Does the medical insurance system really achieved the effect of poverty alleviation for the middle-aged and elderly people in China? Characteristics of vulnerable groups and failure links

BMC Public Health

Heng Li¹  Baoguo Shi²  Tao Sun³  Meiyan Ma⁴  Ye Li⁴  Hui Yin⁴  Nianshi Wang⁴  Qunhong Wu⁴  Mingli Jiao⁴  Wanxin Tian⁴  Libo Liang⁴  Yanhua Hao⁴  Ning Ning⁴  Linghan Shan⁴  Qi Xia⁴  Jiahui Wang⁴  Lijun Gao⁴  Bin Yi⁵  Xuelian Fu⁶ 

[1] China Hospital Development institute of Shanghai Jiao Tong University;Department of Economics, School of Economics, Minzu University of China;Department of Health Service Management, School of Medicine, Hang Zhou Normal University;Department of Social Medicine, School of Health Management, Harbin Medical University;The First Specialized Hospital of Harbin;The Second Affiliated Hospital of Harbin Medical University;

关键词: Medical insurance;    Poverty alleviation;    Healthy poverty;    Catastrophic health expenditure;    Impoverishment by medical expenses;   

DOI  :  10.1186/s12889-020-08554-3

来源: DOAJ

【 摘 要 】

Abstract Background We examined the physiological, household, and spatial agglomeration characteristics of the health poverty population in China. We identified weak links that affect the implementation of the medical insurance and further improve its effectiveness for health poverty alleviation. Methods A national representative sample from the China Health and Retirement Longitudinal Study (CHARLS) was analyzed. The WHO recommended method was adopted to calculate catastrophic health expenditure (CHE) and impoverishment by medical expenses (IME). We created a binary indicator for IME as the outcome variable and applied the treatment-effect model to analyze the determinants of IME. Results The incidence of IME was 7.2% of the overall population, compared to 20.3% of the sample households trapped in CHE. The incidence of IME enrolled in insurance schemes was 7.4% higher than that of uninsured families (4.8%). Economic level, living area, family size, age of household head, having hospitalized members, and participating in insurance were statistically significant for the occurrence of IME. Conclusions The original poverty-promoting policies has not reached the maximum point of convergence with China’s current demand for health. The overlapped health vulnerabilities exacerbated the risk of poverty among the elderly and households with high health needs and utilization. In addition, the medical insurance schemes have proven to be insufficient for protection against economic burden of poor households. So, special health needs, age, and household capacity to pay should be comprehensively considered while strengthening the connection between the disease insurance scheme with supplementary insurance.

【 授权许可】

Unknown