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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

Author

Listed:
  • Yue Zhou

    (Peking University)

  • Haishaerjiang Wushouer

    (Peking University
    Peking University)

  • Daniel Vuillermin

    (Peking University)

  • Xiaodong Guan

    (Peking University
    Peking University)

  • Luwen Shi

    (Peking University
    Peking University)

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

Suggested Citation

  • Yue Zhou & Haishaerjiang Wushouer & Daniel Vuillermin & Xiaodong Guan & Luwen Shi, 2021. "Does the universal medical insurance system reduce catastrophic health expenditure among middle-aged and elderly households in China? A longitudinal analysis," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 22(3), pages 463-471, April.
    • Handle: RePEc:spr:eujhec:v:22:y:2021:i:3:d:10.1007_s10198-021-01267-3
    DOI: 10.1007/s10198-021-01267-3
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    as
    1. Yardim, Mahmut Saadi & Cilingiroglu, Nesrin & Yardim, Nazan, 2010. "Catastrophic health expenditure and impoverishment in Turkey," Health Policy, Elsevier, vol. 94(1), pages 26-33, January.
    2. Xuejie Ding & Francesco C. Billari & Stuart Gietel-Basten, 2017. "Health of midlife and older adults in China: the role of regional economic development, inequality, and institutional setting," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 62(8), pages 857-867, November.
    3. Wagstaff, Adam & Lindelow, Magnus & Jun, Gao & Ling, Xu & Juncheng, Qian, 2009. "Extending health insurance to the rural population: An impact evaluation of China's new cooperative medical scheme," Journal of Health Economics, Elsevier, vol. 28(1), pages 1-19, January.
    4. repec:cii:cepiei:2011-q4-128-4 is not listed on IDEAS
    5. Xiaoyun Liang & Hong Guo & Chenggang Jin & Xiaoxia Peng & Xiulan Zhang, 2012. "The Effect of New Cooperative Medical Scheme on Health Outcomes and Alleviating Catastrophic Health Expenditure in China: A Systematic Review," PLOS ONE, Public Library of Science, vol. 7(8), pages 1-11, August.
    6. Adam Wagstaff & Eddy van Doorslaer, 2003. "Catastrophe and impoverishment in paying for health care: with applications to Vietnam 1993–1998," Health Economics, John Wiley & Sons, Ltd., vol. 12(11), pages 921-933, November.
    7. Wagstaff, Adam & Lindelow, Magnus, 2008. "Can insurance increase financial risk?: The curious case of health insurance in China," Journal of Health Economics, Elsevier, vol. 27(4), pages 990-1005, July.
    8. Jalal El ouardighi, 2011. "Pro-development economic growth and international income mobility: Evidence worldwide," International Economics, CEPII research center, issue 128, pages 77-96.
    9. Kim, Sujin & Kwon, Soonman, 2015. "Impact of the policy of expanding benefit coverage for cancer patients on catastrophic health expenditure across different income groups in South Korea," Social Science & Medicine, Elsevier, vol. 138(C), pages 241-247.
    10. Yip, Winnie & Hsiao, William C., 2009. "Non-evidence-based policy: How effective is China's new cooperative medical scheme in reducing medical impoverishment?," Social Science & Medicine, Elsevier, vol. 68(2), pages 201-209, January.
    11. Li, Hua & Yu, Wei, 2011. "Enhancing community system in China's recent health reform: An effort to improve equity in essential health care," Health Policy, Elsevier, vol. 99(2), pages 167-173, February.
    12. Nakatani, Hiroki & Kondo, Takefumi, 2003. "Characteristics of a medical care program for specific diseases in Japan in an era of changing cost-sharing," Health Policy, Elsevier, vol. 64(3), pages 377-389, June.
    13. Ye Li & Qunhong Wu & Chaojie Liu & Zheng Kang & Xin Xie & Hui Yin & Mingli Jiao & Guoxiang Liu & Yanhua Hao & Ning Ning, 2014. "Catastrophic Health Expenditure and Rural Household Impoverishment in China: What Role Does the New Cooperative Health Insurance Scheme Play?," PLOS ONE, Public Library of Science, vol. 9(4), pages 1-9, April.
    Full references (including those not matched with items on IDEAS)

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    Cited by:

    1. Aleksandra Kolasa & Ewa Weychert, 2024. "The causal effect of catastrophic health expenditure on poverty in Poland," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 25(2), pages 193-206, March.
    2. Deng, Yuanyuan & Fang, Hanming & Hanewald, Katja & Wu, Shang, 2023. "Delay the Pension Age or Adjust the Pension Benefit? Implications for Labor Supply and Individual Welfare in China," Journal of Economic Behavior & Organization, Elsevier, vol. 212(C), pages 1192-1215.
    3. He, Wen, 2023. "Social medical insurance integration and health care disparities in China: Evidence from an administrative claim dataset," Economic Analysis and Policy, Elsevier, vol. 79(C), pages 20-39.
    4. Wen He, 2022. "Effects of establishing a financing scheme for outpatient care on inpatient services: empirical evidence from a quasi-experiment in China," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 23(1), pages 7-22, February.

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    More about this item

    Keywords

    Catastrophic health expenditure; Medical insurance schemes; Middle-aged and elderly households; Out-of-pocket expenditures; Health insurance coverage;
    All these keywords.

    JEL classification:

    • I14 - Health, Education, and Welfare - - Health - - - Health and Inequality

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