Department of Global Health, School of Public Health, Peking University, Beijing, China.
School of Public Health, Peking University, Beijing, China.
Int J Health Policy Manag. 2023;12:7332. doi: 10.34172/ijhpm.2023.7332. Epub 2023 Feb 20.
This study took Beijing as an example to estimate the incidence and regional inequalities of catastrophic health expenditures (CHE) in a megacity of China.
This study used data from the Health Services Survey Beijing (HSSB) 2018. Logistic regressions were used to investigate the risk factors for experiencing CHE, and concentration curves, the concentration index and its decomposition method based on probit models were used to estimate the inequalities in CHE.
CHE occurred in 25.51% of the households of the outer suburb villages, 6.78% of the households of the inner-city area communities, 17.10% of the households of the villages of the inner-city areas, and 11.91% of the households of the communities of the outer suburbs. In areas in the outer suburbs, households with private insurance coverage were associated with a lowered risk of CHE, and lower educational attainment and lower occupational class were related to an increasing risk of CHE. This study also discovered pro-rich financing disparities in CHE in Beijing, with the outer suburbs having the highest levels of CHE disparity. When it comes to the observed contributions of disparities in CHE, a significant portion of them is connected to the sorts of occupations, educational levels, and residential status.
The impoverishment brought on by medical expenses and CHE must still be taken into account in the post-poverty elimination era. The megacity of China was discovered to have significant regional differences in the incidence of pro-rich financing inequity in CHE. Disparities in socioeconomic status (SES), one of the controllable variables, may be a key area to address to lower the risk and minimize CHE inequality in megacities towards the path to UHC. Additionally, it is important to consider the financial protection impact of inclusive supplementary medical insurance on lowering the likelihood of CHE in the periphery areas.
本研究以北京市为例，估算了中国特大城市灾难性卫生支出（ CHE）的发生率和地区差异。
本研究使用了 2018 年北京市卫生服务调查（HSSB）的数据。使用逻辑回归分析了发生 CHE 的风险因素，并采用集中曲线、基于概率模型的集中指数及其分解方法来评估 CHE 的不平等程度。
在外郊村庄的家庭中，25.51%发生了 CHE；在市内社区的家庭中，6.78%发生了 CHE；在内城村庄的家庭中，17.10%发生了 CHE；在外郊社区的家庭中，11.91%发生了 CHE。在外郊区，有私人保险覆盖的家庭发生 CHE 的风险较低，而受教育程度较低和职业阶层较低与 CHE 风险增加有关。本研究还发现北京市 CHE 存在贫富不均的融资差距，其中外郊区的 CHE 差距最大。在 CHE 差距的观察贡献方面，很大一部分与职业、教育水平和居住状况等有关。
在脱贫后时代，必须考虑医疗费用和 CHE 带来的贫困问题。本研究发现，中国特大城市 CHE 存在明显的贫富不均的地区差异。社会经济地位（SES）等可控制变量的差异可能是降低特大城市 CHE 风险和最小化 CHE 不平等的关键领域，同时还应考虑全民医保对降低周边地区 CHE 可能性的财务保护影响。
