Study of catastrophic health expenditure in China's basic health insurance

Background: The catastrophic health expenditure, which could result in impoverishment, is defined as the health expenditure exceeds some fraction of "capacity to pay". In order to protect households from catastrophic health spending, the Chinese government has implemented three basic health insurance schemes (UEMS, URMS and NCMS) in the last decade. However, as only parts of residents' medical expense are reimbursed by these health insurance schemes, the insured households might still have high chance of suffering catastrophic health expenditure. Aim & Objectives: The purpose of our study is to investigate the extent of catastrophic health expenditure for the households enrolled in UEMS, URMS and NCMS, and to identify factors associated with catastrophic health expenditure. Methods: The data came from China's National Health Service Survey conducted in 2008 in Shaanxi province. In this survey, a four-stage stratified random sampling procedure was used to sample households in urban and rural areas. By using a questionnaire designed by the Health Ministry of China, 5960 households were interviewed, from which 1215 households covered by UEMS or URMS and 2875 households covered by NCMS were chosen. The indicators of incidence and intensity of catastrophic expenditure were employed to measure catastrophic health expenditure with different thresholds levels (10, 15, 25 and 40%), and two logistic regression models were used to estimate the factors of the probability of catastrophic expenditure for the households enrolled in urban and rural health insurance schemes. Results: There were 16.87 to 68.07% households covered by UEMS or URMS that suffered catastrophic health expenditure and the average degree by which payment exceeds the thresholds varied from 2.68 to 13.36%. For the households covered by NCMS, the incidence and intensity of catastrophic expenditure were 19.62 to 75.86% and 3.12 to 15.51% respectively. Poor health, families comprised of seniors, small family size and low economic status were significantly led to catastrophic health expenditure for households enrolled in both of urban and rural health insurance schemes. Study Limitations: As indirect costs of health care and the patients' earnings losses were not included in the health expenditure, the catastrophic health expenditure might be under-estimated in this study. Conclusion: In order to reduce catastrophic expenditure, we recommend the Chinese government to expand the health insurance schemes for covering outpatient service as well as improve the reimbursement rates, meanwhile, strengthen illness prevention and subsidize low-income households.