Catastrophic health expenditure incidence and its equity in China: a study on the initial implementation of the medical insurance integration system
Catastrophic health expenditure incidence and its equity in China: a study on the initial implementation of the medical insurance integration system
复制标题
我国灾难性卫生支出发生率及其公平性——医保一体化制度初步实施研究
DOI：
10.1186/s12889-019-8121-2
复制
发表时间：
2019-12-30
影响因子：
4.5
通讯作者：
Ning, Ning
中科院分区：
文献类型：
--
作者：
Liu, Huan;Zhu, Hong;Ning, Ning
背景：到2013年，我国多个地区出台了医保并轨政策。然而，很少有研究涉及医疗保险整合在中国的影响。本研究通过对2013年中国城乡统筹地区和非城乡统筹地区的灾难性卫生支出及其影响因素的分析，探讨了灾难性卫生支出的公平性。最后的样本包括来自一体化地区的19 788户家庭（38.4%）和来自非一体化地区的31 797户家庭（61.6%）。结果：整合地区的灾难性卫生支出发生率高于非整合地区（13.87%vs.13.68%）;综合区和非综合区的集中度指数分别为-0.071和-0.073。统筹地区的平均家庭自付医疗费用和平均支付能力高于非统筹地区。然而，在支付能力方面，一体化地区的家庭自付支出比例低于非一体化地区的家庭。大部分观察到的不平等的灾难性卫生支出可以解释的差异，在医疗保险和户主的受教育程度都在一体化areas.Conclusions：医疗保险一体化制度在中国仍处于探索阶段，因此，其效果是有限的意义，即使该制度的积极影响，低收入居民是肯定的。此外，灾难性的卫生支出与有利于穷人的不平等有关。医疗保障、城乡差距、老年人口和卫生服务利用显著影响灾难性卫生支出发生的公平性，是未来保险一体化政策实施的关键问题。
Background: By 2013, several regions in China had introduced health insurance integration policies. However, few studies addressed the impact of medical insurance integration in China. This study investigates the catastrophic health expenditure and equity in the incidence of catastrophic health expenditure by addressing its potential determinants in both integrated and non-integrated areas in China in 2013.Methods: The primary data are drawn from the fifth China National Health Services Survey in 2013. The final sample comprises 19,788 households (38.4%) from integrated areas and 31,797 households (61.6%) from non-integrated areas. A probit model is employed to decompose inequality in the incidence of catastrophic health expenditure in line with the methodology used for decomposing the concentration index.Results: The incidence of catastrophic health expenditure in integrated areas is higher than in non-integrated areas (13.87% vs. 13.68%, respectively). The concentration index in integrated areas and non-integrated areas is - 0.071 and - 0.073, respectively. Average household out-of-pocket health expenditure and average capacity to pay in integrated areas are higher than those in non-integrated areas. However, households in integrated areas have lower share of out-of-pocket expenditures in the capacity to pay than households in non-integrated areas. The majority of the observed inequalities in catastrophic health expenditure can be explained by differences in the health insurance and householders' educational attainment both in integrated areas and non-integrated areas.Conclusions: The medical insurance integration system in China is still at the exploratory stage; hence, its effects are of limited significance, even though the positive impact of this system on low-income residents is confirmed. Moreover, catastrophic health expenditure is associated with pro-poor inequality. Medical insurance, urban-rural disparities, the elderly population, and use of health services significantly affect the equity of catastrophic health expenditure incidence and are key issues in the implementation of future insurance integration policies.