Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Sep 20;17(1):727.
doi: 10.1186/s12889-017-4713-x.

Income related inequality and influencing factors: a study for the incidence of catastrophic health expenditure in rural China

Hai Gu  1 , Yun Kou  2 , Zhiwen Yan  3 , Yilei Ding  2   4 , Jusheng Shieh  2 , Jun Sun  2 , Nan Cui  2 , Qianjing Wang  2 , Hua You  5   6
Affiliations

Income related inequality and influencing factors: a study for the incidence of catastrophic health expenditure in rural China

Hai Gu et al. BMC Public Health. .

Abstract

Background: Catastrophic health expenditure (CHE) puts a heavy disease burden on patients' families, aggravating income-related inequality. In an attempt to reduce the financial risks of rural families incurring CHE, China began the New Rural Cooperative Medical System (NCMS) on a trial basis in 2003 and has raised the reimbursement rates continuously since then. Based on statistical data about rural families in sample area of Jiangsu province, this study measures the incidence of CHE, analyzes socioeconomic inequality related to CHE, and explores the influences of the NCMS on the incidence of CHE.

Methods: Statistical data were acquired from two surveys about rural health care, one conducted in 2009 and one conducted in 2010. In 2009, 1424 rural families were analyzed; in 2010, 1796 rural families were analyzed. An index of CHE is created to enable the evaluation of the associated financial risks. The concentration index and concentration curve are used to measure the income-related inequality involved in CHE. Multiple logistic regression is utilized to explore the factors that influence the incidence of CHE.

Results: The incidence of CHE decreased from 13.62% in 2009 to 7.74% in 2010. The concentration index of CHE was changed from -0.298 (2009) to -0.323 (2010). Compared with rural families in which all members were covered by the NCMS, rural families in which some members were not covered by the NCMS had a lower incidence of CHE: The odds ratio is 0.65 with a 95% confidence interval of 0.43 to 1.00. For rural families in which all members were covered by the NCMS, the increase in reimbursement rates is correlated to the decline in the incidence of CHE if other influencing factors were controlled: The odds ratio is 0.48 with a 95% confidence interval of 0.36 to 0.64.

Conclusions: Between 2009 and 2010, the incidence rate of CHE in the sampled area decreased sharply, CHE was more concentrated among least wealthy and inequality increased during study period. As of 2010, the poorest rural families still had high risk of experiencing CHE. For rural families in which all members are covered by the NCMS, the rise in reimbursement rates reduces the probability of experiencing CHE.

Keywords: Catastrophic health care expenditure; Concentration index; Income related inequality; New Rural Cooperative Medical Scheme,Reimbursement; Out-of-pocket expenditures.

PubMed Disclaimer

Conflict of interest statement

Authors’ information

Hua You and Hai Gu are co-corresponding authors.

Ethics approval and consent to participate

Ethical approval was obtained from the Medical Faculty Ethics Committee of Nanjing Medical University (file number 316) and written informed consent from every participant was obtained before the investigation.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow chart of the sampling procedure
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Zhang L, Cheng X, Tolhurst R, Tang S, Liu X. How effectively can the new cooperative medical scheme reduce catastrophic health expenditure for the poor and non-poor in rural China? Tropical Med Int Health. 2010;15(4):468–475. - PubMed
    1. The State Council Leading Group Office of Poverty Alleviation and Development/LGOP: five major reasons for poverty; 2015. Available from URL: http://m.news.cntv.cn/2015/11/21/ARTI1448082051328733.shtml. Accessed 29 July 2017.
    1. Kawabata K, Xu K, Carrin G. Preventing impoverishment through protection against catastrophic health expenditure. Bull World Health Organ. 2002;80(8):612. - PMC - PubMed
    1. World Health Organization . Equity in health and health care: a WHO/SIDA initiative. Geneva: WHO; 1996.
    1. Zhou Z, Zhu L, Zhou Z, Li Z, Gao J, Chen G. The effects of China's urban basic medical insurance schemes on the equity of health service utilisation: evidence from Shaanxi Province. Int J Equity Health. 2014;13:23. doi: 10.1186/1475-9276-13-23. - DOI - PMC - PubMed

MeSH terms