy and Management Studies, Nanjing University, Nanjing 210093, China.
Int J Environ Res Public Health. 2022 Nov 2;19(21):14313. doi: 10.3390/ijerph192114313.
China has been piloting the catastrophic medical insurance (CMI) program since 2012 and rolled it out nationally in 2016 to reduce the incidence of catastrophic health expenditure among Chinese residents. Few studies have been conducted to determine its effect on healthcare expenditures, particularly among the elderly. The purpose of this study is to examine the effect of CMI on healthcare expenditures among China's elderly population. The data for this study were derived from 4 waves of the Chinese Longitudinal Healthy Longevity Survey, which included 344 and 1199 individuals in the treatment and control groups, respectively. To examine the effect of CMI on healthcare expenditures among the elderly, we used difference-in-differences and fixed-effects models. Additionally, a heterogeneity analysis was used to examine the differences in the impact of CMI on different groups. Finally, we confirmed the robustness of the results using robustness and placebo tests. CMI increased total health and out-of-pocket expenditures significantly, as well as inpatient and corresponding out-of-pocket expenditures. The reassults of the heterogeneity analysis indicated that CMI had a greater impact on elderly residents of rural areas. Economic burden protection has been enhanced for low-income groups and patients with serious diseases over the last two years. Our research indicated that CMI can promote the use of inpatient medical services for the elderly to a certain extent. Targeted measures such as expanding the CMI compensation list, establishing a more precise compensation scheme, and specific diseases associated with high healthcare expenditures can be considered in the practice of CMI implementation.
中国自 2012 年开始试点灾难性医疗保险（CMI）计划，并于 2016 年在全国范围内推广，以降低中国居民灾难性卫生支出的发生率。很少有研究确定其对医疗支出的影响，特别是对老年人的影响。本研究旨在探讨 CMI 对中国老年人口医疗支出的影响。本研究的数据来自中国纵向健康长寿调查的 4 个波次，治疗组和对照组分别包括 344 人和 1199 人。为了检验 CMI 对老年人医疗支出的影响，我们使用了差异分析和固定效应模型。此外，还进行了异质性分析，以检验 CMI 对不同群体的影响差异。最后，我们使用稳健性和安慰剂检验来确认结果的稳健性。CMI 显著增加了总健康和自付支出，以及住院和相应的自付支出。异质性分析的结果表明，CMI 对农村地区的老年居民影响更大。在过去两年中，低收入群体和重病患者的经济负担保护得到了加强。我们的研究表明，CMI 可以在一定程度上促进老年人住院医疗服务的使用。在实施 CMI 的实践中，可以考虑扩大 CMI 补偿清单、建立更精确的补偿方案以及与高医疗支出相关的特定疾病等针对性措施。
