title: Household catastrophic medical expenses in eastern China: determinants and policy implications.
abstract: BACKGROUND
  Much of research on household catastrophic medical expenses in China has focused on less developed areas and little is known about this problem in more developed areas. This study aimed to analyse the incidence and determinants of catastrophic medical expenses in eastern China.
  
  
  METHODS
  Data were obtained from a health care utilization and expense survey of 11,577 households conducted in eastern China in 2008. The incidence of household catastrophic medical expenses was calculated using the method introduced by the World Health Organization. A multi-level logistic regression model was used to identify the determinants.
  
  
  RESULTS
  The incidence of household catastrophic medical expenses in eastern China ranged from 9.24% to 24.79%. Incidence of household catastrophic medical expenses was lower if the head of household had a higher level of education, labor insurance coverage, while the incidence was higher if they lived in rural areas, had a family member with chronic diseases, had a child younger than 5 years old, had a person at home who was at least 65 years old, and had a household member who was hospitalized. Moreover, the impact of the economic level on catastrophic medical expenses was non-linear. The poorest group had a lower incidence than that of the second lowest income group and the group with the highest income had a higher incidence than that of the second highest income group. In addition, region was a significant determinant.
  
  
  CONCLUSIONS
  Reducing the incidence of household catastrophic medical expenses should be one of the priorities of health policy. It can be achieved by improving residents' health status to reduce avoidable health services such as hospitalization. It is also important to design more targeted health insurance in order to increase financial support for such vulnerable groups as the poor, chronically ill, children, and senior populations.
authors.forename: Xiaohong
authors.initials: X
authors.lastname: Li
authors.forename: Jay J
authors.initials: JJ
authors.lastname: Shen
authors.forename: Jun
authors.initials: J
authors.lastname: Lu
authors.forename: Ying
authors.initials: Y
authors.lastname: Wang
authors.forename: Mei
authors.initials: M
authors.lastname: Sun
authors.forename: Chengyue
authors.initials: C
authors.lastname: Li
authors.forename: Fengshui
authors.initials: F
authors.lastname: Chang
authors.affiliation: Research Institute of Health Development Strategies, School of Public Health, Fudan University, Shanghai, China. haomo03@fudan.edu.cn.
authors.forename: Mo
authors.initials: M
authors.lastname: Hao
mesh_terms: D002388:Catastrophic Illness / Q000191:economics* / Q000453:epidemiology; D002681:China / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000191:economics / Q000706:statistics & numerical data; D005191:Family Characteristics; D005382:Financing, Personal / Q000191:economics / Q000706:statistics & numerical data; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006291:Health Policy; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007182:Income / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires