ArticleBMC public health2019
Catastrophic health expenditure incidence and its equity in China: a study on the initial implementation of the medical insurance integration system.
Article in BMC public health, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 39 papers.
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Who cites it
39 citing papers in PubMed.
- Impact of Catastrophic Health Expenditures on Chinese Household Consumption.Frontiers in public health · 2021Trial
- Regional differences, evolutionary trends, and influencing factors of the level of medical assistance protection across Chinese provinces.BMC public health · 2026Article
- A study on the effect of catastrophic health expenditures on socially vulnerable groups.BMC public health · 2026Article
- Can urban‒rural health insurance integration narrow the urban‒rural income gap? Evidence from China.BMC public health · 2026Article
- The effect of air pollution on catastrophic health expenditure among middle-aged and older adults in China.PloS one · 2026Article
- A study on the impact of catastrophic health expenditure on social stability.Frontiers in public health · 2026Article
- Medical insurance integration and rural-urban benefit disparities, 2006-2021: evidence from quasi-natural experiments in China.BMJ open · 2025Article
- Unequal nursing: the impact of China's public health insurance on nursing services for older adults.BMC nursing · 2025Article
- How Does the Basic Urban-Rural Medical Insurance Affect Resident Health Inequality? Evidence from China.Healthcare (Basel, Switzerland) · 2025Article
- Medical insurance integration and spatial effects in China: evidence from quasi-natural experiments and linked administrative data.BMC health services research · 2025Article
- Marginalized two part model for analyzing multilevel semicontinuous medical costs in Iranian households.Scientific reports · 2025Article
- Health insurance policy enforcement and catastrophic health expenditure: a case study in Sichuan province, China.Frontiers in public health · 2025Article
- Evidence From the China Family Panel Studies Survey on the Effect of Integrating the Basic Medical Insurance System for Urban and Rural Residents on the Health Equity of Residents: Difference-in-Differences Analysis.JMIR public health and surveillance · 2024Article
- Does the increase in health insurance benefits have different effects on the health of middle-aged and older people individuals in rural areas? Analysis based on quantile difference-in-differences method.Frontiers in public health · 2024Article
- Catastrophic Health Expenditure and Associated Factors Among Hospitalized Cancer Patients in Addis Ababa, Ethiopia.Risk management and healthcare policy · 2024Article
- Factors influencing the utilisation of National health insurance program in urban areas of Nepal: Insights from qualitative study.PLOS global public health · 2024Article
- Outpatient depression current care expenditure changes in Liaoning Province from 2015 to 2020: a study based on the "system of health accounts 2011".Frontiers in pharmacology · 2024Article
- Are outpatient costs for hypertension and diabetes care affordable? Evidence from Western Kenya.African journal of primary health care & family medicine · 2023Article
- Incidence of catastrophic health spending in Indonesia: insights from a Household Panel Study 2018-2019.International journal for equity in health · 2023Article
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14 authors.
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Abstract
backgroundBy 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.
methodsThe 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.
resultsThe 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.
conclusionsThe 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.
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