Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Health Services Research
Published in: BMC Health Services Research 1/2019

Open Access 01-12-2019 | Research article

What has driven the spatial spillover of China’s out-of-pocket payments?

Authors: Ruijie Zhang, Jinghua Li, Xiaochun Du, Tianjiao Ma, Li Zhang, Qian Zhang, Fang Xia

Published in: BMC Health Services Research | Issue 1/2019

Login to get access

Abstract

Background

Even though China launched a series of measures to alleviate several financial burdens (including health insurance scheme, increased government investment, and so on), the economic burden of health expenditure has still not been alleviated. Out-of-pocket payments (OPPs) show not only a time correlation but also some degree of spatial correlation. The aims of the current study were thus to identify the spatial cluster of OPPs, to investigate the main factors affecting variation, and to explore the spatial spillover sources of China’s OPP.

Methods

Global and local spatial autocorrelation tests were validated to identify the spatial cluster of OPPs using the panel data of 31 provinces in China from 2005 to 2016. The Spatial Durbin Model, established in this paper, measured the spatial spillover effect of OPPs and analyzed the possible spillover sources (demand, supply, and socio-economic factors.

Results

OPPs were found to have a significant and positive spatial correlation. The results of the Spatial Durbin Model showed the direct and indirect effects of demand, supply, and socio- economic factors on China’s OPPs. Among the demand factors, the direct and indirect correlation (elasticity) coefficients were positive. Among the supply factors, the direct and indirect effects of the share of primary health beds on residents’ OPPs were negative. The ratio of health technicians in hospitals to those in primary health institutions on per capital OPPs had a significant indirect effect. Among the socio-economic factors, the direct effects of GDP, government health expenditure, and urbanization on OPPs were found to be positive. There were no significant indirect effects of socio-economic factors on OPPs.

Conclusion

This paper finds that China’s OPPs are not randomly distributed but, overall, present a positive spatial cluster, even though a series of measures have been launched to promote health equity. Socio-economic factors and those associated with demand were found to be the main influences of variation in OPPs, while demand was seen to be the driver of the positive spatial spillover of OPPs, whereby effective supply could inhibit these positive spillover effects.
Appendix
Available only for authorised users
Literature
1.
Dwivedi R, Pradhan J. Does equity in healthcare spending exist among Indian states? Explaining regional variations from national sample survey data. Int J Equity Health. 2017;16(1):15.PubMedPubMedCentralCrossRef
2.
Wagstaff A, Doorslaer EV: Chapter 34 Equity in health care finance and delivery: Elsevier B.V.; 2000.
3.
Buigut S, Ettarh R, Amendah DD. Catastrophic health expenditure and its determinants in Kenya slum communities. Int J Equity Health. 2015;14(1):1–12.CrossRef
4.
Long Q, Xu L, Bekedam H, Tang SL. Changes in health expenditures in China in 2000s: has the health system reform improved affordability. Int J Equity Health. 2013;12:8.CrossRef
5.
Dengfeng Wu FY, Nie W. Improvement of the reduction in catastrophic health expenditure in China’s public health insurance. PLoS One. 2018;13(4):e0194915.PubMedPubMedCentralCrossRef
6.
Pal R: Can insurance reduce catastrophic out-of-pocket health expenditure? Labor Economics Working Papers 2008.
7.
Ke X, Evans DB, Kei K, Riadh Z, Jan K, Murray CJL. Household catastrophic health expenditure: a multicountry analysis. Lancet. 2003;362(9378):111–7.CrossRef
8.
Zhang C, Zhou K, Yang S, Shao Z. Exploring the transformation and upgrading of China’s economy using electricity consumption data: a VAR–VEC based model. Physica A Statistical Mechanics & Its Applications. 2017;473:144–55.CrossRef
9.
Liu C, Hsu S, Huang Y-K. The determinants of health expenditures in Taiwan: modeling and forecasting using time series analysis. Journal of Statistics & Management Systems. 2010;13(3):515–34.CrossRef
10.
Rezaei S, Fallah R, Karyani AK, Daroudi R, Zandiyan H, Hajizadeh M. Determinants of healthcare expenditures in Iran: evidence from a time series analysis. Med J Islam Repub Iran. 2016;30(1):313.PubMedPubMedCentral
11.
Yang C, Cai W, Li Z, Fang Y. Disparities in out-of-pocket inpatient expenditures in rural Shaanxi Province, western China from 2011 to 2014: a time series analysis. Tropical Med Int Health. 2009;68(20):9.
12.
Mukherjee S, Haddad S, Narayana D. Social class related inequalities in household health expenditure and economic burden: evidence from Kerala, South India. Int J Equity Health. 2011;10(1):1.PubMedPubMedCentralCrossRef
13.
Griffith DA. Spatial econometrics: methods and models by L. Anselin: Springer Netherlands; 1988.
14.
Chen X, Shao S, Tian Z, Xie Z, Yin P. Impacts of air pollution and its spatial spillover effect on public health based on China's big data sample. J Clean Prod. 2017;142:915–25.CrossRef
15.
16.
Grassetti L, Rizzi L. The determinants of individual health care expenditures in the Italian region of Friuli Venezia Giulia: evidence from a hierarchical spatial model estimation. Empir Econ. 2018;4:1–23.
17.
Atella V, Belotti F, Depalo D, Mortari AP. Measuring spatial effects in the presence of institutional constraints: the case of Italian local health authority expenditure ☆. Social Science Electronic Publishing. 2014;49:232–41.
18.
Costafont J, Ponsnovell J. Public health expenditure and spatial interactions in a decentralized national health system. Health Econ. 2010;16(3):291–306.CrossRef
19.
Oyun G. Interstate spillovers, fiscal decentralization, and public spending on Medicaid home-and community-based services. Public Adm Rev. 2017;77(4):566–78.CrossRef
20.
Lippi BM, Mammi I. Spatial effects in hospital expenditures: a district level analysis. Health Econ. 2017;26:63–77.CrossRef
21.
Zhang AW, Nikoloski Z, Mossialos E. Does health insurance reduce out-of-pocket expenditure? Heterogeneity among China’s middle-aged and elderly. Soc Sci Med. 2017;190:11–9.PubMedCrossRef
22.
Ma S, Xu X, Trigo V, Ramalho NJ. Doctor-patient relationships (DPR) in China. J Health Organ Manag. 2017;31(1):110.PubMedCrossRef
23.
Bose S. Determinants of per capita state-level health expenditures in the United States: a spatial panel approach. Journal of Regional Analysis & Policy. 2015;45(1):93–107.
24.
Fabbri D, Robone S. The geography of hospital admission in a national health service with patient choice. Health Econ. 2010;19(9):1029–47.PubMedCrossRef
25.
26.
Zhu B, Fu Y, Liu JL, Mao Y. Modeling the dynamics and spillovers of the health labor market: evidence from China's provincial panel data. Sustainability. 2018;10(2):20.
27.
Fisher ES, Staiger DO, Bynum JP, Gottlieb DJ. Creating accountable care organizations: the extended hospital medical staff. Health Aff. 2007;26(1):w44.
28.
Lundberg J. On the definition of W in empirical models of yardstick competition. Ann Reg Sci. 2014;52(2):597–610.CrossRef
29.
Yu Y, Zhang L, Li F, Zheng X. Strategic interaction and the determinants of public health expenditures in China: a spatial panel perspective. Ann Reg Sci. 2013;50(1):203–21.CrossRef
30.
Que W, Zhang Y, Liu S. The spatial spillover effect of fiscal decentralization on local public provision: mathematical application and empirical estimation. Appl Math Comput. 2018;331:416–29.
31.
Song X, Wei Y, Deng W, Zhang S, Zhou P, Liu Y, Wan J. Spatio-Temporal Distribution, Spillover Effects and Influences of China’s Two Levels of Public Healthcare Resources. Int J Environ Res Public Health. 2019;16:4.
32.
Wang SK, Economics SO. Several types of weights matrix and their extended logic. J Quant Econ. 2013.
33.
Anselin L. Spatial externalities, spatial multipliers, and spatial econometrics. Int Reg Sci Rev. 2014;26(2):153–66.CrossRef
34.
35.
Chao FU, Liu YS. Coordinated development between land use change and population change in urbanizing China. Econ Geogr. 2013.
36.
Xie X, Liu P, Zheng Y, Zhou W, Zou J, Wang X, Wang L, Guo T, Ma X, He Y. Equity of health resource distribution in China during 2009–15: an analysis of cross-sectional nationwide data. Lancet. 2017;390:S6.CrossRef
37.
Si Y, Zhou Z, Min S, Meng M, Xu Y, Heitner J. Catastrophic healthcare expenditure and its inequality for households with hypertension: evidence from the rural areas of Shaanxi Province in China. Int J Equity Health. 2017;16(1):27.PubMedPubMedCentralCrossRef
38.
Xu Y, Ma J, Wu N, Fan X, Zhang T, Zhou Z, Gao J, Ren J, Chen G. Catastrophic health expenditure in households with chronic disease patients: A pre-post comparison of the New Health Care Reform in Shaanxi Province, China. PLoS One. 2018;13(3):e0194539.PubMedPubMedCentralCrossRef
39.
Barber SL, Michael B, Henk B, Jin M. The hospital of the future in China: China's reform of public hospitals and trends from industrialized countries. Health Policy Plan. 2014;29(3):367–78.CrossRefPubMed
40.
Orzol S, Keith R, Hossain M, Barna M, Peterson GG. The impact of a health information technology–focused patient-centered medical neighborhood program among Medicare beneficiaries in primary care practices: the effect on patient outcomes and spending. Med Care. 2018;56(4):299–307.PubMed
41.
Mohanty SK, Ladusingh L, Kastor A, Chauhan RK, Bloom DE. Pattern, growth and determinant of household health spending in India, 1993–2012. J Public Health. 2016;24(3):215–29.CrossRef
Metadata
Title
What has driven the spatial spillover of China’s out-of-pocket payments?
Authors
Ruijie Zhang
Jinghua Li
Xiaochun Du
Tianjiao Ma
Li Zhang
Qian Zhang
Fang Xia
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2019
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-019-4451-0

Other articles of this Issue 1/2019

BMC Health Services Research 1/2019 Go to the issue

Study protocol

Effectiveness of health care workers and peer engagement in promoting access to health services among population at higher risk for HIV in Tanzania (KPHEALTH): study protocol for a quasi experimental trial

Research article

Lessons from a training needs assessment to strengthen the capacity of routine immunization service providers in Nigeria

Research article

What is the long term impact of voucher scheme on primary care? Findings from a repeated cross sectional study using propensity score matching

Research article

Does a transition to accountable care in Medicaid shift the modality of colorectal cancer testing?

Research article

Type 2 diabetes and healthcare resource utilisation in the Kingdom of Bahrain

Research article

A quality indicator set for use in rehabilitation team care of people with rheumatic and musculoskeletal diseases; development and pilot testing