IDEAS home Printed from https://ideas.repec.org/a/gam/jijerp/v19y2022i10p5956-d815276.html
   My bibliography  Save this article

The Comparison of Various Types of Health Insurance in the Healthcare Utilization, Costs and Catastrophic Health Expenditures among Middle-Aged and Older Chinese Adults

Author

Listed:
  • Sha Chen

    (Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China)

  • Zhiye Lin

    (Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China)

  • Xiaoru Fan

    (Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China)

  • Jushuang Li

    (Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China)

  • Yao-Jie Xie

    (School of Nursing, The Hong Kong Polytechnic University, Hong Kong 999077, China)

  • Chun Hao

    (Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
    Sun Yat-sen Global Health Institute, Institute of State Governance, Sun Yat-sen University, Guangzhou 510080, China)

Abstract

Rapid aging in China is increasing the number of older people who tend to require health services for their poor perceived health. Drawing on the China Health and Retirement Longitudinal Study (CHARLS) 2018 data, we used two-part model and binary logistic regression to compare various types of health insurance in the healthcare utilization, costs and catastrophic health expenditures (CHE) among the middle-aged and older adults in China. Compared with uninsured, all types of health insurance promoted hospital utilization rate (ranged from 8.6% to 12.2%) and reduced out-of-pocket (OOP) costs (ranged from 64.9% to 123.6%), but had no significant association with total costs. In contrast, the association of health insurance and outpatient care was less significant. When Urban Employee Medical Insurance (UEMI) as reference, other types of insurance did not show a significant difference. Health insurance could not reduce the risk of CHE. The equity in healthcare utilization improved and healthcare costs had been effectively controlled among the elderly, but health insurance did not protect against CHE risks. Policy efforts should further focus on optimizing healthcare resource allocation and inclining toward the lower socio-economic and poor-health groups.

Suggested Citation

  • Sha Chen & Zhiye Lin & Xiaoru Fan & Jushuang Li & Yao-Jie Xie & Chun Hao, 2022. "The Comparison of Various Types of Health Insurance in the Healthcare Utilization, Costs and Catastrophic Health Expenditures among Middle-Aged and Older Chinese Adults," IJERPH, MDPI, vol. 19(10), pages 1-14, May.
    • Handle: RePEc:gam:jijerp:v:19:y:2022:i:10:p:5956-:d:815276
    as

    Download full text from publisher

    File URL: https://www.mdpi.com/1660-4601/19/10/5956/pdf
    Download Restriction: no
    File URL: https://www.mdpi.com/1660-4601/19/10/5956/
    Download Restriction: no
    ---><---

    References listed on IDEAS

    as
    1. Yu, Hao, 2015. "Universal health insurance coverage for 1.3 billion people: What accounts for China's success?," Health Policy, Elsevier, vol. 119(9), pages 1145-1152.
    2. Wagstaff, Adam & Lindelow, Magnus, 2008. "Can insurance increase financial risk?: The curious case of health insurance in China," Journal of Health Economics, Elsevier, vol. 27(4), pages 990-1005, July.
    3. Zhang, Anwen & Nikoloski, Zlatko & Mossialos, Elias, 2017. "Does health insurance reduce out-of-pocket expenditure? Heterogeneity among China's middle-aged and elderly," Social Science & Medicine, Elsevier, vol. 190(C), pages 11-19.
    4. Stephen Abrokwah & Christine Moser & Edward Norton, 2014. "The effect of social health insurance on prenatal care: the case of Ghana," International Journal of Health Economics and Management, Springer, vol. 14(4), pages 385-406, December.
    5. Tan, Si Ying & Wu, Xun & Yang, Wei, 2019. "Impacts of the type of social health insurance on health service utilisation and expenditures: implications for a unified system in China," Health Economics, Policy and Law, Cambridge University Press, vol. 14(4), pages 468-486, October.
    6. Jeannette Amaya Lara & Fernando Ruiz Gómez, 2011. "Determining factors of catastrophic health spending in Bogota, Colombia," International Journal of Health Economics and Management, Springer, vol. 11(2), pages 83-100, June.
    7. Qi Liu & Jin Liu & Shuntian Sui, 2020. "Public Medical Insurance and Healthcare Utilization and Expenditures of Older with Chronic Diseases in Rural China: Evidence from NRCMS," IJERPH, MDPI, vol. 17(20), pages 1-15, October.
    8. Guindon, G. Emmanuel, 2014. "The impact of health insurance on health services utilization and health outcomes in Vietnam," Health Economics, Policy and Law, Cambridge University Press, vol. 9(4), pages 359-382, October.
    9. Adam Wagstaff & Eddy van Doorslaer, 2003. "Catastrophe and impoverishment in paying for health care: with applications to Vietnam 1993–1998," Health Economics, John Wiley & Sons, Ltd., vol. 12(11), pages 921-933, November.
    10. Cylus, Jonathan & Thomson, Sarah & Evetovits, Tamás, 2018. "Catastrophic health spending in Europe: equity and policy implications of different calculation methods," LSE Research Online Documents on Economics 89062, London School of Economics and Political Science, LSE Library.
    11. Kim, Sujin & Kwon, Soonman, 2015. "Impact of the policy of expanding benefit coverage for cancer patients on catastrophic health expenditure across different income groups in South Korea," Social Science & Medicine, Elsevier, vol. 138(C), pages 241-247.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Mohammad Abu-Zaineh & Habiba Romdhane & Bruno Ventelou & Jean-Paul Moatti & Arfa Chokri, 2013. "Appraising financial protection in health: the case of Tunisia," International Journal of Health Economics and Management, Springer, vol. 13(1), pages 73-93, March.
    2. Syeda Anam Fatima Rizvi, 2021. "Household Catastrophic Health Expenditures and its Determinants in Pakistan," Post-Print hal-03341700, HAL.
    3. Maria-Carmen García-Centeno & Román Mínguez-Salido & Raúl del Pozo-Rubio, 2021. "The Classification of Profiles of Financial Catastrophe Caused by Out-of-Pocket Payments: A Methodological Approach," Mathematics, MDPI, vol. 9(11), pages 1-20, May.
    4. Guangsheng Wan & Zixuan Peng & Yufeng Shi & Peter C. Coyte, 2020. "What Are the Determinants of the Decision to Purchase Private Health Insurance in China?," IJERPH, MDPI, vol. 17(15), pages 1-15, July.
    5. Owen (O.A.) O'Donnell, 2019. "Financial Protection Against Medical Expense," Tinbergen Institute Discussion Papers 19-010/V, Tinbergen Institute.
    6. Yue Zhou & Haishaerjiang Wushouer & Daniel Vuillermin & Xiaodong Guan & Luwen Shi, 2021. "Does the universal medical insurance system reduce catastrophic health expenditure among middle-aged and elderly households in China? A longitudinal analysis," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 22(3), pages 463-471, April.
    7. Ku, Yu-Chun & Chou, Yiing-Jenq & Lee, Miaw-Chwen & Pu, Christy, 2019. "Effects of National Health Insurance on household out-of-pocket expenditure structure," Social Science & Medicine, Elsevier, vol. 222(C), pages 1-10.
    8. Kyriopoulos, Ilias & Nikoloski, Zlatko & Mossialos, Elias, 2021. "Financial protection in health among the middle-aged and elderly: Evidence from the Greek economic recession," Health Policy, Elsevier, vol. 125(9), pages 1256-1266.
    9. Sowmya Dhanaraj, 2014. "Health Shocks and Coping Strategies: State Health Insurance Scheme of Andhra Pradesh, India," WIDER Working Paper Series wp-2014-003, World Institute for Development Economic Research (UNU-WIDER).
    10. repec:eid:wpaper:3/09 is not listed on IDEAS
    11. Rama Pal, 2012. "Measuring incidence of catastrophic out-of-pocket health expenditure: with application to India," International Journal of Health Economics and Management, Springer, vol. 12(1), pages 63-85, March.
    12. Darius Erlangga & Marc Suhrcke & Shehzad Ali & Karen Bloor, 2019. "The impact of public health insurance on health care utilisation, financial protection and health status in low- and middle-income countries: A systematic review," PLOS ONE, Public Library of Science, vol. 14(8), pages 1-20, August.
    13. Lin, Lin & Zai, Xianhua, 2022. "The Power of Public Insurance With Limited Benefits: Evidence from China's New Cooperative Medical Scheme," GLO Discussion Paper Series 1180, Global Labor Organization (GLO).
    14. Bernal, Noelia & Carpio, Miguel A. & Klein, Tobias J., 2017. "The effects of access to health insurance: Evidence from a regression discontinuity design in Peru," Journal of Public Economics, Elsevier, vol. 154(C), pages 122-136.
    15. Dilek Basar & Sarah Brown & Arne Risa Hole, 2012. "Out-of-Pocket Health Care Expenditure in Turkey: Analysis of the Household Budget Surveys 2002-2008," Working Papers 2012020, The University of Sheffield, Department of Economics.
    16. Brown, Sarah & Hole, Arne Risa & Kilic, Dilek, 2014. "Out-of-pocket health care expenditure in Turkey: Analysis of the 2003–2008 Household Budget Surveys," Economic Modelling, Elsevier, vol. 41(C), pages 211-218.
    17. Samuel Ampaw & Simon Appleton & Xuyan Lou, 2020. "Heterogeneous effect of health insurance on financial risk: Evidence from two successive surveys in Ghana," Discussion Papers 2020-04, University of Nottingham, CREDIT.
    18. Ramses H. Abul Naga & Karine Lamiraud, 2008. "Catastrophic Health ExpenditureandHousehold Well-Being," STICERD - Distributional Analysis Research Programme Papers 098, Suntory and Toyota International Centres for Economics and Related Disciplines, LSE.
    19. Ligane Séne & Momath Cissé, 2015. "Catastrophic out-of-pocket payments for health and poverty nexus: evidence from Senegal," International Journal of Health Economics and Management, Springer, vol. 15(3), pages 307-328, September.
    20. Supon Limwattananon & Sven Neelsen & Owen O'Donnell & Phusit Prakongsai & Viroj Tangcharoensathien & Eddy van Doorslaer & Vuthiphan Vongmongkol, 2013. "Universal Coverage on a Budget: Impacts on Health Care Utilization and Out-Of-Pocket Expenditures in Thailand," CESifo Working Paper Series 4262, CESifo.
    21. Sparrow, Robert & Suryahadi, Asep & Widyanti, Wenefrida, 2013. "Social health insurance for the poor: Targeting and impact of Indonesia's Askeskin programme," Social Science & Medicine, Elsevier, vol. 96(C), pages 264-271.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:gam:jijerp:v:19:y:2022:i:10:p:5956-:d:815276. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: MDPI Indexing Manager (email available below). General contact details of provider: https://www.mdpi.com .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.