Li Linwei, Guo Bingqing, Liu Chaojie, Yao Qiang
School of Political Science and Public Administration, Wuhan University, No. 299 Bayi Road, Wuchang District, Wuhan 430072, China.
School of Public Health, Imperial College London, 90 Woodlane, London W12 0BZ, United Kingdom.
Health Policy Plan. 2025 Jun 12;40(6):625-640. doi: 10.1093/heapol/czaf026.
Healthcare costs are a major driver of poverty, accounting for 44.1% of poverty cases in China. By 2015, nearly 20 million people fell into or returned to poverty due to health issues. In response, the Chinese government launched the national health poverty alleviation project in 2016. This study aims to evaluate the distribution and trends of healthcare-induced poverty from 2013 to 2019. Using data from the China Household Finance Survey (CHFS), we estimated the incidence of household catastrophic health expenditure (CHE) and impoverishing health expenditure (IHE) and analyzed their determinants through multi-level logistic regression models. Subgroup analyses were conducted based on rural/urban location, geographic region, and province. In 2013, 31.83% of households experienced CHE, while 9.56% faced IHE. CHE incidence declined significantly after 2016 [adjusted odds ratio (AOR) = 0.493-0.766, P < 0.001]. IHE incidence initially increased in 2015 (AOR = 1.580, P < 0.001) before declining from 2017 onward (AOR = 0.465-0.607, P < 0.001). The most significant reduction (9.99%-10.95%) occurred among the highest income quartile. CHE and IHE shared similar determinants. Higher odds of CHE and IHE were associated with older age of the household head (AOR = 1.225-2.175, P < 0.001), rural residency (AOR = 1.093-1.199, P < 0.05), the presence of an elderly household member (AOR = 1.237-1.336, P < 0.001), and having more household members in poor self-rated health (AOR = 2.455-4.137, P < 0.001). Conversely, lower odds of CHE and IHE were associated with higher educational attainment (AOR = 0.681-0.879, P < 0.001) and employment (AOR = 0.610-0.708, P < 0.001) of the household head, higher household income per capita (AOR = 0.017-0.860, P < 0.001), and larger household size (AOR = 0.335-0.684, P < 0.001). Households in urban areas and the eastern developed region had lower incidences of CHE and IHE compared to others. In conclusion, China has seen a significant decline in CHE and IHE, particularly after implementing the national poverty alleviation project. However, regional, urban-rural, and income-related disparities persist, underscoring the need for equity-focused interventions.
医疗费用是贫困的主要驱动因素，在中国占贫困案例的44.1%。到2015年，近2000万人因健康问题陷入贫困或返贫。作为回应，中国政府于2016年启动了国家健康扶贫工程。本研究旨在评估2013年至2019年医疗导致贫困的分布情况和趋势。利用中国家庭金融调查（CHFS）的数据，我们估计了家庭灾难性医疗支出（CHE）和致贫性医疗支出（IHE）的发生率，并通过多层次逻辑回归模型分析了它们的决定因素。基于农村/城市地区、地理区域和省份进行了亚组分析。2013年，31.83%的家庭经历了灾难性医疗支出，而9.56%的家庭面临致贫性医疗支出。2016年后灾难性医疗支出发生率显著下降[调整优势比（AOR）=0.493 - 0.766，P<0.001]。致贫性医疗支出发生率在2015年最初有所上升（AOR = 1.580，P<0.001），之后从2017年起下降（AOR = 0.465 - 0.607，P<0.001）。最大幅度的下降（9.99% - 10.95%）出现在收入最高的四分位数组中。灾难性医疗支出和致贫性医疗支出有相似的决定因素。灾难性医疗支出和致贫性医疗支出的较高发生率与户主年龄较大（AOR = 1.225 - 2.175，P<0.001）、农村居住（AOR = 1.093 - 1.199，P<0.05）、有老年家庭成员（AOR = 1.237 - 1.336，P<0.001）以及自评健康状况较差的家庭成员较多（AOR = 2.455 - 4.137，P<0.001）相关。相反，灾难性医疗支出和致贫性医疗支出的较低发生率与户主受教育程度较高（AOR = 0.681 - 0.879，P<0.001）、就业（AOR = 0.610 - 0.708，P<0.001）、人均家庭收入较高（AOR = 0.017 - 0.860，P<0.001）以及家庭规模较大（AOR = 0.335 - 0.684，P<0.001）相关。与其他地区相比，城市地区和东部发达地区的家庭灾难性医疗支出和致贫性医疗支出发生率较低。总之，中国的灾难性医疗支出和致贫性医疗支出显著下降，特别是在实施国家扶贫工程之后。然而，地区、城乡和收入相关的差距仍然存在，这凸显了以公平为重点的干预措施的必要性。
