Nianshi Wang1, Wei Gao2, Meiyan Ma1, Linghan Shan1, Xuelian Fu3, Tao Sun4, Qi Xia1, Wanxin Tian1, Limin Liu3, Huiying Yang3, Baoguo Shi5, Heng Li6, Yanan Ma7, Mingli Jiao8, Qunhong Wu9, Dingyun You10, Ye Li11. 1. Harbin Medical University, Policy and Management Research Center, School of Health Management, Department of Social Medicine; School of Public Health, No. 157 Baojian Road, Nangang District, Harbin, Heilongjiang, 150086, China. 2. Heilongjiang Provincial Hospital, Department of Infectious Diseases, No. 82, Zhongshan Road, Xiangfang District, Harbin, Heilongjiang, 150000, China. 3. The Second Affiliated Hospital of Harbin Medical University, No. 246 Xuefu Road, Nangang District, Harbin, Heilongjiang, 150001, China. 4. Department of Health Service Management, School of Medicine, Hang Zhou Normal University, Zhejiang, China. 5. Department of Economics, School of Economics, Minzu University of China, Beijing, China. 6. Hospital Development Institute of Shanghai Jiao Tong University, Shanghai, China. 7. China Medical University, Liaoning, China. 8. Harbin Medical University, Policy and Management Research Center, School of Health Management, Department of Social Medicine; School of Public Health, No. 157 Baojian Road, Nangang District, Harbin, Heilongjiang, 150086, China. Electronic address: minglijiao@126.com. 9. Harbin Medical University, Policy and Management Research Center, School of Health Management, Department of Social Medicine; School of Public Health, No. 157 Baojian Road, Nangang District, Harbin, Heilongjiang, 150086, China. Electronic address: wuqunhong@163.com. 10. School of Public Health, Kunming Medical University, Kunming, Yunnan, 650500, China. Electronic address: youdingyun@qq.com. 11. Harbin Medical University, Policy and Management Research Center, School of Health Management, Department of Social Medicine; School of Public Health, No. 157 Baojian Road, Nangang District, Harbin, Heilongjiang, 150086, China. Electronic address: liye8459@163.com.
Abstract
OBJECTIVES: Little is known about the magnitude of catastrophic health expenditure (CHE) attributable to critical disease, especially in the middle-aged and elderly population. This research aimed to exploring the key aspects of how the health insurance fails to protect the middle-aged and elderly against CHE in the past five years. And propose corresponding measures to improve. METHODS: Data were obtained from the 2011 to 2015 China Health and Retirement Longitudinal Study. The method was adapted from WHO to calculate the catastrophic health expenditure (CHE) and impoverishment by medical expense (IME), and use Generalized Linear Mixed Models (GLMMs) to comprehensively analyze the risk factors that cause middle-aged and elderly people to fall into CHE. RESULTS: The incidence of CHE of China's middle-aged and elderly population has been rose in the five years from 2011 (10.5 %) to 2013 (17.5 %) to 2015 (19.7 %). The CHE of richest families was almost 6 times from 2011 to 2015. Urban Employee Medical Insurance Scheme, the incidence of CHE was up 10 percentage from 2011 to 2015. According to the GLMMs, families have inpatient cares as the most important factor to CHE. The incidence of CHE increased by 2.25 times compared with those who did not use inpatient services. CONCLUSIONS: The health system needs to control the irrational growth of health expenses and reduce residents' overuse of health services. Government should take supplementary measures to comprehensively strengthen the advantages of health insurance. Raise residents' awareness of health care, enhance citizens' physical fitness, and avoid unnecessary waste of health resources.
OBJECTIVES: Little is known about the magnitude of catastrophic health expenditure (CHE) attributable to critical disease, especially in the middle-aged and elderly population. This research aimed to exploring the key aspects of how the health insurance fails to protect the middle-aged and elderly against CHE in the past five years. And propose corresponding measures to improve. METHODS: Data were obtained from the 2011 to 2015 China Health and Retirement Longitudinal Study. The method was adapted from WHO to calculate the catastrophic health expenditure (CHE) and impoverishment by medical expense (IME), and use Generalized Linear Mixed Models (GLMMs) to comprehensively analyze the risk factors that cause middle-aged and elderly people to fall into CHE. RESULTS: The incidence of CHE of China's middle-aged and elderly population has been rose in the five years from 2011 (10.5 %) to 2013 (17.5 %) to 2015 (19.7 %). The CHE of richest families was almost 6 times from 2011 to 2015. Urban Employee Medical Insurance Scheme, the incidence of CHE was up 10 percentage from 2011 to 2015. According to the GLMMs, families have inpatient cares as the most important factor to CHE. The incidence of CHE increased by 2.25 times compared with those who did not use inpatient services. CONCLUSIONS: The health system needs to control the irrational growth of health expenses and reduce residents' overuse of health services. Government should take supplementary measures to comprehensively strengthen the advantages of health insurance. Raise residents' awareness of health care, enhance citizens' physical fitness, and avoid unnecessary waste of health resources.