Does the medical insurance system play a real role in reducing catastrophic economic burden in elderly patients with cardiovascular disease in China? Implication for accurately targeting vulnerable characteristics

Globalization and Health

Baoguo Shi¹  Tao Sun²  Yuze Li³  Jian Kang⁴  Heng Li⁵  Qi Xia⁶  Xiyu Zhang⁶  Linghan Shan⁶  Wenqing Miao⁶  Yanhua Hao⁶  Wanxin Tian⁶  Meiyan Ma⁶  Qunhong Wu⁶  Ye Li⁶  Nianshi Wang⁶  Yiyun Zhang⁷  Han Gao⁸  Xuelian Fu⁹ 

[1]Department of Economics, School of Economics, Minzu University of China, Beijing, China

[2]Department of Health Service Management, School of Medicine, Hang Zhou Normal University, Hangzhou, Zhejiang, China

[3]Department of Medicine, Jiamusi University, 154007, Jiamusi, Heilongjiang, China

[4]Heilongjiang Provincial Hospital, Harbin, Heilongjiang, China

[5]Hospital Development institute of Shanghai Jiao Tong University, Shanghai, China

[6]Research Center of Public Policy and Management, School of Health Management, Harbin Medical University, 150086, Harbin, Heilongjiang, China

[7]School of Ethnology and Sociology, Yunnan University, Kunming, Yunnan, China

[8]The Affiliated Tumor Hospital of Harbin Medical University, Harbin, Heilongjiang, China

[9]The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China

关键词: Cardiovascular disease;    Catastrophic health expenditure;    Impoverishment by medical expense;    Medical insurance;    Health policy;    China;   

DOI  :  10.1186/s12992-021-00683-7

来源: Springer

【 摘 要 】

BackgroundThe vulnerability of cardiovascular disease (CVD) patients’ health abilities, combined with the severity of the disease and the overlapping risk factors, leads such people to bear the economic burden of the disease due to the medical services. We estimated the economic burden of CVD and identified the weak link in the design of the medical insurance.MethodsData from 5610 middle-aged and elderly with CVD were drawn from the 2015 wave of “China Health and Retirement Longitudinal Study” (CHARLS). The recommended method of the “World Health Organization” (WHO) was adopted to calculate “catastrophic health expenditure” (CHE), “impoverishment by medical expenses” (IME), and applied the treatment-effect model to analyze the determinants of CHE.ResultsThe incidence of CHE was 19.9% for the elderly families with CVD members, which was 3.6% higher than for uninsured families (16.3%). Families with CVD combined with > 3 other chronic diseases (38.88%) were the riskiest factor for the high CHE in the new rural cooperative medical system (NCMS). Moreover, families with members > 75 years old (33.33%), having two chronic disease (30.74%), and families having disabled members (33.33%), hospitalization members (32.41%) were identified as the high risky determinants for the high CHE in NCMS.ConclusionsElderly with physical vulnerabilities were more prone to CHE. The medical insurance only reduced barriers to accessing health resources for elderly with CVD; however it lacked the policy inclination for high-utilization populations, and had poorly accurate identification of the vulnerable characteristics of CVD, which in turn affects the economic protection ability of the medical insurance. The dispersion between the multiple medical security schemes leads to the existence of blind spots in the economic risk protection of individuals and families.

【 授权许可】

CC BY