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Open Access Research article

Household catastrophic medical expenses in eastern China: determinants and policy implications

Xiaohong Li1, Jay J Shen2, Jun Lu1, Ying Wang1, Mei Sun1, Chengyue Li1, Fengshui Chang1 and Mo Hao1*

Author Affiliations

1 Research Institute of Health Development Strategies, School of Public Health, Fudan University, Shanghai, China

2 Department of Health Care Administration and Policy, University of Nevada, Las Vegas, USA

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BMC Health Services Research 2013, 13:506  doi:10.1186/1472-6963-13-506

Published: 5 December 2013

Abstract

Background

Much of research on household catastrophic medical expenses in China has focused on less developed areas and little is known about this problem in more developed areas. This study aimed to analyse the incidence and determinants of catastrophic medical expenses in eastern China.

Methods

Data were obtained from a health care utilization and expense survey of 11,577 households conducted in eastern China in 2008. The incidence of household catastrophic medical expenses was calculated using the method introduced by the World Health Organization. A multi-level logistic regression model was used to identify the determinants.

Results

The incidence of household catastrophic medical expenses in eastern China ranged from 9.24% to 24.79%. Incidence of household catastrophic medical expenses was lower if the head of household had a higher level of education, labor insurance coverage, while the incidence was higher if they lived in rural areas, had a family member with chronic diseases, had a child younger than 5 years old, had a person at home who was at least 65 years old, and had a household member who was hospitalized. Moreover, the impact of the economic level on catastrophic medical expenses was non-linear. The poorest group had a lower incidence than that of the second lowest income group and the group with the highest income had a higher incidence than that of the second highest income group. In addition, region was a significant determinant.

Conclusions

Reducing the incidence of household catastrophic medical expenses should be one of the priorities of health policy. It can be achieved by improving residents’ health status to reduce avoidable health services such as hospitalization. It is also important to design more targeted health insurance in order to increase financial support for such vulnerable groups as the poor, chronically ill, children, and senior populations.