Decomposing inequality in catastrophic health expenditure for self-reported hypertension household in Urban Shaanxi, China from 2008 to 2013: two waves' cross-sectional study
Decomposing inequality in catastrophic health expenditure for self-reported hypertension household in Urban Shaanxi, China from 2008 to 2013: two waves' cross-sectional study
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2008年至2013年中国陕西城区自报高血压家庭灾难性医疗支出不平等的分解：两波——横断面研究
DOI：
10.1136/bmjopen-2018-023033
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发表时间：
2019-05-01
期刊：
影响因子：
2.9
通讯作者：
Chen, Xi
中科院分区：
文献类型：
--
作者：
Si, Yafei;Zhou, Zhongliang;Chen, Xi
研究目的2009年启动的新一轮中国医疗改革在农村地区取得了前所未有的进展，但对中国城市特定弱势群体的灾难性卫生支出（CHE）却知之甚少。本研究旨在估计高血压家庭中CHE的发病率、强度和不平等性的趋势方法根据2008年和2013年陕西省第四次和第五次全国卫生服务调查资料，分别对陕西省2008年和2013年的460户和1289户高血压患者家庭进行调查，我们的分析。我们将高血压家庭分为两组：单纯家庭（仅患有高血压）和混合家庭（患有高血压和其他非传染性疾病）。如果自付医疗支出等于或高于家庭支付能力的40%，则将确定CHE。结果2008年，11.2%的单式家庭和22.1%的混合式家庭发生了家庭经济不平等，2013年，21.5%的单式家庭和46.9%的混合式家庭发生了家庭经济不平等。此外，在2008年和2013年，单一家庭（-0.279和-0.283）和混合家庭（-0.362和-0.262）的高等教育存在严重的扶贫不平等。结论2008 - 2013年陕西省城市居民家庭经济状况、户主健康状况、家庭成员中有老年人等因素均与家庭健康不平等相关。本研究提示，中国城市高血压家庭等弱势群体需要更多关注。
Objective Despite the latest wave of China's healthcare reform initiated in 2009 has achieved unprecedented progress in rural areas, little is known for specific vulnerable groups' catastrophic health expenditure (CHE) in urban China. This study aims to estimate the trend of incidence, intensity and inequality of CHE in hypertension households (households with one or more than one hypertension patient) in urban Shaanxi, China from 2008 to 2013.Methods Based on the fourth and the fifth National Health Service Surveys of Shaanxi, we identified 460 and 1289 households with hypertension in 2008 and 2013, respectively for our analysis. We classified hypertension households into two groups: simplex households (with hypertension only) and mixed households (with hypertension plus other non-communicable diseases). CHE would be identified if out-of-pocket healthcare expenditure was equal to or higher than 40% of a household's capacity to pay. Concentration index and its decomposition based on Probit regressions were employed to measure the income-related inequality of CHE.Results We find that CHE occurred in 11.2% of the simplex households and 22.1% of the mixed households in 2008, and the 21.5% of the simplex households and the 46.9% of mixed households incurred CHE in 2013. Furthermore, there were strong pro-poor inequalities in CHE in the simplex households (-0.279 and -0.283) and mixed households (-0.362 and -0.262) both in 2008 and 2013. The majority of observed inequalities in CHE could be associated with household economic status, household head's health status and having elderly members.Conclusion We find a sharp increase of CHE occurrence and the sustained strong pro-poor inequalities for simplex and mixed households in urban Shaanxi Province of China from 2008 to 2013. Our study suggests that more concerns are needed for the vulnerable groups such as hypertension households in urban areas of China.