TY - JOUR
T1 - Decomposing inequality in catastrophic health expenditure for self-reported hypertension household in Urban Shaanxi, China from 2008 to 2013
T2 - Two waves' cross-sectional study
AU - Si, Yafei
AU - Zhou, Zhongliang
AU - Su, Min
AU - Wang, Xiao
AU - Lan, Xin
AU - Wang, Dan
AU - Gong, Shaoqing
AU - Xiao, Xiao
AU - Shen, Chi
AU - Ren, Yangling
AU - Zhao, Dantong
AU - Hong, Zihan
AU - Bian, Ying
AU - Chen, Xi
N1 - Funding Information:
Funding This study was funded by China Medical Board (15-277), National Natural Science Foundation of China (71874137), Shaanxi Social Science Foundation (2017S024), Research Program of Shaanxi Soft Science (2015KRM117), the National high-level talents special support plan (thousands of people plan), Shaanxi provincial youth star of science and technology in 2016, China Scholarship Council (201706280307 & 201806280021), the US PEPPER Center Scholar Award (P30AG021342), and two NIH/NIA grants (R03AG048920; K01AG053408).
Publisher Copyright:
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2019/5/1
Y1 - 2019/5/1
N2 - Objective Despite the latest wave of China's healthcare reform initiated in 2009 has achieved unprecedented progress in rural areas, little is known for specific vulnerable groups' catastrophic health expenditure (CHE) in urban China. This study aims to estimate the trend of incidence, intensity and inequality of CHE in hypertension households (households with one or more than one hypertension patient) in urban Shaanxi, China from 2008 to 2013. Methods Based on the fourth and the fifth National Health Service Surveys of Shaanxi, we identified 460 and 1289 households with hypertension in 2008 and 2013, respectively for our analysis. We classified hypertension households into two groups: simplex households (with hypertension only) and mixed households (with hypertension plus other non-communicable diseases). CHE would be identified if out-of-pocket healthcare expenditure was equal to or higher than 40% of a household's capacity to pay. Concentration index and its decomposition based on Probit regressions were employed to measure the income-related inequality of CHE. Results We find that CHE occurred in 11.2% of the simplex households and 22.1% of the mixed households in 2008, and the 21.5% of the simplex households and the 46.9% of mixed households incurred CHE in 2013. Furthermore, there were strong pro-poor inequalities in CHE in the simplex households (-0.279 and -0.283) and mixed households (-0.362 and -0.262) both in 2008 and 2013. The majority of observed inequalities in CHE could be associated with household economic status, household head's health status and having elderly members. Conclusion We find a sharp increase of CHE occurrence and the sustained strong pro-poor inequalities for simplex and mixed households in urban Shaanxi Province of China from 2008 to 2013. Our study suggests that more concerns are needed for the vulnerable groups such as hypertension households in urban areas of China.
AB - Objective Despite the latest wave of China's healthcare reform initiated in 2009 has achieved unprecedented progress in rural areas, little is known for specific vulnerable groups' catastrophic health expenditure (CHE) in urban China. This study aims to estimate the trend of incidence, intensity and inequality of CHE in hypertension households (households with one or more than one hypertension patient) in urban Shaanxi, China from 2008 to 2013. Methods Based on the fourth and the fifth National Health Service Surveys of Shaanxi, we identified 460 and 1289 households with hypertension in 2008 and 2013, respectively for our analysis. We classified hypertension households into two groups: simplex households (with hypertension only) and mixed households (with hypertension plus other non-communicable diseases). CHE would be identified if out-of-pocket healthcare expenditure was equal to or higher than 40% of a household's capacity to pay. Concentration index and its decomposition based on Probit regressions were employed to measure the income-related inequality of CHE. Results We find that CHE occurred in 11.2% of the simplex households and 22.1% of the mixed households in 2008, and the 21.5% of the simplex households and the 46.9% of mixed households incurred CHE in 2013. Furthermore, there were strong pro-poor inequalities in CHE in the simplex households (-0.279 and -0.283) and mixed households (-0.362 and -0.262) both in 2008 and 2013. The majority of observed inequalities in CHE could be associated with household economic status, household head's health status and having elderly members. Conclusion We find a sharp increase of CHE occurrence and the sustained strong pro-poor inequalities for simplex and mixed households in urban Shaanxi Province of China from 2008 to 2013. Our study suggests that more concerns are needed for the vulnerable groups such as hypertension households in urban areas of China.
KW - catastrophic health expenditure
KW - concentration index
KW - decomposition
KW - hypertension
KW - inequality
UR - http://www.scopus.com/inward/record.url?scp=85065731730&partnerID=8YFLogxK
U2 - 10.1136/bmjopen-2018-023033
DO - 10.1136/bmjopen-2018-023033
M3 - Article
C2 - 31076467
AN - SCOPUS:85065731730
SN - 2044-6055
VL - 9
JO - BMJ Open
JF - BMJ Open
IS - 5
M1 - e023033
ER -