Improvement of the reduction in catastrophic health expenditure in China's public health insurance

PLoS One. 2018 Apr 10;13(4):e0194915. doi: 10.1371/journal.pone.0194915. eCollection 2018.

Abstract

This study aimed to locate the contributing factors of Catastrophic Health Expenditure (CHE), evaluate their impacts, and try to propose strategies for reducing the possibilities of CHE in the context of China's current public health insurance system. The financial data of all hospitalization cases from a sample hospital in 2013 were gathered and used to determine the pattern of household medical costs. A simulation model was constructed based on China's current public health insurance system to evaluate the financial burden for medical service on Chinese patients, as well as to calculate the possibilities of CHE. Then, by adjusting several parameters, suggestions were made for China's health insurance system in order to reduce CHE. It's found with China's current public health insurance system, the financial aid that a patient may receive depends on whether he is from an urban or rural area and whether he is employed. Due to the different insurance policies and the wide income gap between urban and rural areas, rural residents are much more financially vulnerable during health crisis. The possibility of CHE can be more than 50% for low-income rural families. The CHE ratio can be dramatically lowered by applying different policies for different household income groups. It's concluded the financial burden for medical services of Chinese patients is quite large currently, especially for those from rural areas. By referencing different healthcare policies in the world, applying different health insurance policies for different income groups can dramatically reduce the possibility of CHE in China.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • China
  • Computer Simulation
  • Decision Making
  • Economics, Hospital
  • Game Theory
  • Health Care Costs*
  • Health Care Reform
  • Health Services Research
  • Hospitalization / economics
  • Humans
  • Insurance, Health / economics*
  • National Health Programs / economics*
  • Poverty
  • Public Health
  • Rural Population
  • Systems Theory
  • Urban Population

Grants and funding

This research is funded by the National Natural Foundation of China 71661018, 71663034, CMB16-261, Project of Science and Technology Department 20161BBA100, and Project of Education Department JC1562 of Jiangxi Province. It is also supported by the University of Arkansas and Jiujiang University Hospital. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.