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Does the universal medical insurance system reduce catastrophic health expenditure among middle-aged and elderly households in China? A longitudinal analysis

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Abstract

Background

The Chinese government has made great progress in establishing the universal medical insurance system. This study aimed to analyze whether the universal medical insurance system protected middle-aged and elderly households from catastrophic health expenditure (CHE).

Methods

The data were obtained from the China Health and Retirement Longitudinal Study. We used household as our unit of analysis and CHE was measured as out-of-pocket expenditures ≥ 40% of nonfood household expenditures. Univariate analysis was deployed to examine the impacts of different medical insurance schemes on CHE, and the factors associated with CHE were estimated using a random-effects logit regression model.

Results

We identified 10,005, 10,370, and 11,567 households in 2011, 2013, and 2015, respectively, and found 12.9% (2011), 26.6% (2013) and 27.9% (2015) of the households experienced CHE. When compared with no insurance, households enrolled in New Rural Cooperative Medical Insurance Scheme (P = 0.023) were associated with a lower incidence of CHE, but other insurance schemes were not significant. Households with members older than 65 years (P < 0.001), members with chronic diseases (P < 0.001), members with poor self-reported health conditions (P < 0.001), and members receiving health care (P < 0.001) had a higher risk of CHE. Large household size (P < 0.001) and high household income per capita (P < 0.001) were major protective factors to CHE incidence.

Conclusions

Despite China’s great stride in the medical insurance coverage, it fell short to provide financial protection against medical expenditure burden. To reduce the risk of CHE, an integrated poverty and elderly-oriented medical insurance system could be put in place to address these problems.

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Availability of data and material

The datasets supporting the conclusions of this article are available in China Health and Retirement Longitudinal Study (http://charls.pku.edu.cn).

Code availability

Not applicable.

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Acknowledgements

We gratefully acknowledge the national development research institute at Peking University for providing us with the CHARLS data.

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Authors and Affiliations

  1. Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, Beijing, China

    Yue Zhou, Haishaerjiang Wushouer, Xiaodong Guan & Luwen Shi

  2. International Research Center for Medicinal Administration, Peking University, Beijing, China

    Haishaerjiang Wushouer, Xiaodong Guan & Luwen Shi

  3. School of Health Humanities, Peking University, Beijing, China

    Daniel Vuillermin

Authors
  1. Yue Zhou
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  2. Haishaerjiang Wushouer
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  3. Daniel Vuillermin
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  4. Xiaodong Guan
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  5. Luwen Shi
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Contributions

XG and LS conceived the study. YZ and XG designed the study. All authors acquired and analyzed the data. YZ, and HW interpreted the findings. YZ wrote the first draft of the manuscript. XG drafted subsequent versions. All authors critically reviewed this article and approved the final version.

Corresponding author

Correspondence to Xiaodong Guan.

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The authors declare that they have no conflict of interest.

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Ethical approval for this study was not necessary because it was based exclusively on publicly available data, CHARLS, and the study subjects were not directly approached.

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Zhou, Y., Wushouer, H., Vuillermin, D. et al. Does the universal medical insurance system reduce catastrophic health expenditure among middle-aged and elderly households in China? A longitudinal analysis. Eur J Health Econ 22, 463–471 (2021). https://doi.org/10.1007/s10198-021-01267-3

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  • DOI: https://doi.org/10.1007/s10198-021-01267-3

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