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Published in: BMC Health Services Research 1/2021

Open Access 01-12-2021 | Research

Can health service equity alleviate the health expenditure poverty of Chinese patients? Evidence from the CFPS and China health statistics yearbook

Authors: Shaoliang Tang, Ling Yao, Chaoyu Ye, Zhengjun Li, Jing Yuan, Kean Tang, David Qian

Published in: BMC Health Services Research | Issue 1/2021

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Abstract

Objectives

To comprehend the relationship between various indicators of health service equity and patients’ health expenditure poverty in different regions of China, identify areas where equity in health service is lacking and provide ideas for improving patients’ health expenditure poverty.

Method

Data from China Family Panel Studies (CFPS) in 2018 and the HFGT index formula were used to calculate the health expenditure poverty index of each province. Moreover, Global Moran’s I and Local Moran’s I test are applied to measure whether there is spatial aggregation of health expenditure poverty. Finally, an elastic net regression model is established to analyze the impact of health service equity on health expenditure poverty, with the breadth of health expenditure poverty as the dependent variable and health service equity as the independent variable.

Results

In the developed eastern provinces of China, the breadth of health expenditure poverty is relatively low. There is a significant positive spatial agglomeration. “Primary medical and health institutions per 1,000 population”, “rural doctors and health workers per 1,000 population”, “beds in primary medical institutions per 1,000 population”, “proportion of government health expenditure” and “number of times to participate in medical insurance (be aided) per 1,000 population” have a positive impact on health expenditure poverty. “Number of health examinations per capita” and “total health expenditure per capita” have a negative impact on health expenditure poverty. Both effects passed the significance test.

Conclusion

To enhance the fairness of health resource allocation in China and to alleviate health expenditure poverty, China should rationally plan the allocation of health resources at the grassroots level, strengthen the implementation of hierarchical diagnosis and treatment and encourage the investment in business medical insurance industry. Meanwhile, it is necessary to increase the intensity of medical assistance and enrich financing methods. All medical expenses of the poorest should be covered by the government.
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Literature
1.
go back to reference Lei G. A probe into the equity in the health system of China [D]. Wu'han: Wuhan University; 2016. Lei G. A probe into the equity in the health system of China [D]. Wu'han: Wuhan University; 2016.
2.
go back to reference Liu X, Yu Z, Li XY, Liu S. Reviewing the progress on research of health services equity [J]. Chin Health Serv Manage. 2011;28(05):323–6. Liu X, Yu Z, Li XY, Liu S. Reviewing the progress on research of health services equity [J]. Chin Health Serv Manage. 2011;28(05):323–6.
3.
go back to reference Manderbacka Kristiina, Jutta Järvelin, Martti Arffman, et al. National and regional trends in equity within specialised health care in Finland in 2002–2010[J]. Scand J Public Health. 2015;43(5):514–7. Manderbacka Kristiina, Jutta Järvelin, Martti Arffman, et al. National and regional trends in equity within specialised health care in Finland in 2002–2010[J]. Scand J Public Health. 2015;43(5):514–7.
4.
go back to reference Lostao L, Blane D, Gimeno D, et al. Socioeconomic patterns in use of private and public health services in Spain and Britain: implications for equity in health care[J]. Health & Place. 2014;25:19–25. Lostao L, Blane D, Gimeno D, et al. Socioeconomic patterns in use of private and public health services in Spain and Britain: implications for equity in health care[J]. Health & Place. 2014;25:19–25.
5.
go back to reference Mangano A. An analysis of the regional differences in health care utilization in Italy[J].Health & Place. 2010;16(2):301–308. Mangano A. An analysis of the regional differences in health care utilization in Italy[J].Health & Place. 2010;16(2):301–308.
6.
go back to reference Monteiro CN, Beenackers MA, Goldbaum M, et al. Use, access, and equity in health care services in São Paulo, Brazil[J]. Cadernos de Saúde Pública. 2017;33(4):e00078015. Monteiro CN, Beenackers MA, Goldbaum M, et al. Use, access, and equity in health care services in São Paulo, Brazil[J]. Cadernos de Saúde Pública. 2017;33(4):e00078015.
7.
go back to reference Sarah Salway, Ghazala Mir, Daniel Turner, et al. Obstacles to “race equality” in the English National Health Service: Insights from the healthcare commissioning arena[J]. Social Science & Medicine.2016;152:102–110. Sarah Salway, Ghazala Mir, Daniel Turner, et al. Obstacles to “race equality” in the English National Health Service: Insights from the healthcare commissioning arena[J]. Social Science & Medicine.2016;152:102–110.
8.
go back to reference Reckers-Droog V, van Exel J, Brouwer W. Equity Weights for Priority Setting in Healthcare: Severity, Age, or Both?[J]. Value Health. 2019;22(12):1441–9. Reckers-Droog V, van Exel J, Brouwer W. Equity Weights for Priority Setting in Healthcare: Severity, Age, or Both?[J]. Value Health. 2019;22(12):1441–9.
9.
go back to reference Schafer D, Moten A. A paradigm shift in public health structures: creating sustainable systems to achieve global healthcare equity[J]. Antimicrob Resist Infec Control. 2015;4(S1):105. Schafer D, Moten A. A paradigm shift in public health structures: creating sustainable systems to achieve global healthcare equity[J]. Antimicrob Resist Infec Control. 2015;4(S1):105.
10.
go back to reference Burström B, Burström K, Nilsson G, et al. Equity aspects of the Primary Health Care Choice Reform in Sweden-a scoping review[J]. Int J Equity Health. 2017;16(1):29. Burström B, Burström K, Nilsson G, et al. Equity aspects of the Primary Health Care Choice Reform in Sweden-a scoping review[J]. Int J Equity Health. 2017;16(1):29.
11.
go back to reference Frenz P, Delgado I, Kaufman JS, et al. Achieving effective universal health coverage with equity: evidence from Chile[J]. Health Policy and Planning. 2014;29(6):717–31. Frenz P, Delgado I, Kaufman JS, et al. Achieving effective universal health coverage with equity: evidence from Chile[J]. Health Policy and Planning. 2014;29(6):717–31.
12.
go back to reference Puschel K, Furlan E, Dekkers W. Social Health Disparities in Clinical Care: A New Approach to Medical Fairness[J]. Pub Health Ethics. 2017;10(1):78–85. Puschel K, Furlan E, Dekkers W. Social Health Disparities in Clinical Care: A New Approach to Medical Fairness[J]. Pub Health Ethics. 2017;10(1):78–85.
13.
go back to reference Ustrup M, Ngwira B, Stockman LJ, et al. Potential barriers to healthcare in Malawi for under-five children with cough and fever: a national household survey[J]. J Health, Popul Nutr. 2014;32(1):68–78. Ustrup M, Ngwira B, Stockman LJ, et al. Potential barriers to healthcare in Malawi for under-five children with cough and fever: a national household survey[J]. J Health, Popul Nutr. 2014;32(1):68–78.
14.
go back to reference Ju MP. Equity in the utilization of physician and inpatient hospital services: evidence from Korean health panel survey[J]. Int J Equity in Health. 2016;15(1):159. Ju MP. Equity in the utilization of physician and inpatient hospital services: evidence from Korean health panel survey[J]. Int J Equity in Health. 2016;15(1):159.
15.
go back to reference Penning MJ, Zheng C. Income Inequities in Health Care Utilization among Adults Aged 50 and Older[J]. Canadian J Aging. 2016;35(1):55–69. Penning MJ, Zheng C. Income Inequities in Health Care Utilization among Adults Aged 50 and Older[J]. Canadian J Aging. 2016;35(1):55–69.
16.
go back to reference Zeng WJ. Research and vision about impartiality of health service in China[J]. Contemporpary Economic Management. 2012;28(05):535-538. Zeng WJ. Research and vision about impartiality of health service in China[J]. Contemporpary Economic Management. 2012;28(05):535-538.
17.
go back to reference Liburd LC, Hall JE, Mpofu JJ, et al. Addressing health equity in public health practice: frameworks, promising strategies, and measurement considerations[J]. Annu Rev Public Health. 2020;41:417–32. Liburd LC, Hall JE, Mpofu JJ, et al. Addressing health equity in public health practice: frameworks, promising strategies, and measurement considerations[J]. Annu Rev Public Health. 2020;41:417–32.
18.
go back to reference Sun X, Zhang H, Hu X, et al. Measurement and analysis of equity in health: a case study conducted in Zhejiang Province, China[J]. Int J Equity Health. 2018;17(1):36. Sun X, Zhang H, Hu X, et al. Measurement and analysis of equity in health: a case study conducted in Zhejiang Province, China[J]. Int J Equity Health. 2018;17(1):36.
19.
go back to reference Dover DC, Belon AP. The health equity measurement framework: a comprehensive model to measure social inequities in health[J]. Int J Equity Health. 2019;18(1):36. Dover DC, Belon AP. The health equity measurement framework: a comprehensive model to measure social inequities in health[J]. Int J Equity Health. 2019;18(1):36.
20.
go back to reference Towards a global monitoring system for implementing the Rio Political Declaration on Social Determinants of Health: developing a core set of indicators for government action on the social determinants of health to improve health equity[J]. BioMed Central. 2018;17(1):136. Towards a global monitoring system for implementing the Rio Political Declaration on Social Determinants of Health: developing a core set of indicators for government action on the social determinants of health to improve health equity[J]. BioMed Central. 2018;17(1):136.
21.
go back to reference Ye D, He Y, Ma L, Aixiang H. Study on the equity of rural health service in the experimental region of new rural cooperative medical scheme, Yuexi county, Anhui province [J]. Chin J Epidemiol. 2006;11:934–8. Ye D, He Y, Ma L, Aixiang H. Study on the equity of rural health service in the experimental region of new rural cooperative medical scheme, Yuexi county, Anhui province [J]. Chin J Epidemiol. 2006;11:934–8.
22.
go back to reference McCollum R, Taegtmeyer M, Otiso L, et al. Healthcare equity analysis: applying the Tanahashi model of health service coverage to community health systems following devolution in Kenya[J]. Int J Equity Health. 2019;18(1):65. McCollum R, Taegtmeyer M, Otiso L, et al. Healthcare equity analysis: applying the Tanahashi model of health service coverage to community health systems following devolution in Kenya[J]. Int J Equity Health. 2019;18(1):65.
23.
go back to reference Lang W, Radke JD, Chen T, et al. Will affordability policy transcend climate change? a new lens to re-examine equitable access to healthcare in the San Francisco Bay Area[J]. Cities. 2016;58:124–36. Lang W, Radke JD, Chen T, et al. Will affordability policy transcend climate change? a new lens to re-examine equitable access to healthcare in the San Francisco Bay Area[J]. Cities. 2016;58:124–36.
24.
go back to reference Rezapour A, Azar FE, Aghdash SA, et al. Inequity in household's capacity to pay and health payments inTehran-lran-2013[J]. Med J Islamic Repub Iran. 2014;29:245–5. Rezapour A, Azar FE, Aghdash SA, et al. Inequity in household's capacity to pay and health payments inTehran-lran-2013[J]. Med J Islamic Repub Iran. 2014;29:245–5.
25.
go back to reference Zhao Y, Oldenburg B, Mahal A, et al. Trends and socio-economic disparities in catastrophic health expenditure and health impoverishment in China: 2010 to 2016[J]. Trop Med Int Health. 2020;25(2):236–47. Zhao Y, Oldenburg B, Mahal A, et al. Trends and socio-economic disparities in catastrophic health expenditure and health impoverishment in China: 2010 to 2016[J]. Trop Med Int Health. 2020;25(2):236–47.
28.
go back to reference Xie J. Study on reimbursement effect of health insurance schemes for impatient families in rural China in the view of health expenditure poverty: based on the empirical analysis of M city, in Hubei province [D]. Wuhan: Wuhan University; 2018. Xie J. Study on reimbursement effect of health insurance schemes for impatient families in rural China in the view of health expenditure poverty: based on the empirical analysis of M city, in Hubei province [D]. Wuhan: Wuhan University; 2018.
29.
go back to reference Charlotte K, Claire H, Tracey F, et al. Are differences in travel time or distance to healthcare for adults in global north countries associated with an impact on health outcomes? a systematic review[J]. BMJ Open. 2016;6(11):e013059. Charlotte K, Claire H, Tracey F, et al. Are differences in travel time or distance to healthcare for adults in global north countries associated with an impact on health outcomes? a systematic review[J]. BMJ Open. 2016;6(11):e013059.
30.
go back to reference Tao Kong S, Wu Q. Chinese Family and Society Dynamics Using the China Family Panel Studies (CFPS) Household Panel[J]. Aust Econ Rev. 2019;52(1):127–33. Tao Kong S, Wu Q. Chinese Family and Society Dynamics Using the China Family Panel Studies (CFPS) Household Panel[J]. Aust Econ Rev. 2019;52(1):127–33.
31.
go back to reference Yu X, Hu J. An Introduction to the China Family Panel Studies (CFPS)[J]. Chinese Sociological Review. 2015;47(1):3–29. Yu X, Hu J. An Introduction to the China Family Panel Studies (CFPS)[J]. Chinese Sociological Review. 2015;47(1):3–29.
33.
34.
go back to reference Shorrocks B, Sevenster JG. Explaining Local Species Diversity [J]. Proceed Biol Sci. 1995;260(1359):305–9.CrossRef Shorrocks B, Sevenster JG. Explaining Local Species Diversity [J]. Proceed Biol Sci. 1995;260(1359):305–9.CrossRef
36.
go back to reference Sun W, Feng X, Bin X. Study on the poverty reduction effect of rural residents in China from the perspective of heterogeneity: a new decomposition method based on FGT poverty index [J]. Stat Res. 2020;37(09):44–55. Sun W, Feng X, Bin X. Study on the poverty reduction effect of rural residents in China from the perspective of heterogeneity: a new decomposition method based on FGT poverty index [J]. Stat Res. 2020;37(09):44–55.
37.
go back to reference Lu K. Poverty Indices: Construction and Re-construction [J]. Sociological Studies. 2007;(04):1–22+243. Lu K. Poverty Indices: Construction and Re-construction [J]. Sociological Studies. 2007;(04):1–22+243.
39.
go back to reference Yin F, Luo L. Education poverty measurement and simulation of China from 1982 to 2010 [J]. Northwest Popul J. 2013;34(01):30–5. Yin F, Luo L. Education poverty measurement and simulation of China from 1982 to 2010 [J]. Northwest Popul J. 2013;34(01):30–5.
40.
go back to reference Yuan J. Study on health services equity and the poverty of patients' health expenditure in different regions of China [D]. Nanjing: Nanjing University of Chinese Medicine; 2019. Yuan J. Study on health services equity and the poverty of patients' health expenditure in different regions of China [D]. Nanjing: Nanjing University of Chinese Medicine; 2019.
44.
go back to reference Tibshirani R. Regression shrinkage and selection via the lasso [J]. J R Stat Soc. 1996;58(1):267–88. Tibshirani R. Regression shrinkage and selection via the lasso [J]. J R Stat Soc. 1996;58(1):267–88.
45.
go back to reference Candes E, Tao T. The dantzig selector: statistical estimation when p is much larger than n [J]. Ann Stat. 2007;35(6):2313–51. Candes E, Tao T. The dantzig selector: statistical estimation when p is much larger than n [J]. Ann Stat. 2007;35(6):2313–51.
49.
go back to reference Xu Z, Chen J. Research on youth happiness and its influencing factors——An empirical analysis based on CGSS2015[J]. World Surv Res. 2019;12:27–33. Xu Z, Chen J. Research on youth happiness and its influencing factors——An empirical analysis based on CGSS2015[J]. World Surv Res. 2019;12:27–33.
50.
go back to reference Tobler WR. A Computer Movie Simulating Urban Growth in the Detroit Region [C]//International Geograph hical Union,Commission on Quantitative Methods. Economic Geography, vol. 46. America: Clark University; 1970. p. 234–40. Tobler WR. A Computer Movie Simulating Urban Growth in the Detroit Region [C]//International Geograph hical Union,Commission on Quantitative Methods. Economic Geography, vol. 46. America: Clark University; 1970. p. 234–40.
51.
go back to reference Sun Y, Gong H, Chen B, Zhou C, Chen W, Zhang X. Quantitative analysis of uneven subsidence by Moran's I and cross wavelet [J]. Remote Sensing Land Resources. 2020;32(02):186–95. Sun Y, Gong H, Chen B, Zhou C, Chen W, Zhang X. Quantitative analysis of uneven subsidence by Moran's I and cross wavelet [J]. Remote Sensing Land Resources. 2020;32(02):186–95.
52.
go back to reference Fang XU, Liu W. The determinations of Chinese urban residents health care expenditure: a Cointegration approach [J]. China Popul Resources Environ. 2014;24(S1):239–43. Fang XU, Liu W. The determinations of Chinese urban residents health care expenditure: a Cointegration approach [J]. China Popul Resources Environ. 2014;24(S1):239–43.
53.
go back to reference Zhang D, Atikur RKM. Government health expenditure, out-of-pocket payment and social inequality: A cross-national analysis of China and OECD countries[J]. Int J Health Plann Manage. 2020;35:1111-26. Zhang D, Atikur RKM. Government health expenditure, out-of-pocket payment and social inequality: A cross-national analysis of China and OECD countries[J]. Int J Health Plann Manage. 2020;35:1111-26.
54.
go back to reference Chen J, Han B. Empirical analysis on the resident's medical services expenditure in Jiangsu province [J]. Chinese J Health Policy. 2011;(9):57–66. Chen J, Han B. Empirical analysis on the resident's medical services expenditure in Jiangsu province [J]. Chinese J Health Policy. 2011;(9):57–66.
55.
go back to reference Mao J, Zhao J. The economic effect of government investment in public health: a rural consumption test [J]. Soc Sci China. 2017;10:70–89. Mao J, Zhao J. The economic effect of government investment in public health: a rural consumption test [J]. Soc Sci China. 2017;10:70–89.
56.
go back to reference Yin H, Lin M. Estimation of the medical assistance on the poor families : analysis based on the data of Chinese urban and rural poor families and social policy support system construction [J]. Soc Secur Stud. 2017;01:57–64. Yin H, Lin M. Estimation of the medical assistance on the poor families : analysis based on the data of Chinese urban and rural poor families and social policy support system construction [J]. Soc Secur Stud. 2017;01:57–64.
57.
go back to reference Zhang Z. The medical burden of urban and rural poor families and strategy advices for improving the medical assistance: based on the survey data from " the social policy support system project of urban and rural poor family" [J]. Soc Secur Stud. 2018;02:37–40. Zhang Z. The medical burden of urban and rural poor families and strategy advices for improving the medical assistance: based on the survey data from " the social policy support system project of urban and rural poor family" [J]. Soc Secur Stud. 2018;02:37–40.
58.
go back to reference Sun C. The institution dilemma and legislative path of medical assistance for major diseases in China [J]. Health Econ Res. 2020;37(12):12–6. Sun C. The institution dilemma and legislative path of medical assistance for major diseases in China [J]. Health Econ Res. 2020;37(12):12–6.
Metadata
Title
Can health service equity alleviate the health expenditure poverty of Chinese patients? Evidence from the CFPS and China health statistics yearbook
Authors
Shaoliang Tang
Ling Yao
Chaoyu Ye
Zhengjun Li
Jing Yuan
Kean Tang
David Qian
Publication date
01-12-2021
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2021
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-021-06675-y

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