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Catastrophic health expenditure in households with chronic disease patients: A pre-post comparison of the New Health Care Reform in Shaanxi Province, China

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  • Yongjian Xu
  • Jie Ma
  • Na Wu
  • Xiaojing Fan
  • Tao Zhang
  • Zhongliang Zhou
  • Jianmin Gao
  • Jianping Ren
  • Gang Chen

Abstract

Introduction: In 2009, China officially launched the New Health Care Reform (NHCR). One important purpose of the reform was to reduce financial burden of health care through health insurance expansion and health care provider regulations. This study aimed to provide evidence on the effect of the NHCR reform on catastrophic health expenditure (CHE) by comparing the occurrence and inequality of CHE among households with chronic diseases patients before and after the reform. Methods: This study used the subset of data from the 2008 and 2013 National Health Services Survey conducted in Shaanxi Province. Our sample included households with chronic diseases patients and excluded observations with key variables missing. The final sample size was 1942 households in 2008 and 7704 households in 2013. We defined CHE occurrence following the definition of the World Health Organization (WHO). The income-related inequality in CHE was measured by the concentration index. A multi-level logistic regression model was used in the study to explore the influence of the NHCR on CHE occurrence, controlling for important covariates. Results: From 2008 to 2013, the occurrence rate of CHE in rural areas declined from 29.15% to 23.62%. However, the CHE rate in urban areas increased from 19.18% to 24.95%. The interaction term between year and rural/urban location was statistically significant, confirming that the influence of the NHCR on the CHE occurrence rates were heterogeneous between rural and urban areas. As for the CHE inequality, the concentration index in rural areas decreased from -0.4572 to -0.5499 with a p-value less than 0.05. This implied that the CHE occurrence inequality was increased after the implementation of the NHCR. Conclusion: Our study suggested that the implementation of the NHCR might not have been effective in reducing the CHE occurrence for households with chronic disease patients. Although the occurrence of CHE of rural households had decreased, the occurrence of CHE in urban areas was higher than before. In addition, the income inequality of CHE occurrence was greater in 2013 compared to that in 2008 in rural areas. Although the reform resulted in higher insurance coverage and higher government expenditure in health care, the financial burden of health care on households did not necessarily improve. Further efforts on developing the current health insurance system and optimizing the hierarchical health care system are required to improve the protection against CHE.

Suggested Citation

  • Yongjian Xu & Jie Ma & Na Wu & Xiaojing Fan & Tao Zhang & Zhongliang Zhou & Jianmin Gao & Jianping Ren & Gang Chen, 2018. "Catastrophic health expenditure in households with chronic disease patients: A pre-post comparison of the New Health Care Reform in Shaanxi Province, China," PLOS ONE, Public Library of Science, vol. 13(3), pages 1-13, March.
  • Handle: RePEc:plo:pone00:0194539
    DOI: 10.1371/journal.pone.0194539
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    References listed on IDEAS

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    1. Ruger, J.P. & Kim, H.-J., 2007. "Out-of-pocket healthcare spending by the poor and chronically III in the republic of Korea," American Journal of Public Health, American Public Health Association, vol. 97(5), pages 804-811.
    2. Baltica Cabieses & Richard Cookson & Manuel Espinoza & Gillian Santorelli & Iris Delgado, 2015. "Did Socioeconomic Inequality in Self-Reported Health in Chile Fall after the Equity-Based Healthcare Reform of 2005? A Concentration Index Decomposition Analysis," PLOS ONE, Public Library of Science, vol. 10(9), pages 1-21, September.
    3. W. J. Browne & S. V. Subramanian & K. Jones & H. Goldstein, 2005. "Variance partitioning in multilevel logistic models that exhibit overdispersion," Journal of the Royal Statistical Society Series A, Royal Statistical Society, vol. 168(3), pages 599-613, July.
    4. Eddy van Doorslaer & Owen O'Donnell & Ravindra P. Rannan-Eliya & Aparnaa Somanathan & Shiva Raj Adhikari & Charu C. Garg & Deni Harbianto & Alejandro N. Herrin & Mohammed Nazmul Huq & Shamsia Ibragimo, 2007. "Catastrophic payments for health care in Asia," Health Economics, John Wiley & Sons, Ltd., vol. 16(11), pages 1159-1184.
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    Cited by:

    1. Chen, Mingsheng & Xu, Lizheng & Si, Lei & Wang, Zhonghua & Jan, Stephen, 2023. "Examining the level and distribution of catastrophic health expenditure from 2013 to 2018: A province-level study in China," Economic Modelling, Elsevier, vol. 121(C).
    2. Yongjian Xu & Siyu Zhu & Tao Zhang & Duolao Wang & Junteng Hu & Jianmin Gao & Zhongliang Zhou, 2020. "Explaining Income-Related Inequalities in Dietary Knowledge: Evidence from the China Health and Nutrition Survey," IJERPH, MDPI, vol. 17(2), pages 1-15, January.
    3. Thuong, Nguyen Thi Thu, 2021. "Catastrophic health expenditure and impoverishment in Vietnam: Evidence from national Household Living Standards Surveys 2008–2018," Economic Analysis and Policy, Elsevier, vol. 72(C), pages 668-684.
    4. Micheal Kofi Boachie & Tatjana Põlajeva & Albert Opoku Frimpong, 2020. "Infant Mortality in Low- and Middle-income Countries: Does Government Health Spending Matter?," Journal of Development Policy and Practice, , vol. 5(1), pages 54-73, January.
    5. Albert Opoku Frimpong & Eugenia Amporfu & Eric Arthur, 2021. "Effect of the Ghana National Health Insurance Scheme on exit time from catastrophic healthcare expenditure," African Development Review, African Development Bank, vol. 33(3), pages 492-505, September.

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