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Wang J, Qi X, Shan L, Wang K, Tan X, Kang Z, Ning N, Liang L, Gao L, Jiao M, Cui Y, Hao Y, Wu Q, Li Y. What fragile factors hinder the pace of China's alleviation efforts of the poverty-stricken population? A study from the perspective of impoverishment caused by medical expenses. BMC Health Serv Res 2022; 22:963. [PMID: 35906603 PMCID: PMC9336080 DOI: 10.1186/s12913-022-08237-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 06/14/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE China has made remarkable achievements in poverty alleviation. However, with the change in economic development and age structure, the population stricken by poverty due to medical expenses and disability accounted for 42.3 and 14.4% of the total poverty-stricken population, respectively. Accordingly, it is crucial to accurately pinpoint the characteristics of people who are about to become poor due to illness. In this study, we analyzed the incidence of impoverishment by medical expense at the provincial, family, and different medical insurance scheme levels to identify the precise groups that are vulnerable to medical-related poverty. METHOD Data were extracted from the Fifth National Health Service Survey in China in 2013 through a multi-stage, stratified, and random sampling method, leaving 93,570 households (273,626 people) for the final sample. The method recommended by World Health Organization (WHO) was adopted to calculate impoverishment by medical expense, and logistic regression was adopted to evaluate its determinants. RESULTS The poverty and impoverishment rate in China were 16.2 and 6.3% respectively. The poverty rate in western region was much higher than that of central and eastern regions. The rate of impoverishment by medical expense (IME) was higher in the western region (7.2%) than that in the central (6.5%) and eastern (5.1%) regions. The New Cooperative Medical Scheme (NCMS) was associated with the highest rate (9.1%) of IME cases. The top three diseases associated with IME were malignant tumor, congenital heart disease, and mental disease. Households with non-communicable disease members or hospitalized members had a higher risk on IME. NCMS-enrolled, poorer households were more likely to suffer from IME. CONCLUSION The joint roles of economic development, health service utilization, and welfare policies result in medical impoverishment for different regions. Poverty and health service utilization are indicative of households with high incidence of medical impoverishment. Chronic diseases lead to medical impoverishment. The inequity existing in different medical insurance schemes leads to different degrees of risk of IME. A combined strategy to precise target multiple vulnerabilities of poor population would be more effective.
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Affiliation(s)
- Jiahui Wang
- Centre of Health Policy & Management, Health Management College, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China.,Department of Social Medicine, School of Public Health, Health Management College, Harbin Medical University, No.157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Xinye Qi
- Centre of Health Policy & Management, Health Management College, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China.,Department of Social Medicine, School of Public Health, Health Management College, Harbin Medical University, No.157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Linghan Shan
- Centre of Health Policy & Management, Health Management College, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China.,Department of Social Medicine, School of Public Health, Health Management College, Harbin Medical University, No.157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Kexin Wang
- Centre of Health Policy & Management, Health Management College, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China.,Department of Social Medicine, School of Public Health, Health Management College, Harbin Medical University, No.157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Xiao Tan
- Shenzhen Hospital of Guangzhou University of traditional Chinese Medicine (Futian), 6001 Beihuan Avenue, Futian District, Shenzhen, Guangdong Province, China
| | - Zheng Kang
- Centre of Health Policy & Management, Health Management College, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China.,Department of Social Medicine, School of Public Health, Health Management College, Harbin Medical University, No.157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Ning Ning
- Centre of Health Policy & Management, Health Management College, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China.,Department of Social Medicine, School of Public Health, Health Management College, Harbin Medical University, No.157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Libo Liang
- Centre of Health Policy & Management, Health Management College, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China.,Department of Social Medicine, School of Public Health, Health Management College, Harbin Medical University, No.157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Lijun Gao
- Centre of Health Policy & Management, Health Management College, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China.,Department of Social Medicine, School of Public Health, Health Management College, Harbin Medical University, No.157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Mingli Jiao
- Centre of Health Policy & Management, Health Management College, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China.,Department of Social Medicine, School of Public Health, Health Management College, Harbin Medical University, No.157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Yu Cui
- Centre of Health Policy & Management, Health Management College, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China.,Department of Social Medicine, School of Public Health, Health Management College, Harbin Medical University, No.157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Yanhua Hao
- Centre of Health Policy & Management, Health Management College, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China.,Department of Social Medicine, School of Public Health, Health Management College, Harbin Medical University, No.157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Qunhong Wu
- Centre of Health Policy & Management, Health Management College, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China. .,Department of Social Medicine, School of Public Health, Health Management College, Harbin Medical University, No.157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China.
| | - Ye Li
- Centre of Health Policy & Management, Health Management College, Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China. .,Department of Social Medicine, School of Public Health, Health Management College, Harbin Medical University, No.157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China.
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