The Impact of Catastrophic Medical Insurance in China: A five-year patient-level panel study.
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ABSTRACT:
SUBMITTER: Yu M
PROVIDER: S-EPMC8358690 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description: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.
| S-EPMC9656772 | biostudies-literature
Project description:BACKGROUND:By 2013, several regions in China had introduced health insurance integration policies. However, few studies addressed the impact of medical insurance integration in China. This study investigates the catastrophic health expenditure and equity in the incidence of catastrophic health expenditure by addressing its potential determinants in both integrated and non-integrated areas in China in 2013. METHODS:The primary data are drawn from the fifth China National Health Services Survey in 2013. The final sample comprises 19,788 households (38.4%) from integrated areas and 31,797 households (61.6%) from non-integrated areas. A probit model is employed to decompose inequality in the incidence of catastrophic health expenditure in line with the methodology used for decomposing the concentration index. RESULTS:The incidence of catastrophic health expenditure in integrated areas is higher than in non-integrated areas (13.87% vs. 13.68%, respectively). The concentration index in integrated areas and non-integrated areas is -?0.071 and?-?0.073, respectively. Average household out-of-pocket health expenditure and average capacity to pay in integrated areas are higher than those in non-integrated areas. However, households in integrated areas have lower share of out-of-pocket expenditures in the capacity to pay than households in non-integrated areas. The majority of the observed inequalities in catastrophic health expenditure can be explained by differences in the health insurance and householders' educational attainment both in integrated areas and non-integrated areas. CONCLUSIONS:The medical insurance integration system in China is still at the exploratory stage; hence, its effects are of limited significance, even though the positive impact of this system on low-income residents is confirmed. Moreover, catastrophic health expenditure is associated with pro-poor inequality. Medical insurance, urban-rural disparities, the elderly population, and use of health services significantly affect the equity of catastrophic health expenditure incidence and are key issues in the implementation of future insurance integration policies.
| S-EPMC6937839 | biostudies-literature
Project description:China has the world's largest floating (migrant) population, which has characteristics largely different from the rest of the population. Our goal is to study health insurance coverage and its impact on medical cost for this population.A telephone survey was conducted in 2012. 644 subjects were surveyed. Univariate and multivariate analysis were conducted on insurance coverage and medical cost.82.2% of the surveyed subjects were covered by basic insurance at hometowns with hukou or at residences. Subjects' characteristics including age, education, occupation, and presence of chronic diseases were associated with insurance coverage. After controlling for confounders, insurance coverage was not significantly associated with gross or out-of-pocket medical cost.For the floating population, health insurance coverage needs to be improved. Policy interventions are needed so that health insurance can have a more effective protective effect on cost.
| S-EPMC4227680 | biostudies-other
Project description:BackgroundChina's universal medical insurance system (UMIS) is designed to promote social fairness through improving access to medical services and reducing out-of-pocket (OOP) costs for all Chinese. However, it is still not known whether UMIS has a significant impact on the accessibility of medical service supply and the affordability, as well as the seeking-care choice, of patients in China.MethodsSegmented time-series regression analysis, as a powerful statistical method of interrupted time series design, was used to estimate the changes in the quantity and quality of medical service supply before and after the implementation of UMIS. The rates of catastrophic payments and seeking-care choices for UMIS beneficiaries were selected to measure the affordability and medical service flow of patients after the implementation of UMIS.ResultsChina's UMIS was established in 2008. After that, the trending increase of the expenditure of the UMIS was higher than that of increase in revenue compared to previous years. Up to 2014, the UMIS had covered 97.5% of the entire population in China. After introduction of the UMIS, there were significant increases in licensed physicians, nurses, and hospital beds per 1000 individuals. In addition, hospital outpatient visits and inpatient visits per year increased compared to the pre-UMIS period. The average fatality rate of inpatients in the overall hospital and general hospital and the average fatality rate due to acute myocardial infarction (AMI) in general hospitals was significantly decreased. In contrast, no significant and prospective changes were observed in rural physicians per 1000 individuals, inpatient visits and inpatient fatality rate in the community centers and township hospitals compared to the pre-UMIS period. After 2008, the rates of catastrophic payments for UMIS inpatients at different income levels were declining at three levels of hospitals. Whichever income level, the rate of catastrophic payments for inpatients of Urban Employee's Basic Medical Insurance was the lowest. For the low-income patients, a single hospitalization at a tertiary hospital can lead to catastrophic payments. It is needless to say what the economic burden could be if patients required multiple hospitalizations within a year. UMIS beneficiaries showed the intention of growth to seek hospitalization services in tertiary hospitals.ConclusionsIntroduction of the UMIS contributed to an increase in available medical services and the use thereof, and a decrease in fatality rate. The affordability of UMIS beneficiaries for medical expenses was successfully ameliorated. The differences in patients' affordability are mainly manifested in different medical insurance schemes and different seeking-care choices. The ability of the poor patients covered by UMIS to resist catastrophic medical payments is still relatively weak. Therefore, the current UMIS should reform the insurance payment model to promote the integration of medical services and the formation of a tiered treatment system. UMIS also should establish supplementary medical insurance packages for the poor.
| S-EPMC5841764 | biostudies-literature
Project description:BackgroundMuch of research on household catastrophic medical expenses in China has focused on less developed areas and little is known about this problem in more developed areas. This study aimed to analyse the incidence and determinants of catastrophic medical expenses in eastern China.MethodsData were obtained from a health care utilization and expense survey of 11,577 households conducted in eastern China in 2008. The incidence of household catastrophic medical expenses was calculated using the method introduced by the World Health Organization. A multi-level logistic regression model was used to identify the determinants.ResultsThe incidence of household catastrophic medical expenses in eastern China ranged from 9.24% to 24.79%. Incidence of household catastrophic medical expenses was lower if the head of household had a higher level of education, labor insurance coverage, while the incidence was higher if they lived in rural areas, had a family member with chronic diseases, had a child younger than 5 years old, had a person at home who was at least 65 years old, and had a household member who was hospitalized. Moreover, the impact of the economic level on catastrophic medical expenses was non-linear. The poorest group had a lower incidence than that of the second lowest income group and the group with the highest income had a higher incidence than that of the second highest income group. In addition, region was a significant determinant.ConclusionsReducing the incidence of household catastrophic medical expenses should be one of the priorities of health policy. It can be achieved by improving residents' health status to reduce avoidable health services such as hospitalization. It is also important to design more targeted health insurance in order to increase financial support for such vulnerable groups as the poor, chronically ill, children, and senior populations.
| S-EPMC4234144 | biostudies-literature
Project description:Background: To provide an updated estimate of the level and change in catastrophic health expenditure in China and examine the association between catastrophic health expenditure and family net income, we obtained data from four waves of the China Family Panel Studies conducted between 2010 and 2016. Method: We defined catastrophic health expenditure as out-of-pocket payments equaling or exceeding 40% of the household's capacity to pay. The Poisson regression with robust variance and generalized estimated equation (Poisson-GEE) model was used to quantify the level and change of catastrophic health expenditure, as well as the association between catastrophic heath expenditure and family net income. Result: Overall, the incidence of catastrophic expenditure in China experienced a 0.70-fold change between 2010 (12.57%) and 2016 (8.94%). The incidence of catastrophic health expenditure (CHE) decreased more in the poorest income quintile than the richest income quintile (annual decrease of 1.17% vs. 0.24% in urban areas, p < 0.001; 1.64% vs. -0.02% in rural areas, p < 0.001). Every 100% increase in income was associated with a 14% relative-risk reduction in CHE (RR = 0.86, 95% CI: 0.85-0.88) after adjusting for demographics, health needs, and health utilization characteristics; this association was weaker in recent years. Conclusion: Our analysis found that China made progress to reduce catastrophic health expenditure, especially for poorer groups. Income growth is strongly associated with this change.
| S-EPMC6926556 | biostudies-literature
Project description:BackgroundEnhancing the pooling of basic medical insurance plays a vital role in strengthening the resilience to risk and co-payment capacity of medical insurance funds. In China, there is a concerted effort to shift from municipal to provincial pooling of medical insurance. While existing research suggests that provincial pooling of basic health insurance affects the health of participants, the findings are not yet consistent, and there is limited research on the specific pathways of impact between the two. Therefore, this study aims to explore the influence of provincial pooling of basic medical insurance on participants' health and analyze the mediating role of medical cost burden and medical service utilization.MethodsUsing data from the 2012-2018 China Labor Dynamics Survey (CLDS), this study focuses on a sample of urban workers enrolled in basic medical insurance. After excluding samples with missing information, a total of 5,684 participants were included in the analysis. The effects of the provincial pooling policy of basic medical insurance on participants' medical cost burden, medical service utilization, and health were analyzed using double difference modeling. Furthermore, structural equation modeling was employed to explore the mediating paths between provincial pooling and health.ResultsThe findings reveal that provincial pooling of basic medical insurance significantly impacts participants' medical cost burden, medical service utilization, and health. Specifically, provincial pooling helps reduce the participants' medical cost burden (β = -0.1205; P < 0.001), improves the level of medical institutions visited (β = 1.7962; P < 0.001), and promotes health improvement (β = 1.8370; P < 0.001). The mediating effect analysis demonstrates that the direct effect of provincial pooling on health is 1.073 (P < 0.001), with a mediating effect of medical cost burden between provincial pooling and health measuring 0.129 (P < 0.001). Heterogeneity analysis indicates that provincial pooling is more effective in reducing the burden of medical costs for low-income (β = -0.2273; P < 0.001) and high-age participants (β = -0.2710; P < 0.001), and it also helps increase the burden of medical costs for low-income (β = 4.0875; P < 0.001) and high-age participants (β = 1.9010; P < 0.001) based on provider ranking. Moreover, it is found that provincial pooling is more beneficial in improving the health of high-income (β = 1.7984; P < 0.001) and middle- and high-age enrollees (β = 1.9220; P < 0.001; β = 0.5900; P < 0.001). Further analysis reveals that the provincial unified income and expenditure mode has a more positive effect than the provincial risk adjustment fund mode in reducing the medical expense burden of the insured (-0.2053 < -0.0775), improving the grade of medical institutions (1.8552 > 0.8878), and enhancing the health level (2.8406 > 0.6812).ConclusionThe study concludes that provincial pooling of basic medical insurance has a direct positive impact on participants' health and indirectly promotes health improvement by reducing the burden of medical costs. The effects of provincial pooling on participants' medical cost burden, medical service utilization, and health vary based on income and age. Additionally, the provincial-level unified collection and payment model proves to be more advantageous in optimizing the functioning of health insurance funds through the "law of large numbers" principle.
| S-EPMC10246363 | biostudies-literature
Project description:BACKGROUND:China's fragmentation of social health insurance schemes has become a key obstacle that hampers equal access to health care and financial protection. This study aims to explores if the policy intervention Urban and Rural Residents Basic Medical Insurance (URRBMI) scheme, which integrates Urban Resident Basic Medical Insurance (URBMI) and New Rural Cooperative Medical Scheme (NCMS), can curb the persistent inequity of catastrophic health expenditure (CHE) and further analyses the determinants causing inequity. METHODS:Data were derived from the Fifth National Health Service Survey (NHSS). A total of 11,104 households covered by URRBMI and 20,590 households covered by URBMI or NCMS were selected to analyze CHE and the impoverishment rate from medical expenses. Moreover, the decomposition method based on a probit model was employed to analyse factors contributing CHE inequity. RESULTS:The overall incidence of CHE under integrated insurance scheme was 15.53%, about 1.10% higher than the non-integrated scheme; however, the intensity of CHE and impoverishment among the poorest was improved. Although CHE was still concentrated among the poor under URRBMI (CI = -0.53), it showed 28.38% lower in the degree of inequity. For URRBMI households, due to the promotion of integration reform to the utilization of rural residents' better health services, the factor of residence (24.41%) turns out to be a major factor in increasing inequity, the factor of households with hospitalized members (- 84.53%) played a positive role in reducing inequity and factors related to social economic status also contributed significantly in increasing inequity. CONCLUSION:The progress made in the integrated URRBMI on CHE equity deserves recognition, even though it did not reduce the overall CHE or the impoverishment rate effectively. Therefore, for enhanced equity, more targeted solutions should be considered, such as promoting more precise insurance intervention for the most vulnerable population and including costly diseases suitable for outpatient treatment into benefit packages. Additionally, comprehensive strategies such as favourable targeted benefit packages or job creation are required for the disadvantaged.
| S-EPMC7126184 | biostudies-literature
Project description:BackgroundOvercrowding of high-level health facilities is a major concern in a Vietnamese health system. This may increase an economic burden to the households since health insurance is still insufficient in providing financial risk protection. This paper sought to examine the association between the use of high-level health facilities and household-level expenditure status such as out-of-pocket (OOP), and catastrophic expenditure on health, as well as a moderating effect of health insurances in rural and urban districts of Vietnam.MethodsData utilized a health system community survey collected between 2015 and 2017 in two districts of Vietnam (one from rural area in northern part, and the other one from urban area in sourthern part). The world Health Organization's definition of catastrophic expenditure was used. Multivariate tobit and logistic regression were employed for catastrophic expenditure and OOP respectively. Interaction term between health insurance status and visit frequency in high-level facilities was included to investigate the moderating effect of health insurance.ResultsHealth insurance status was associated with neither OOP health expenditure nor catastrophic expenditure occurrence, whereas visit frequency of high-level health facilities was strongly associated with both outcomes in both districts(e.g., for catastrophic expenditure, ORs are 1.77 and 1.30 in northern and southern district respecitvely. P values are < 0.001). Significant interaction between health insurance status and use of high-level facilities on catastrophic expenditure occurrence was found in Quoc Oai district (OR = 0.68, p < 0.05).ConclusionsThe present study demonstrated negative financial impact of utilizing high-level facility on household financial status and weak role of health insurance in decreasing this impact. Multi-faceted approach is called for to mitigate the patient's financial burden.
| S-EPMC6528376 | biostudies-literature
Project description:BackgroundThere is a need to evaluate the latest information regarding a potential late safety signal in patients treated with paclitaxel-coated devices for peripheral artery disease. We evaluated the 5-year all-cause mortality rate of the Stellarex drug-coated balloon (DCB) compared with percutaneous transluminal angioplasty (PTA).MethodsAn independent third-party performed a patient-level meta-analysis of the pooled ILLUMENATE Pivotal and EU randomized controlled trials. The primary outcome was time to death. Kaplan-Meier estimates of all-cause mortality were compared with the log-rank test. Predictors of mortality were assessed with Cox proportional hazard modeling. A blinded clinical events committee adjudicated all serious adverse events (including death). The follow-up was 60 months.ResultsA total of 589 patients were followed for a median of 4.9 years (IQR, 4.8, 5.1 years); 419 were randomized to Stellarex DCB and 170 to PTA. Vital status was obtained for 93.8%. The 5-year Kaplan-Meier estimates of freedom from all-cause death were 80.4% (95% CI, 76.7%-84.3%) in the Stellarex DCB arm versus 80.4% (95% CI, 74.3%-86.5%) in the PTA arm (log-rank, P = .7754). There was no difference in all-cause mortality when stratified by paclitaxel dose terciles. Predictors of mortality included renal insufficiency, reference vessel diameter, age, and lesion length, but not paclitaxel dose nor paclitaxel exposure.ConclusionsThere was no difference in all-cause mortality between the Stellarex DCB and PTA through the final 5-year follow-up window of 2 ILLUMENATE randomized controlled trials. These long-term data build on the previously reported safety of the Stellarex DCB for treating symptomatic femoropopliteal peripheral artery disease.
| S-EPMC11308630 | biostudies-literature