title: Factors affecting catastrophic health expenditure and impoverishment from medical expenses in China: policy implications of universal health insurance.
abstract: OBJECTIVE
  To assess the degree to which the Chinese people are protected from catastrophic household expenditure and impoverishment from medical expenses and to explore the health system and structural factors influencing the first of these outcomes.
  
  
  METHODS
  Data were derived from the Fourth National Health Service Survey. An analysis of catastrophic health expenditure and impoverishment from medical expenses was undertaken with a sample of 55 556 households of different characteristics and located in rural and urban settings in different parts of the country. Logistic regression was used to identify the determinants of catastrophic health expenditure.
  
  
  RESULTS
  The rate of catastrophic health expenditure was 13.0%; that of impoverishment was 7.5%. Rates of catastrophic health expenditure were higher among households having members who were hospitalized, elderly, or chronically ill, as well as in households in rural or poorer regions. A combination of adverse factors increased the risk of catastrophic health expenditure. Families enrolled in the urban employee or resident insurance schemes had lower rates of catastrophic health expenditure than those enrolled in the new rural corporative scheme. The need for and use of health care, demographics, type of benefit package and type of provider payment method were the determinants of catastrophic health expenditure.
  
  
  CONCLUSIONS
  Although China has greatly expanded health insurance coverage, financial protection remains insufficient. Policy-makers should focus on designing improved insurance plans by expanding the benefit package, redesigning cost sharing arrangements and provider payment methods and developing more effective expenditure control strategies.
authors.affiliation: Harbin Medical University, 157 Baojian Road, Nangang District, Harbin, Heilongjiang, 150086, China.
authors.forename: Ye
authors.initials: Y
authors.lastname: Li
authors.forename: Qunhong
authors.initials: Q
authors.lastname: Wu
authors.forename: Ling
authors.initials: L
authors.lastname: Xu
authors.forename: David
authors.initials: D
authors.lastname: Legge
authors.forename: Yanhua
authors.initials: Y
authors.lastname: Hao
authors.forename: Lijun
authors.initials: L
authors.lastname: Gao
authors.forename: Ning
authors.initials: N
authors.lastname: Ning
authors.forename: Gang
authors.initials: G
authors.lastname: Wan
mesh_terms: D002681:China; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006291:Health Policy; D006301:Health Services Needs and Demand; D006801:Humans; D007354:Insurance, Major Medical / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011203:Poverty / Q000706:statistics & numerical data*; D012306:Risk; D012959:Socioeconomic Factors; D019472:Universal Health Insurance / Q000706:statistics & numerical data*