Analysis of medical impoverishment and its influencing factors among China's rural near-poor, 2016-2020

Abstract

Objective: This study investigates the determinants of medical impoverishment among China's rural near-poor, aiming to enhance public health services and establish preventative and monitoring systems.

Methods: Using China Family Panel Studies and World Bank methods, we categorized rural populations and calculated their 2020 Poverty Incidence (PI) and Poverty Gap (PG), with impoverishing health expenditures (IHE) as the primary indicator. We analyzed the data from 2016 to 2020 using a conditional fixed-effects multinomial logit model and 2020 logistic regression to identify factors influencing medical impoverishment risk.

Results: (1) In 2020, the near-poor in China faced a PI of 16.65% post-health expenditures, 8.63 times greater than the non-poor's PI of 1.93%. The near-poor's Average Poverty Gap (APG) was CNY 1,920.67, notably surpassing the non-poor's figure of CNY 485.58. Health expenses disproportionately affected low-income groups, with the near-poor more prone to medical impoverishment. (2) Disparities in medical impoverishment between different economic household statuses were significant (P < 0.001), with the near-poor being particularly vulnerable. (3) For rural near-poor households in China, those with over six members faced a lower risk of medical impoverishment compared to those with three or fewer. Unmarried individuals had a 7.1% reduced risk of medical impoverishment relative to married/cohabiting counterparts. Unemployment was associated with a 9% increased risk. A better self-rated health status was linked to a lower probability of IHE, with the "very healthy" reporting a 25.8% lower risk than those "unhealthy." Chronic disease sufferers in the near-poor and non-poor categories were at an increased risk of 12 and 1.4%, respectively. Other surveyed factors, including migrant status, age, insurance type, gender, educational level, and recent smoking or drinking, were not statistically significant (P > 0.05).

Conclusion: Rural near-poor in China are much more susceptible to medical impoverishment, influenced by specific socio-economic factors. The findings advocate for policy enhancements and health system reforms to mitigate health poverty. Further research should extend to urban areas for comprehensive health poverty strategy development.

Keywords: conditional fixed-effects multinomial logit model; impoverishing health expenditures; influencing factors; medical impoverishment; near-poor; relative poverty; rural China.

Figure 1

Comparison of rural residents' income before and after health expenditures nationwide. The horizontal axis represents the cumulative percentage of the population sorted by income level, while the vertical axis shows the ratio of individual income to the PL, which is expressed as a multiple of the PL. A horizontal line in the charts indicates the income level equivalent to the PL. The two vertical marker lines, from left to right, indicate the PL and the near-poverty line, respectively. The rising curves from left to right depict individual incomes before and after health expenditures; the smoother upper curve represents pre-expenditure income, while the stepped curve below reflects post-expenditure income, with the drops indicating the amount spent on health. A drop below the line representing the PL indicates IHE.

Figure 2

Comparison of income among near-poor rural residents before and after health expenditures nationwide. The horizontal axis represents the cumulative percentage of the population sorted by income level, while the vertical axis shows the ratio of individual income to the PL, which is expressed as a multiple of the PL. A horizontal line in the charts indicates the income level equivalent to the PL. The two vertical marker lines, from left to right, indicate the PL and the near-poverty line, respectively. The rising curves from left to right depict individual incomes before and after health expenditures; the smoother upper curve represents pre-expenditure income, while the stepped curve below reflects post-expenditure income, with the drops indicating the amount spent on health. A drop below the line representing the PL indicates IHE.

Figure 3

Comparison of income among non-poor rural residents before and after health expenditures nationwide. The horizontal axis represents the cumulative percentage of the population sorted by income level, while the vertical axis shows the ratio of individual income to the PL, which is expressed as a multiple of the PL. A horizontal line in the charts indicates the income level equivalent to the PL. The vertical marker line indicates the near-poverty line. The rising curves from left to right depict individual incomes before and after health expenditures; the smoother upper curve represents pre-expenditure income, while the stepped curve below reflects post-expenditure income, with the drops indicating the amount spent on health. A drop below the line representing the PL indicates IHE.