ArticleBMC public health2026
Medical insurance scheme and out-of-pocket medical burden among Chinese adults: repeated cross-sectional evidence from CFPS 2016-2022.
Article in BMC public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundChina has achieved broad health insurance coverage, but financial protection may still differ across schemes. We assessed whether insurance scheme was associated with out-of-pocket medical burden among Chinese adults.
methodsWe analyzed repeated cross-sectional adult person-wave data from the China Family Panel Studies for 2016, 2018, 2020, and 2022. Adults were classified as employee/public insured, resident insured, uninsured, or covered by other or multiple schemes. The primary outcome was log-transformed annual out-of-pocket expenditure after reimbursement. Among medical spenders, the second financial-protection outcome was an out-of-pocket ratio of at least 50% of total medical expenditure. Weighted regression models adjusted for age, sex, education, relative income rank, employment, urban residence, chronic disease, and survey year. Exact-scheme and sensitivity analyses tested robustness.
resultsThe study included 120,063 adult observations; 107,116 had a known insurance scheme, 49,111 entered the primary out-of-pocket model, and 8,034 medical spenders entered the high-ratio model. In the weighted analytic sample, resident insurance accounted for 69.9% of observations, employee/public insurance for 18.0%, and no insurance for 8.7%. Compared with employee/public insurance, resident insurance was associated with higher log out-of-pocket expenditure (beta 0.275, 95% CI 0.188 to 0.362, p < 0.001), as was no insurance (beta 0.313, 95% CI 0.177 to 0.449, p < 0.001). Among medical spenders, resident insurance and no insurance were associated with higher probability of an out-of-pocket ratio of at least 50% (risk difference 0.174, 95% CI 0.127 to 0.221, p < 0.001; and 0.177, 95% CI 0.098 to 0.256, p < 0.001, respectively). Exact-scheme, province fixed-effect, clustered-standard-error, income-rank, year-stratified, and alternative-threshold analyses were directionally consistent.
conclusionsIn CFPS 2016-2022, resident insurance and no insurance were associated with higher out-of-pocket medical burden than employee/public insurance. Causal interpretation should remain cautious because plan-level benefit design, health-care utilization intensity, and household capacity to pay were not fully observed.
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