What fragile factors hinder the pace of China's alleviation efforts of the poverty-stricken population? A study from the perspective of impoverishment caused by medical expenses.
What fragile factors hinder the pace of China's alleviation efforts of the poverty-stricken population? A study from the perspective of impoverishment caused by medical expenses.
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哪些脆弱因素阻碍了中国脱贫攻坚的步伐？
DOI：
10.1186/s12913-022-08237-2
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发表时间：
2022-07-29
影响因子：
2.8
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中科院分区：
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中国在扶贫方面取得了显著成就。然而，随着经济发展和年龄结构的变化，因医疗费用和残疾致贫的人口分别占贫困人口总数的42.3%和14.4%。因此，准确找出因病致贫人群的特征至关重要。在本研究中，我们从省级、家庭以及不同医疗保险方案层面分析了医疗费用致贫发生率，以确定易受医疗相关贫困影响的精准群体。
数据是通过多阶段、分层、随机抽样方法从2013年中国第五次国家卫生服务调查中提取的，最终样本为93570户（273626人）。采用世界卫生组织（WHO）推荐的方法计算医疗费用致贫情况，并采用逻辑回归分析评估其决定因素。
中国的贫困率和致贫率分别为16.2%和6.3%。西部地区的贫困率远高于中部和东部地区。西部地区医疗费用致贫率（IME）（7.2%）高于中部地区（6.5%）和东部地区（5.1%）。新型农村合作医疗（NCMS）的医疗费用致贫率最高（9.1%）。与医疗费用致贫相关的前三大疾病是恶性肿瘤、先天性心脏病和精神疾病。有非传染性疾病成员或有住院成员的家庭医疗费用致贫风险更高。参加新型农村合作医疗的较贫困家庭更有可能遭受医疗费用致贫。
经济发展、卫生服务利用和福利政策的共同作用导致了不同地区的医疗致贫。贫困和卫生服务利用是医疗致贫发生率高的家庭的特征。慢性病导致医疗致贫。不同医疗保险方案中存在的不公平导致医疗费用致贫的风险程度不同。针对贫困人口的多种脆弱性制定精准综合策略会更有效。
网络版包含补充材料，可在10.1186/s12913 - 022 - 08237 - 2获取。
China has made remarkable achievements in poverty alleviation. However, with the change in economic development and age structure, the population stricken by poverty due to medical expenses and disability accounted for 42.3 and 14.4% of the total poverty-stricken population, respectively. Accordingly, it is crucial to accurately pinpoint the characteristics of people who are about to become poor due to illness. In this study, we analyzed the incidence of impoverishment by medical expense at the provincial, family, and different medical insurance scheme levels to identify the precise groups that are vulnerable to medical-related poverty. Data were extracted from the Fifth National Health Service Survey in China in 2013 through a multi-stage, stratified, and random sampling method, leaving 93,570 households (273,626 people) for the final sample. The method recommended by World Health Organization (WHO) was adopted to calculate impoverishment by medical expense, and logistic regression was adopted to evaluate its determinants. The poverty and impoverishment rate in China were 16.2 and 6.3% respectively. The poverty rate in western region was much higher than that of central and eastern regions. The rate of impoverishment by medical expense (IME) was higher in the western region (7.2%) than that in the central (6.5%) and eastern (5.1%) regions. The New Cooperative Medical Scheme (NCMS) was associated with the highest rate (9.1%) of IME cases. The top three diseases associated with IME were malignant tumor, congenital heart disease, and mental disease. Households with non-communicable disease members or hospitalized members had a higher risk on IME. NCMS-enrolled, poorer households were more likely to suffer from IME. The joint roles of economic development, health service utilization, and welfare policies result in medical impoverishment for different regions. Poverty and health service utilization are indicative of households with high incidence of medical impoverishment. Chronic diseases lead to medical impoverishment. The inequity existing in different medical insurance schemes leads to different degrees of risk of IME. A combined strategy to precise target multiple vulnerabilities of poor population would be more effective. The online version contains supplementary material available at 10.1186/s12913-022-08237-2.