Background
Data and description
Sampling method and sample selection
The NCMS in sample districts
2009 | 2012 | |||||
---|---|---|---|---|---|---|
Zhangqiu | Changqing | Pingyin | Zhangqiu | Changqing | Pingyin | |
Deductible (yuan) | ||||||
Township hospital | 0 (0 USD) | 0 (0 USD) | 0 (0 USD) | 300 (47.01 USD) | 200 (31.34 USD) | 200 (31.34 USD) |
County-level hospital | 1,000 (156.7 USD) | 0 (0 USD) | 0 (0 USD) | 400 (62.68 USD) | 400 (62.68 USD) | 400 (62.68 USD) |
Ceiling (yuan) | 35,000 (5,484.5 USD) | 50,000 (7,835 USD) | 20,000 (3,134 USD) | 100,000 (15,670 USD) | 120,000 (18,804 USD) | 100,000 (15,670 USD) |
Reimbursement percent (%) | ||||||
Township hospital | 30 | 55 | 40 | 70 | 80 | 70 |
County-level hospital | 25 | 22.5 | 40 | 55 | 45 | 55 |
Above county hospital | 15 | 10 | 40 | 40 | 35 | 40 |
NCMS participation N (%) | ||||||
NCMS enrolees | 3,558 (96.21) | 7,881 (97.18) | ||||
Non-enrolees | 140 (3.79) | 229 (2.82) |
Descriptive statistics
Variables | 2009 | 2012 |
---|---|---|
N (%) |
N (%) | |
Economic status (reference group = Quintile1) | ||
Quintile2 | 194 (19.98) | 139 (20.03) |
Quintile3 | 194 (19.98) | 138 (19.88) |
Quintile4 | 194 (19.98) | 139 (20.03) |
Quintile5 | 194 (19.98) | 139 (20.03) |
Household member ≥ 65 | 256 (26.36) | 223 (32.13) |
Household member ≤ 5 | 194 (19.98) | 96 (13.83) |
Household head | ||
Sex (male) | 890 (91.66) | 641 (92.36) |
Education (reference group = below primary school level) | ||
Junior middle school | 406 (41.81) | 279 (40.20) |
Senior middle school and above | 99 (10.20) | 65 (9.37) |
Occupation (farmer) | 826 (85.07) | 600 (86.46) |
Household size (reference group = 1–3 members) | ||
≥ 4 members | 525 (54.07) | 382 (55.04) |
Chronic disease | 588 (60.56) | 352 (50.72) |
Self-assessed health (reference group = worse) | ||
Normal | 261 (26.88) | 168 (24.21) |
Better | 493 (50.77) | 413 (59.51) |
Total | 971 | 694 |
Methods
Definition of CHEs
Incidence and intensity of “catastrophic” payments
Inequality between poor and non-poor households
Decomposing CHE inequalities
Decomposing changes in CHE inequalities
Results
Determinants of hospitalisation of households
Coefficient | Std.Err |
p
| |
---|---|---|---|
Economic status (reference group = Quintile1) | |||
Quintile2 | 0.288 | 0.298 | 0.333 |
Quintile3 | 0.725 | 0.292 | 0.013 |
Quintile4 | 1.326 | 0.295 | 0.000 |
Quintile5 | 1.879 | 0.303 | 0.000 |
Household member ≥ 65 | 0.175 | 0.193 | 0.365 |
Household member ≤ 5 | 0.700 | 0.223 | 0.002 |
Household head | |||
Sex (male) | 0.782 | 0.350 | 0.026 |
Education (reference group = below primary school level) | |||
Junior middle school | −0.262 | 0.189 | 0.166 |
Senior middle school and above | −0.337 | 0.325 | 0.299 |
Occupation (farmer) | 0.290 | 0.268 | 0.279 |
Household size (reference group = 1–3 members) | |||
≥ 4 members | 0.444 | 0.189 | 0.019 |
Chronic disease | 0.577 | 0.215 | 0.007 |
Self-assessed health (reference group = worse) | |||
Normal | −0.484 | 0.213 | 0.023 |
Better | −1.091 | 0.236 | 0.000 |
year (2012) | 0.118 | 0.054 | 0.029 |
CHE and its inequality according to economic status
Threshold | Before reimbursement (a) (%) | After reimbursement (b) (%) | Reduction by the NCMS | |||
---|---|---|---|---|---|---|
(a–b)/a (%) | ||||||
2009 | 2012 | 2009 | 2012 | 2009 | 2012 | |
20 % | 61.83 | 74.07 | 54.96 | 52.78 | 11.11 | 28.74 |
30 % | 45.80 | 62.04 | 42.75 | 39.81 | 6.66 | 35.83 |
40 % | 31.30 | 46.30 | 26.72 | 26.85 | 14.63 | 42.01 |
50 % | 22.14 | 28.70 | 19.85 | 14.81 | 10.34 | 48.40 |
60 % | 16.79 | 22.22 | 12.21 | 8.33 | 27.28 | 62.51 |
Threshold | Before reimbursement (A) (%) | After reimbursement (B) (%) | Reduction by NCMS | |||
---|---|---|---|---|---|---|
A–B | ||||||
2009 | 2012 | 2009 | 2012 | 2009 | 2012 | |
20 % | 17.62 | 22.42 | 13.79 | 12.49 | 3.83 | 9.93 |
30 % | 12.43 | 15.78 | 9.06 | 7.90 | 3.37 | 7.88 |
40 % | 8.33 | 10.52 | 5.82 | 4.47 | 2.51 | 6.05 |
50 % | 5.69 | 6.89 | 3.52 | 2.39 | 2.17 | 4.50 |
60 % | 3.71 | 4.35 | 1.91 | 1.18 | 1.80 | 3.17 |
Threshold | Before reimbursement (A) (%) | After reimbursement (B) (%) | Reduction by NCMS A–B | |||
---|---|---|---|---|---|---|
2009 | 2012 | 2009 | 2012 | 2009 | 2012 | |
20 % | 28.50 | 30.27 | 25.09 | 23.66 | 3.41 | 6.60 |
30 % | 27.14 | 25.44 | 21.19 | 19.84 | 5.95 | 5.59 |
40 % | 26.61 | 22.72 | 21.78 | 16.65 | 4.83 | 6.07 |
50 % | 25.70 | 24.01 | 17.73 | 16.14 | 7.97 | 7.87 |
60 % | 22.10 | 19.58 | 15.64 | 14.17 | 6.45 | 5.41 |
Year | Before reimbursement | After reimbursement | ||
---|---|---|---|---|
2009 | 2012 | 2009 | 2012 | |
CE
| 0.031 | −0.011 | 0.073 | 0.021 |
CO
| 0.075 | −0.028 | 0.130 | −0.203 |
Decomposition of socioeconomic inequality in catastrophic health care expenditures
Coefficient | Mean | Elasticity | Concentration index (CI) | Contribution to CI | ||||||
---|---|---|---|---|---|---|---|---|---|---|
2009 | 2012 | 2009 | 2012 | 2009 | 2012 | 2009 | 2012 | 2009 | 2012 | |
Economic status (reference group = Quintile1) | ||||||||||
Quintile2 | −0.089 | −0.068 | 0.198 | 0.194 | −0.066 | −0.049 | −0.392 | −0.402 | 0.026 | 0.020 |
Quintile3 | −0.094 | −0.162 | 0.198 | 0.204 | −0.070 | −0.123 | 0.008 | 0.000 | −0.001 | 0.000 |
Quintile4 | −0.103 | −0.165 | 0.198 | 0.194 | −0.077 | −0.12 | 0.408 | 0.402 | −0.031 | −0.048 |
Quintile5 | −0.071 | −0.119 | 0.198 | 0.204 | −0.053 | −0.090 | 0.808 | 0.804 | −0.043 | −0.073 |
Household member ≥ 65 | 0.274* | −0.009 | 0.359 | 0.370 | 0.368 | −0.012 | −0.067 | −0.037 | −0.025 | 0.000 |
Household member ≤ 5 | 0.172 | 0.010 | 0.244 | 0.222 | 0.157 | 0.008 | −0.259 | −0.192 | −0.041 | −0.002 |
Household head | ||||||||||
Sex (male) | −0.040 | −0.107 | 0.947 | 0.935 | −0.141 | −0.373 | −0.026 | −0.025 | 0.004 | 0.009 |
Education level (reference group = below primary school level) | ||||||||||
Junior middle school | 0.152 | −0.031 | 0.382 | 0.352 | 0.217 | −0.040 | −0.042 | 0.025 | −0.009 | −0.001 |
Senior middle school and above | −0.049 | −0.059 | 0.076 | 0.074 | −0.014 | −0.016 | 0.398 | −0.112 | −0.006 | 0.002 |
Occupation (farmer) | −0.148 | 0.033 | 0.863 | 0.926 | −0.478 | 0.115 | 0.006 | 0.001 | −0.003 | 0.000 |
Household size (reference group = 1–3 members) | ||||||||||
≥ 4 members | −0.348** | −0.145 | 0.580 | 0.676 | −0.756 | −0.366 | −0.115 | −0.092 | 0.087 | 0.034 |
Real reimbursement | −0.067 | −0.857** | 0.179 | 0.331 | −0.045 | −1.055 | −0.025 | −0.028 | 0.001 | 0.030 |
Length of stay (reference group = fewer than 8 days) | ||||||||||
8–14 days | −0.003 | −0.050 | 0.267 | 0.287 | −0.003 | −0.053 | 0.070 | −0.238 | 0.000 | 0.013 |
≥ 15 days | 0.471** | 0.221* | 0.328 | 0.398 | 0.579 | 0.328 | 0.146 | 0.257 | 0.085 | 0.084 |
Inpatient institution (reference group = town level) | ||||||||||
County level | 0.080 | 0.111 | 0.519 | 0.537 | 0.155 | 0.222 | 0.038 | 0.038 | 0.006 | 0.008 |
County above | 0.487** | 0.365 | 0.183 | 0.213 | 0.334 | 0.290 | 0.038 | 0.183 | 0.013 | 0.053 |
Self-assessed health (reference group = worse) | ||||||||||
Normal | −0.047 | −0.035 | 0.305 | 0.324 | −0.053 | −0.042 | −0.178 | −0.040 | 0.009 | 0.002 |
Better | −0.089 | −0.062 | 0.305 | 0.380 | −0.102 | −0.088 | 0.156 | −0.089 | −0.016 | 0.008 |
Decomposing changes in CHE inequalities between 2009 and 2012
2009–2012 | ||||
---|---|---|---|---|
∆C*η | ∆η*C | Total | % | |
Economic status (reference group = Quintile1) | ||||
Quintile2 | 0.000 | −0.007 | −0.006 | 11.873 |
Quintile3 | 0.001 | 0.000 | 0.001 | −1.077 |
Quintile4 | 0.001 | −0.018 | −0.017 | 32.354 |
Quintile5 | 0.000 | −0.030 | −0.030 | 56.800 |
Household member ≥ 65 | 0.000 | 0.025 | 0.025 | −48.308 |
Household member ≤ 5 | 0.001 | 0.039 | 0.039 | −75.207 |
Household head | ||||
Sex (male) | 0.000 | 0.006 | 0.006 | −10.883 |
Education level (reference group = below primary school level) | ||||
Junior middle school | −0.003 | 0.011 | 0.008 | −15.580 |
Senior middle school and above | 0.008 | −0.001 | 0.007 | −14.162 |
Occupation (farmer) | −0.001 | 0.004 | 0.003 | −5.737 |
Household size (reference group = 1–3 members) | ||||
≥ 4 members | −0.008 | −0.045 | −0.053 | 102.438 |
Real reimbursement | 0.003 | 0.025 | 0.028 | −54.644 |
Length of stay (reference group = fewer than 8 days) | ||||
8–14 days | 0.016 | −0.004 | 0.013 | −24.662 |
≥ 15 days | 0.036 | −0.037 | 0.000 | 0.578 |
Inpatient institution (reference group = town level) | ||||
County level | 0.000 | 0.003 | 0.003 | −4.911 |
County above | 0.042 | −0.002 | 0.040 | −77.572 |
Self-assessed health (reference group = worse) | ||||
Normal | −0.006 | −0.002 | −0.008 | 14.912 |
Better | 0.022 | 0.002 | 0.024 | −45.662 |