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      Factors affecting catastrophic health expenditure and impoverishment from medical expenses in China: policy implications of universal health insurance Translated title: Facteurs affectant les dépenses de santé catastrophiques et l'appauvrissement dû aux dépenses médicales en Chine: implications des politiques de l'assurance de santé universelle Translated title: Factores que afectan a los gastos sanitarios catastróficos y el empobrecimiento provocado por los gastos médicos en China: repercusiones políticas de un seguro sanitario universal

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          Abstract

          OBJECTIVE: To assess the degree to which the Chinese people are protected from catastrophic household expenditure and impoverishment from medical expenses and to explore the health system and structural factors influencing the first of these outcomes. METHODS: Data were derived from the Fourth National Health Service Survey. An analysis of catastrophic health expenditure and impoverishment from medical expenses was undertaken with a sample of 55 556 households of different characteristics and located in rural and urban settings in different parts of the country. Logistic regression was used to identify the determinants of catastrophic health expenditure. FINDINGS: The rate of catastrophic health expenditure was 13.0%; that of impoverishment was 7.5%. Rates of catastrophic health expenditure were higher among households having members who were hospitalized, elderly, or chronically ill, as well as in households in rural or poorer regions. A combination of adverse factors increased the risk of catastrophic health expenditure. Families enrolled in the urban employee or resident insurance schemes had lower rates of catastrophic health expenditure than those enrolled in the new rural corporative scheme. The need for and use of health care, demographics, type of benefit package and type of provider payment method were the determinants of catastrophic health expenditure. CONCLUSION: Although China has greatly expanded health insurance coverage, financial protection remains insufficient. Policy-makers should focus on designing improved insurance plans by expanding the benefit package, redesigning cost sharing arrangements and provider payment methods and developing more effective expenditure control strategies.

          Translated abstract

          <img border=0 src="/img/revistas/bwho/v90n9/a11img02.jpg">

          Translated abstract

          <img border=0 src="/img/revistas/bwho/v90n9/a11img03.jpg">

          Translated abstract

          OBJECTIF: Évaluer dans quelle mesure le peuple chinois est protégé contre les dépenses catastrophiques et l'appauvrissement dû aux dépenses médicales, mais aussi étudier le système de santé et les facteurs structurels qui influencent le premier de ces résultats. MÉTHODES: Des données ont été obtenues de la quatrième enquête nationale sur les services de santé. Une analyse des dépenses de santé catastrophiques et de l'appauvrissement dû aux dépenses médicales a été réalisée sur un échantillon de 55 556 ménages présentant diverses caractéristiques et vivant dans des environnements ruraux et urbains de différentes régions du pays. La régression logistique a été utilisée pour identifier les déterminants des dépenses de santé catastrophiques. RÉSULTATS: Le taux des dépenses de santé catastrophiques s'élevait à 13,0 % et celui de l'appauvrissement à 7,5%. Les taux de dépenses de santé catastrophiques étaient supérieurs dans les familles dont certains membres étaient hospitalisés, souffraient de maladies chroniques ou étaient des personnes âgées, ainsi que dans les familles des régions rurales ou plus pauvres. Une combinaison de facteurs défavorables augmentait le risque de dépenses de santé catastrophiques. Les familles bénéficiant de régimes d'assurance de résident ou d'employé urbain présentaient des taux de dépenses de santé catastrophiques inférieurs aux familles bénéficiant du nouveau régime corporatif rural. Le besoin en soins de santé et leur utilisation, les données démographiques, le type d'assurance et le type de méthode de paiement des fournisseurs étaient les déterminants des dépenses de santé catastrophiques. CONCLUSION: Bien que la Chine ait considérablement développé la couverture de son assurance-maladie, la protection financière reste insuffisante. L'objectif des responsables politiques doit être de créer des programmes d'assurance améliorés en étendant les prestations sociales, en redessinant les arrangements du partage des coûts et les méthodes de paiements des fournisseurs, mais aussi en développant des stratégies de contrôle des dépenses plus efficaces.

          Translated abstract

          <img border=0 src="/img/revistas/bwho/v90n9/a11img01.jpg">

          Translated abstract

          OBJETIVO: Evaluar el grado de protección de los habitantes de China frente a los gastos familiares catastróficos y el empobrecimiento provocado por los gastos médicos y examinar el sistema sanitario y los factores estructurales que influyen en el primero de estos resultados. MÉTODOS: Los datos se obtuvieron de la 4ª Encuesta nacional sobre los servicios sanitarios. Se emprendió la tarea de analizar los gastos sanitarios catastróficos y el empobrecimiento provocado por los gastos médicos con una muestra de 55.556 hogares con características diferentes localizados tanto en entornos rurales como urbanos en distintas partes del país. Se empleó un modelo de regresión logística para identificar los determinantes del gasto sanitario catastrófico. RESULTADOS: La tasa del gasto sanitario catastrófico fue del 13.0% y la del empobrecimiento, del 7,5%. La tasa del gasto sanitario imprevisto fue superior en los hogares en los que alguno de los miembros estaba hospitalizado, era anciano o sufría una enfermedad crónica, así como en los hogares de zonas rurales o más pobres. Una combinación de factores adversos aumentó el riesgo de sufrir gastos sanitarios catastróficos. Las familias inscritas en los seguros urbanos para empleados o residentes presentaron una tasa menor de gastos sanitarios catastróficos que aquellas que estaban inscritas en el nuevo seguro corporativo rural. La necesidad y el uso de la atención sanitaria, la demografía, el tipo de prestaciones así como el método de pago al proveedor fueron los determinantes del gasto sanitario imprevisto. CONCLUSIÓN: Aunque China ha ampliado mucho la cobertura del seguro de salud, la protección financiera sigue siendo insuficiente. Las autoridades deberían centrarse en diseñar planes de seguros mejorados aumentando las prestaciones, rediseñando los acuerdos para la financiación de los gastos y los métodos de pago al proveedor y desarrollar estrategias más eficaces para el control de los gastos.

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          Most cited references44

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          The world health report 2000 - Health systems: improving performance

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            Reform of how health care is paid for in China: challenges and opportunities.

            China's current strategy to improve how health services are paid for is headed in the right direction, but much more remains to be done. The problems to be resolved, reflecting the setbacks of recent decades, are substantial: high levels of out-of-pocket payments and cost escalation, stalled progress in providing adequate health insurance for all, widespread inefficiencies in health facilities, uneven quality, extensive inequality, and perverse incentives for hospitals and doctors. China's leadership is taking bold steps to accelerate improvement, including increasing government spending on health and committing to reaching 100% insurance coverage by 2010. China's efforts are part of a worldwide transformation in the financing of health care that will dominate global health in the 21st century. The prospects that China will complete this transformation successfully in the next two decades are good, although success is not guaranteed. The real test, as other countries have experienced, will come when tougher reforms have to be introduced.
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              Catastrophic health payments and health insurance: some counterintuitive evidence from one low-income country.

              The purpose of the study is to quantitatively analyze the role of health insurance in the determinants of catastrophic health payments in a low-income country setting. The study uses the most recent publicly available household level data from Zambia collected in 1998 containing detailed information on health care utilization and spending and on other key individual, household, and community factors. An econometric model is estimated by means of multivariate regression. The main results are counterintuitive in that health insurance is not found to provide financial protection against the risk of catastrophic payments; indeed, insurance is found to increase this risk. Reasons for the findings are discussed using additional available information focusing on the amount of care per illness episode and the type of care provided. The key conclusion is that the true impact of health insurance is an empirical issue depending on several key context factors, including quality assurance and service provision oversight.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
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                Role: ND
                Journal
                bwho
                Bulletin of the World Health Organization
                Bull World Health Organ
                World Health Organization (Genebra )
                0042-9686
                September 2012
                : 90
                : 9
                : 664-671
                Affiliations
                [1 ] Harbin Medical University Peoples R China
                [2 ] Ministry of Health Jamaica
                [3 ] La Trobe University Australia
                [4 ] Beijing Ditan Hospital Peoples R China
                Article
                S0042-96862012000900011
                10.2471/BLT.12.102178
                3442391
                22984311
                fe9b2098-ee85-4f93-82a8-4900ca58d667

                http://creativecommons.org/licenses/by/4.0/

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                SciELO Public Health

                Self URI (journal page): http://www.scielosp.org/scielo.php?script=sci_serial&pid=0042-9686&lng=en
                Categories
                Health Policy & Services

                Public health
                Public health

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