ArticleThe European journal of health economics : HEPAC : health economics in prevention and care2021
Does the universal medical insurance system reduce catastrophic health expenditure among middle-aged and elderly households in China? A longitudinal analysis.
Article in The European journal of health economics : HEPAC : health economics in prevention and care, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers.
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26 citing papers in PubMed, 37 citations in OpenAlex.
- Residents' preference trade-offs for critical illness insurance scheme design: a discrete choice experiment in Shandong Province, China.Health policy and planning · 2026Article
- Does chronic disease coverage for outpatient care affect healthcare utilization and expenditures in China? Evidence from an administrative claim dataset.The European journal of health economics : HEPAC : health economics in prevention and care · 2026Article
- The hidden cost of ageing: measuring the impact of health expenditure on poverty among households with older adults in India.Frontiers in public health · 2026Article
- Factors influencing residents' willingness to choose medical institutions first for treatment in the highland agricultural and pastoral areas of Qinghai province: a study based on the Anderson model.Frontiers in health services · 2026Article
- The effect of air pollution on catastrophic health expenditure among middle-aged and older adults in China.PloS one · 2026Article
- Strengthening financial protection through multitiered health coverage: evidence from 667 055 low-income households in China.BMJ global health · 2025Article
- Medical insurance integration and rural-urban benefit disparities, 2006-2021: evidence from quasi-natural experiments in China.BMJ open · 2025Article
- Medical insurance integration and spatial effects in China: evidence from quasi-natural experiments and linked administrative data.BMC health services research · 2025Article
- Spatio-temporal patterns and determinants of persistent catastrophic health expenditure in China: evidence from the China Family Panel Studies.Frontiers in public health · 2025Article
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- Incidence and intensity of catastrophic health expenditure and impoverishment among the elderly: an empirical evidence from India.Scientific reports · 2024Article
- The causal effect of catastrophic health expenditure on poverty in Poland.The European journal of health economics : HEPAC : health economics in prevention and care · 2024Article
- Analysis of health risk factors for older adults living alone in China and establishment and evaluation of a nomogram prediction model.Frontiers in public health · 2024Article
- Hospitalization costs of COPD cases and its associated factors: an observational study at two large public tertiary hospitals in Henan Province, China.BMC geriatrics · 2023Observational
- The impact of medical insurance on family financial support: evidence from CHARLS in China.Health economics review · 2023Article
- Factors influencing catastrophic health expenditure of households with people with diabetes in Northwest China-an example from Gansu Province.BMC health services research · 2023Article
- Does basic medical insurance promote public health? Evidence from China family panel study.Frontiers in public health · 2023Article
- Regional catastrophic health expenditure and health inequality in China.Frontiers in public health · 2023Article
- Changes in health care utilization and financial protection after integration of the rural and urban social health insurance schemes in Beijing, China.BMC health services research · 2022Article
- Catastrophic health expenditure among Chinese adults living alone with cognitive impairment: findings from the CHARLS.BMC geriatrics · 2022Article
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5 authors at 1 institution in 1 country.
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Abstract
backgroundThe Chinese government has made great progress in establishing the universal medical insurance system. This study aimed to analyze whether the universal medical insurance system protected middle-aged and elderly households from catastrophic health expenditure (CHE).
methodsThe data were obtained from the China Health and Retirement Longitudinal Study. We used household as our unit of analysis and CHE was measured as out-of-pocket expenditures ≥ 40% of nonfood household expenditures. Univariate analysis was deployed to examine the impacts of different medical insurance schemes on CHE, and the factors associated with CHE were estimated using a random-effects logit regression model.
resultsWe identified 10,005, 10,370, and 11,567 households in 2011, 2013, and 2015, respectively, and found 12.9% (2011), 26.6% (2013) and 27.9% (2015) of the households experienced CHE. When compared with no insurance, households enrolled in New Rural Cooperative Medical Insurance Scheme (P = 0.023) were associated with a lower incidence of CHE, but other insurance schemes were not significant. Households with members older than 65 years (P < 0.001), members with chronic diseases (P < 0.001), members with poor self-reported health conditions (P < 0.001), and members receiving health care (P < 0.001) had a higher risk of CHE. Large household size (P < 0.001) and high household income per capita (P < 0.001) were major protective factors to CHE incidence.
conclusionsDespite China's great stride in the medical insurance coverage, it fell short to provide financial protection against medical expenditure burden. To reduce the risk of CHE, an integrated poverty and elderly-oriented medical insurance system could be put in place to address these problems.
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