School of Humanities and Management, Hunan University of Chinese Medicine, Changsha, Hunan, China.
Key Laboratory of Vascular Biology and Translational Medicine, Medical School, Hunan University of Chinese Medicine, Changsha, China.
Front Public Health. 2024 May 16;12:1412536. doi: 10.3389/fpubh.2024.1412536. eCollection 2024.
This study investigates the determinants of medical impoverishment among China's rural near-poor, aiming to enhance public health services and establish preventative and monitoring systems.
Using China Family Panel Studies and World Bank methods, we categorized rural populations and calculated their 2020 Poverty Incidence (PI) and Poverty Gap (PG), with impoverishing health expenditures (IHE) as the primary indicator. We analyzed the data from 2016 to 2020 using a conditional fixed-effects multinomial logit model and 2020 logistic regression to identify factors influencing medical impoverishment risk.
(1) In 2020, the near-poor in China faced a PI of 16.65% post-health expenditures, 8.63 times greater than the non-poor's PI of 1.93%. The near-poor's Average Poverty Gap (APG) was CNY 1,920.67, notably surpassing the non-poor's figure of CNY 485.58. Health expenses disproportionately affected low-income groups, with the near-poor more prone to medical impoverishment. (2) Disparities in medical impoverishment between different economic household statuses were significant ( < 0.001), with the near-poor being particularly vulnerable. (3) For rural near-poor households in China, those with over six members faced a lower risk of medical impoverishment compared to those with three or fewer. Unmarried individuals had a 7.1% reduced risk of medical impoverishment relative to married/cohabiting counterparts. Unemployment was associated with a 9% increased risk. A better self-rated health status was linked to a lower probability of IHE, with the "very healthy" reporting a 25.8% lower risk than those "unhealthy." Chronic disease sufferers in the near-poor and non-poor categories were at an increased risk of 12 and 1.4%, respectively. Other surveyed factors, including migrant status, age, insurance type, gender, educational level, and recent smoking or drinking, were not statistically significant ( > 0.05).
Rural near-poor in China are much more susceptible to medical impoverishment, influenced by specific socio-economic factors. The findings advocate for policy enhancements and health system reforms to mitigate health poverty. Further research should extend to urban areas for comprehensive health poverty strategy development.
本研究旨在探讨中国农村准贫困人口医疗致贫的决定因素，以加强公共卫生服务并建立预防和监测系统。
使用中国家庭追踪调查和世界银行的方法，我们对农村人口进行了分类，并计算了他们 2020 年的贫困发生率（PI）和贫困差距（PG），以医疗支出致贫（IHE）为主要指标。我们使用条件固定效应多项逻辑回归模型和 2020 年的逻辑回归分析了 2016 年至 2020 年的数据，以确定影响医疗致贫风险的因素。
（1）2020 年，中国的准贫困人口在健康支出后面临 16.65%的贫困发生率（PI），是贫困发生率为 1.93%的非贫困人口的 8.63 倍。准贫困人口的平均贫困差距（APG）为 1920.67 元，明显高于非贫困人口的 485.58 元。医疗支出对低收入群体的影响不成比例，准贫困人口更容易陷入医疗贫困。（2）不同经济家庭状况下的医疗贫困差距具有显著差异（<0.001），准贫困人口尤其脆弱。（3）对于中国农村的准贫困人口家庭来说，家庭成员超过 6 人的家庭比家庭成员为 3 人或更少的家庭面临较低的医疗贫困风险。与已婚/同居者相比，未婚者的医疗贫困风险降低了 7.1%。失业会增加 9%的风险。自我评估健康状况较好的人发生医疗支出致贫的概率较低，“非常健康”的人比“不健康”的人低 25.8%。准贫困人口和非贫困人口中患有慢性病的人风险分别增加了 12%和 1.4%。其他调查因素，包括移民身份、年龄、保险类型、性别、教育水平以及最近的吸烟或饮酒情况，没有统计学意义（>0.05）。
中国农村的准贫困人口更容易陷入医疗贫困，这受到特定社会经济因素的影响。研究结果主张加强政策和卫生系统改革，以减轻健康贫困。应将研究扩展到城市地区，以制定全面的健康贫困战略。
