title: Trends of out-of-pocket expenditure for influenza in China Health and Nutrition Survey during 1989-2006.
abstract: OBJECTIVE
  To examine the trends of out-of-pocket expenditure for influenza during 1989-2006 in China.
  
  
  METHODS
  Data were extracted from the China Health and Nutrition Survey (CHNS) during 1989-2006 (in seven waves). A fixed effect model with robust standard errors was employed to examine trends of out-of-pocket expenditure (adjusted to 2006 Chinese RMB).
  
  
  RESULTS
  The out-of-pocket expenditure increased from 11.92 RMB in 1989 to 50.75 RMB in 2006. The final sample for fixed effect model was 23,050 households. Income elasticity of out-of-pocket expenditure was 1.6%. Using 1989 as reference, the predicted increase was 242.23% [95% confidence interval (CI): 225.79-259.50%] in 2006; it was 143.54% in city hospitals [95% CI: 130.43-157.40%] compared to village clinics.
  
  
  CONCLUSIONS
  Adjusted for inflation and income elasticity, Chinese households experienced an increase of more than double the out-of-pocket expenditure during 1989-2006. The expenditure was higher in higher-level facilities. Policy implications include the government fixed-budget financing to health providers could contribute to the rapidly increased financial burden; a referral system should be rebuilt; private health providers may play an important role in containing healthcare price in China.
authors.affiliation: School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA.
authors.forename: Jinan
authors.initials: J
authors.lastname: Liu
authors.forename: Lizheng
authors.initials: L
authors.lastname: Shi
authors.forename: Mahmud
authors.initials: M
authors.lastname: Khan
authors.forename: Lingzhong
authors.initials: L
authors.lastname: Xu
authors.forename: Liya
authors.initials: L
authors.lastname: Wang
mesh_terms: D002681:China; D016001:Confidence Intervals; D005382:Financing, Personal / Q000639:trends*; D005102:Health Expenditures / Q000639:trends*; D006291:Health Policy; D006306:Health Surveys; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000191:economics*; D012189:Retrospective Studies