School of Public Health, Peking University Health Science Center, Beijing, China.
BMC Public Health. 2023 Sep 19;23(1):1820. doi: 10.1186/s12889-023-16679-4.
Providing financial risk protection is one of the fundamental goals of health systems. Catastrophic health expenditure (CHE) and medical impoverishment (MI) are two common indicators in evaluating financial risk protection in health. As China continues its health system reform to provide accessible and affordable health care, it is important to have a clear understanding of China's progress in financial risk protection. However, past research showed discrepancies in the incidence of CHE and MI. In this article, using data from four national household surveys, we analyzed levels and characteristics of CHE and MI in China under different definitions.
We used multiple conventional thresholds for CHE and MI to comprehensively describe the levels of financial risk protection in China. We used data from four national household surveys to measure the incidence of CHE and MI, and their inequalities by urban/rural status and by income quartiles. The Probit regression model was used to explore influencing factors of CHE and MI.
We found that the incidences of CHE and MI were largely consistent across four national household surveys, despite different sampling methods and questionnaire designs. At the 40% nonfood expenditure threshold, the incidence of CHE in China was 14.95%-17.73% across four surveys during the period of 2016-2017. Meanwhile, at the 1.9 US dollars poverty line, the incidence of MI was 2.01%-5.63%. Moreover, rural residents, lower-income subgroups, and smaller households were faced with higher financial risks from healthcare expenditures. Although positive progress in financial risk protection has been achieved in recent years, China has disproportionately high incidences of CHE and MI, compared to other countries.
China has large margins for improvements in risk financial protection, with large inequalities across subgroups. Providing better financial protection for low-income groups in rural areas is the key to improve financial protection in China.
提供财务风险保护是卫生系统的基本目标之一。灾难性卫生支出 (CHE) 和医疗贫困 (MI) 是评估卫生财务风险保护的两个常见指标。随着中国继续进行卫生系统改革，以提供可及和负担得起的医疗保健，了解中国在财务风险保护方面的进展情况非常重要。然而，过去的研究表明 CHE 和 MI 的发生率存在差异。在本文中，我们使用来自四项全国性家庭调查的数据，根据不同的定义分析了中国在 CHE 和 MI 方面的水平和特征。
我们使用 CHE 和 MI 的多个常规阈值来全面描述中国的财务风险保护水平。我们使用来自四项全国性家庭调查的数据来衡量 CHE 和 MI 的发生率及其在城乡和收入四分位数之间的不平等。使用 Probit 回归模型探讨 CHE 和 MI 的影响因素。
我们发现，尽管采用了不同的抽样方法和问卷设计，但四项全国性家庭调查的 CHE 和 MI 发生率基本一致。在 2016-2017 年期间，以非食品支出的 40%为阈值，中国 CHE 的发生率为 14.95%-17.73%。同时，以 1.9 美元的贫困线为标准，MI 的发生率为 2.01%-5.63%。此外，农村居民、低收入群体和小家庭面临更高的医疗支出财务风险。尽管近年来在财务风险保护方面取得了积极进展，但与其他国家相比，中国 CHE 和 MI 的发生率相对较高，存在较大的不平等。
中国在风险财务保护方面还有很大的改进空间，各亚组之间存在较大的不平等。为农村地区的低收入群体提供更好的财务保护是改善中国财务保护的关键。
