Factors that dynamically affect provincial incidences of catastrophic health expenditure among middle-aged and elderly Chinese population-transition of disease financial risk protection from global to local
Abstract Background The high incidence of catastrophic health expenditure (ICHE) among middle-aged and elderly population is a major deterrent for reducing the financial risk of disease. Current research is predominantly based on the assumption of spatial homogeneity of nationwide population charact...
| Main Authors: | , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-09-01
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| Series: | BMC Geriatrics |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12877-022-03432-6 |
| _version_ | 1811267696988258304 |
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| author | Xiyu Zhang Wenqing Miao Bing Wu Yongqiang Lai Mingli Jiao Qi Xia Chenxi Zhang Wanxin Tian Zhe Song Linghan Shan Lingqin Hu Xinhao Han Hui Yin Xiaonan Cheng Ye Li Baoguo Shi Qunhong Wu |
| author_facet | Xiyu Zhang Wenqing Miao Bing Wu Yongqiang Lai Mingli Jiao Qi Xia Chenxi Zhang Wanxin Tian Zhe Song Linghan Shan Lingqin Hu Xinhao Han Hui Yin Xiaonan Cheng Ye Li Baoguo Shi Qunhong Wu |
| author_sort | Xiyu Zhang |
| collection | DOAJ |
| description | Abstract Background The high incidence of catastrophic health expenditure (ICHE) among middle-aged and elderly population is a major deterrent for reducing the financial risk of disease. Current research is predominantly based on the assumption of spatial homogeneity of nationwide population characteristics, ignoring the differences in regional characteristics. Thus, our study aimed to explore the impact of various influencing factors on the ICHE from a spatiotemporal perspective. Methods We used data from the China Health and Retirement Longitudinal Study (waves 1 to 4), to conduct a retrospective cohort study across 28 provinces, from 2011 to 2018. We measured regional incidences of catastrophic health expenditure using methods recommended by the World Health Organization. Ordinary least squares (OLS) and geographical and temporal weighted regression (GTWR) were used as the global and local estimation models, respectively. The Fortheringham method was used to test the spatiotemporal non-stationarity. Results National ICHE showed a gradual increase from 2011 to 2015, but suddenly decreased from 2015 to 2018, also showing the spatial heterogeneity. And the southwest area and Hebei showed persistently high ICHE (Qinghai even reached the highest value of 27.5% in 2015). Out-of-pocket payment, gross domestic product, PM2.5, ageing, incidence of non-communicable diseases and disabilities, number of nurses, and health insurance coverage in the global estimation passed the significance test, and the GTWR model showed a better model fit (0.769) than the OLS model (0.388). Furthermore, except for health insurance coverage, all seven variables had spatiotemporal non-stationarity among their impacts on ICHE. Conclusion In this longitudinal study, we found spatiotemporal non-stationarity among the variable relationships, supporting regional governments’ adoption of regional-target policies. First, after the completion of universal health insurance coverage, the spatiotemporal non-stationarity of the prevalence of non-communicable diseases and disability and ageing should be the focus of the next phase of health insurance design, where improvements to compensation coverage and benefit packages are possible policy instruments. Second, the governance and causes of catastrophic health expenditure need to be laid out from a macro perspective rather than only from the individual/household perspective, especially for the potential impact of economic development, air pollution and nursing resources. |
| first_indexed | 2024-04-12T21:07:19Z |
| format | Article |
| id | doaj.art-7c16cbc1841d4c2ca880110efe505701 |
| institution | Directory Open Access Journal |
| issn | 1471-2318 |
| language | English |
| last_indexed | 2024-04-12T21:07:19Z |
| publishDate | 2022-09-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Geriatrics |
| spelling | doaj.art-7c16cbc1841d4c2ca880110efe5057012022-12-22T03:16:40ZengBMCBMC Geriatrics1471-23182022-09-0122111410.1186/s12877-022-03432-6Factors that dynamically affect provincial incidences of catastrophic health expenditure among middle-aged and elderly Chinese population-transition of disease financial risk protection from global to localXiyu Zhang0Wenqing Miao1Bing Wu2Yongqiang Lai3Mingli Jiao4Qi Xia5Chenxi Zhang6Wanxin Tian7Zhe Song8Linghan Shan9Lingqin Hu10Xinhao Han11Hui Yin12Xiaonan Cheng13Ye Li14Baoguo Shi15Qunhong Wu16Research Center of Health Policy and Hospital Management, School of Health Management, Harbin Medical UniversityResearch Center of Health Policy and Hospital Management, School of Health Management, Harbin Medical UniversityResearch Center of Health Policy and Hospital Management, School of Health Management, Harbin Medical UniversityResearch Center of Health Policy and Hospital Management, School of Health Management, Harbin Medical UniversityResearch Center of Health Policy and Hospital Management, School of Health Management, Harbin Medical UniversityResearch Center of Health Policy and Hospital Management, School of Health Management, Harbin Medical UniversityResearch Center of Health Policy and Hospital Management, School of Health Management, Harbin Medical UniversityResearch Center of Health Policy and Hospital Management, School of Health Management, Harbin Medical UniversityThe second affiliated hospital of Harbin Medical UniversitySchool of Public Health, Harbin Medical UniversityThe forth affiliated hospital of Heilongjiang University of Chinese MedicineDepartment of Biostatistics, School of Public Health, Harbin Medical UniversitySchool of Public Health, Harbin Medical UniversityThe second affiliated hospital of Harbin Medical UniversityResearch Center of Health Policy and Hospital Management, School of Health Management, Harbin Medical UniversityDepartment of Economics, School of Economics, Minzu University of ChinaSchool of Public Health, Harbin Medical UniversityAbstract Background The high incidence of catastrophic health expenditure (ICHE) among middle-aged and elderly population is a major deterrent for reducing the financial risk of disease. Current research is predominantly based on the assumption of spatial homogeneity of nationwide population characteristics, ignoring the differences in regional characteristics. Thus, our study aimed to explore the impact of various influencing factors on the ICHE from a spatiotemporal perspective. Methods We used data from the China Health and Retirement Longitudinal Study (waves 1 to 4), to conduct a retrospective cohort study across 28 provinces, from 2011 to 2018. We measured regional incidences of catastrophic health expenditure using methods recommended by the World Health Organization. Ordinary least squares (OLS) and geographical and temporal weighted regression (GTWR) were used as the global and local estimation models, respectively. The Fortheringham method was used to test the spatiotemporal non-stationarity. Results National ICHE showed a gradual increase from 2011 to 2015, but suddenly decreased from 2015 to 2018, also showing the spatial heterogeneity. And the southwest area and Hebei showed persistently high ICHE (Qinghai even reached the highest value of 27.5% in 2015). Out-of-pocket payment, gross domestic product, PM2.5, ageing, incidence of non-communicable diseases and disabilities, number of nurses, and health insurance coverage in the global estimation passed the significance test, and the GTWR model showed a better model fit (0.769) than the OLS model (0.388). Furthermore, except for health insurance coverage, all seven variables had spatiotemporal non-stationarity among their impacts on ICHE. Conclusion In this longitudinal study, we found spatiotemporal non-stationarity among the variable relationships, supporting regional governments’ adoption of regional-target policies. First, after the completion of universal health insurance coverage, the spatiotemporal non-stationarity of the prevalence of non-communicable diseases and disability and ageing should be the focus of the next phase of health insurance design, where improvements to compensation coverage and benefit packages are possible policy instruments. Second, the governance and causes of catastrophic health expenditure need to be laid out from a macro perspective rather than only from the individual/household perspective, especially for the potential impact of economic development, air pollution and nursing resources.https://doi.org/10.1186/s12877-022-03432-6Spatiotemporal non-stationarityCatastrophic health expenditureFinancial risk of diseaseRegional policyHealth insurance |
| spellingShingle | Xiyu Zhang Wenqing Miao Bing Wu Yongqiang Lai Mingli Jiao Qi Xia Chenxi Zhang Wanxin Tian Zhe Song Linghan Shan Lingqin Hu Xinhao Han Hui Yin Xiaonan Cheng Ye Li Baoguo Shi Qunhong Wu Factors that dynamically affect provincial incidences of catastrophic health expenditure among middle-aged and elderly Chinese population-transition of disease financial risk protection from global to local BMC Geriatrics Spatiotemporal non-stationarity Catastrophic health expenditure Financial risk of disease Regional policy Health insurance |
| title | Factors that dynamically affect provincial incidences of catastrophic health expenditure among middle-aged and elderly Chinese population-transition of disease financial risk protection from global to local |
| title_full | Factors that dynamically affect provincial incidences of catastrophic health expenditure among middle-aged and elderly Chinese population-transition of disease financial risk protection from global to local |
| title_fullStr | Factors that dynamically affect provincial incidences of catastrophic health expenditure among middle-aged and elderly Chinese population-transition of disease financial risk protection from global to local |
| title_full_unstemmed | Factors that dynamically affect provincial incidences of catastrophic health expenditure among middle-aged and elderly Chinese population-transition of disease financial risk protection from global to local |
| title_short | Factors that dynamically affect provincial incidences of catastrophic health expenditure among middle-aged and elderly Chinese population-transition of disease financial risk protection from global to local |
| title_sort | factors that dynamically affect provincial incidences of catastrophic health expenditure among middle aged and elderly chinese population transition of disease financial risk protection from global to local |
| topic | Spatiotemporal non-stationarity Catastrophic health expenditure Financial risk of disease Regional policy Health insurance |
| url | https://doi.org/10.1186/s12877-022-03432-6 |
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