The comparison of catastrophic health expenditure and its inequality between urban and rural households in China.
The comparison of catastrophic health expenditure and its inequality between urban and rural households in China.
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DOI：
10.1186/s13561-022-00365-z
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发表时间：
2022-03-09
影响因子：
2.4
通讯作者：
Fu XZ
中科院分区：
文献类型：
--
作者：
Fu XZ
近年来，中国基本实现了基本医保全覆盖的目标，但疾病经济负担重仍是不少家庭致贫的主要原因。探讨灾难性卫生支出(CHE)及其不平等对于前瞻性决策非常重要。本研究旨在比较中国地区城乡居民CHE的发生率、强度和不均衡性。这项研究基于2012年至2018年进行的具有全国代表性的家庭调查--中国家庭小组研究。用浓度指数(CI)衡量CHE发病与超调的不等性，用CI分解法估计影响CHE发病不均的主要影响因素。2012-2018年，城镇居民家庭CHE发病率从11.01%上升到11.88%，农村居民家庭CHE发病率从18.42%下降到18.31%。在同一时期，城市家庭CHE发病率的CI从− 0.1480下降到− 0.1693，而农村家庭CHE的CI从− 0.1062下降到− 0.1501。亲贫型CHE发病率不平等的主要原因是社会经济地位、CHE滞后、接受住院服务、有老年成员、户主受教育程度以及自评户主健康状况。农村家庭罹患CHE的风险高于城市家庭。在CHE发病率和超调方面，两组都存在强烈的扶贫不平等。农村地区低收入群体的因病致贫问题比城市地区更为严重。相关政策干预要进一步聚焦鼓励发展补充医疗保险，提高医疗救助制度住院费用报销率。
In recent years, the goal of universal coverage of the basic medical insurance schemes has been basically achieved in China, but the heavy economic burden of diseases is still the main cause of poverty in many households. Exploring catastrophic health expenditure (CHE) and its inequality are highly important for forward-looking policymaking. This study aims to compare the incidence, intensity and inequality of CHE between urban and rural households in China. This study was based on a national representative household survey—the China Family Panel Studies (CFPS)—that was conducted from 2012 to 2018. Concentration index (CI) was employed to measure the inequality of CHE incidence and overshoot, while the decomposition method of the CI was used to estimate the main influencing factors affecting inequality of CHE incidence. From 2012 to 2018, the CHE incidence of urban households increased from 11.01 to 11.88%, while the CHE incidence of rural households decreased from 18.42 to 18.31%. During the same period, the CI of CHE incidence for urban households decreased from − 0.1480 to − 0.1693, while that for rural households declined from − 0.1062 to − 0.1501. The major contribution to the pro-poor inequality in CHE incidence was associated with socioeconomic status, lagged CHE, receiving inpatient services, having elderly members, education of household head, and self-assessed health status of household head. Rural households had higher risk of incurring CHE than urban households. The strong pro-poor inequality for CHE incidence and overshoot could be found in both two groups. The problem of poverty due to illness was more severe among low-income groups in rural areas than in urban areas. The relevant policy interventions should further focus on encouraging the development of supplementary medical insurance and increasing the reimbursement rate for hospitalization expenses in the medical assistance system.
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影响因子：
4.8
作者：
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通讯作者：
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影响因子：
2.7
作者：
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通讯作者：
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作者：
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4.5
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4.8
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通讯作者：
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