CoChat
Sign Up
Cited by 62Healthcare Systems and ReformsHealthcare Policy and ManagementEconomic and Financial Impacts of Cancer

The DOI matches its Crossref record; 42 of the 42 references it cites were found in a registry or an index.

Catastrophic health expenditure incidence and its equity in China: a study on the initial implementation of the medical insurance integration system

Open access
Liu, Huan, Zhu, Hong, Wang, Jiahui, Qi, Xinye, Zhao, Miaomiao, Shan, Linghan, Gao, Lijun, Kang, Zheng, Jiao, Mingli, Pan, Lin, Chen, Ruohui, Liu, Baohua, Wu, Qunhong, Ning, Ning·2019·BMC Public Health
DOI 10.1186/s12889-019-8121-2PMC PMC6937839

Published version of a preprint

Open this paper in CoChat — free accountOpen PDF

Abstract

BACKGROUND: By 2013, several regions in China had introduced health insurance integration policies. However, few studies addressed the impact of medical insurance integration in China. This study investigates the catastrophic health expenditure and equity in the incidence of catastrophic health expenditure by addressing its potential determinants in both integrated and non-integrated areas in China in 2013. METHODS: The primary data are drawn from the fifth China National Health Services Survey in 2013. The final sample comprises 19,788 households (38.4%) from integrated areas and 31,797 households (61.6%) from non-integrated areas. A probit model is employed to decompose inequality in the incidence of catastrophic health expenditure in line with the methodology used for decomposing the concentration index. RESULTS: The incidence of catastrophic health expenditure in integrated areas is higher than in non-integrated areas (13.87% vs. 13.68%, respectively). The concentration index in integrated areas and non-integrated areas is - 0.071 and - 0.073, respectively. Average household out-of-pocket health expenditure and average capacity to pay in integrated areas are higher than those in non-integrated areas. However, households in integrated areas have lower share of out-of-pocket expenditures in the capacity to pay than households in non-integrated areas. The majority of the observed inequalities in catastrophic health expenditure can be explained by differences in the health insurance and householders' educational attainment both in integrated areas and non-integrated areas. CONCLUSIONS: The medical insurance integration system in China is still at the exploratory stage; hence, its effects are of limited significance, even though the positive impact of this system on low-income residents is confirmed. Moreover, catastrophic health expenditure is associated with pro-poor inequality. Medical insurance, urban-rural disparities, the elderly population, and use of health services significantly affect the equity of catastrophic health expenditure incidence and are key issues in the implementation of future insurance integration policies.

Overview

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1186/s12889-019-8121-2

Cites

42 of 42 references verified0 citation errors · 0 not checkable

Statistics

Verification

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • The study's catastrophic health expenditure definitions and data collection methods have been externally validated by several studies conducted in similar research contexts.

    “Our CHE definitions and data collection methods have been externally validated by several studies conducted in similar research contexts [22–24].”

    From Community and facility-level barriers to achieving UHC in Kono District, Sierra Leone and Maryland County, Liberia (2023) · cites this paper as [24]

    The Background and Methods (Statistical analysis and Data sources; pages unavailable) describe a CHE definition and survey-based data collection. They do not establish that the citing study’s definitions or methods were externally validated; this paper alone also cannot establish validation by several studies. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Citations

Cites

Flagged first, then by citations

Research works printed but not linked: 10

  1. Wu QHLY, Xu L, Hao YH. Effect of health insurance on reduction of catastrophic health expenditure in China. Chin J Health Policy. 2012;05(9):62–6.
  2. Tang Changmin FX, Xiaoyan Z. Analysis on necessity and feasible path of the integration of medical insurance system for residents in urban and rural areas. Chin Health Econ. 2016;35(5):38–40.
  3. National Health and Family Planning Commission: China health statistics yearbook 2013. Beijing Union Medical University Press :2013 126–251.
  4. National Health and Family Planning Commission: China health statistics yearbook 2014. Beijing Union Medical University Press 2014:125.
  5. Chunlin Yang YL. The path choice and effect analysis of integration of urban and rural medical insurance——based on the practice of Changsha City. China Health Insur. 2013;6:16–8.
  6. Ma Chao ZG, Hai G. The effect of urban-rural integrated medical insurance system on rural Residents’Health care behavior. Stat Res. 2016;33(4):78–85.
  7. Qiu Yulin ZP. From "National Health Insurance" to "fair medical insurance": current situation assessment and path analysis of the integration of medical insurance system for urban and rural residents in China. J Hebei Univ (Philos Soc Sci Ed). 2019;44(2):128–38.
  8. Qiu Yulin WZ. The evaluation and analysis of integrating urban and rural residents basic medical insurance system. China Health Insur. 2018;2:16–20.
  9. Lliu X. The integrated urban and rural medical insurance and the utilization of medical care: evidence from China. J World Econ. 2017;3:169–92.
  10. Byles J, Curryer C, Edwards N, Weaver N, D'Este C, Hall J, Kowal P. The Health of older people in selected countries of the Western Pacific region; 2014.

Cited by

Sorted by citations

Related

Metadata

Authors
Liu, H., Zhu, H., Wang, J., Qi, X., Zhao, M., Shan, L., Gao, L., Kang, Z., Jiao, M., Pan, L., Chen, R., Liu, B., Wu, Q., & Ning, N.
Affiliations
Harbin Medical University (CN)
Corresponding author
  • Wu, Qunhong
  • Ning, Ning
ORCID
Venue
BMC Public Health
Publisher
Springer Science and Business Media LLC
Published
2019-12
Volume
19
Issue
1
Pages
1761-1761
ISSN
1471-2458 (ISSN-L)
DOI
10.1186/s12889-019-8121-2
PMC
PMC6937839
OpenAlex
W2998651013
Cited by
62
References
42
Citations by year
2026: 7 · 2025: 8 · 2024: 12 · 2023: 13 · 2022: 12 · 2021: 10
FWCI
6.96
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Public Health (publishedVersion, cc-by)
  • Research Square (acceptedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
  • National Natural Science Foundation of China (71333003, 71804036)
  • Natural Science Foundation of Heilongjiang Province (YQ2019G003)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Healthcare Systems and Reforms
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Economic and Financial Impacts of Cancer
Keywords
catastrophic health expenditure, health insurance integration, health equity, concentration index decomposition, out-of-pocket health expenditure, payment capacity, educational attainment, urban-rural disparities, older adults, health care utilization, China
MeSH terms
Aged, Catastrophic Illness, China, Health Expenditures, Female, Humans, Male, Middle Aged, National Health Programs, Surveys and Questionnaires, Socioeconomic Factors

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review