Improvement of the reduction in catastrophic health expenditure in China’s public health insurance

<div><p>This study aimed to locate the contributing factors of Catastrophic Health Expenditure (CHE), evaluate their impacts, and try to propose strategies for reducing the possibilities of CHE in the context of China’s current public health insurance system. The financial data of all hospitalization cases from a sample hospital in 2013 were gathered and used to determine the pattern of household medical costs. A simulation model was constructed based on China’s current public health insurance system to evaluate the financial burden for medical service on Chinese patients, as well as to calculate the possibilities of CHE. Then, by adjusting several parameters, suggestions were made for China’s health insurance system in order to reduce CHE. It’s found with China’s current public health insurance system, the financial aid that a patient may receive depends on whether he is from an urban or rural area and whether he is employed. Due to the different insurance policies and the wide income gap between urban and rural areas, rural residents are much more financially vulnerable during health crisis. The possibility of CHE can be more than 50% for low-income rural families. The CHE ratio can be dramatically lowered by applying different policies for different household income groups. It’s concluded the financial burden for medical services of Chinese patients is quite large currently, especially for those from rural areas. By referencing different healthcare policies in the world, applying different health insurance policies for different income groups can dramatically reduce the possibility of CHE in China.</p></div

Funnel plot for publication bias in selection of studies on the <i>CTLA-4</i> −318 C/T polymorphism (CC+CT vs. TT).

<p>Funnel plot for publication bias in selection of studies on the <i>CTLA-4</i> −318 C/T polymorphism (CC+CT vs. TT).</p

Calculation of out-of-pocket cap based on five-level family income.

Calculation of out-of-pocket cap based on five-level family income.</p

Meta-analysis with a random-effects model for the association between asthma risk and the <i>CTLA-4</i> +49 A/G polymorphism (AA vs. AG+GG).

<p>Meta-analysis with a random-effects model for the association between asthma risk and the <i>CTLA-4</i> +49 A/G polymorphism (AA vs. AG+GG).</p

Meta-analysis with a random-effects model for the association between asthma risk and the <i>PAI-1</i> 4G/5G polymorphism (4G4G+4G5G vs. 5G5G).

<p>Meta-analysis with a random-effects model for the association between asthma risk and the <i>PAI-1</i> 4G/5G polymorphism (4G4G+4G5G vs. 5G5G).</p

Characteristics of the case-control studies included in meta-analysis.

*<p>Data for atopic or non-atopic asthma patients could be separately extracted.</p><p>ATS, American Thoracic Society; NHLBI, The National Heart, Lung, and Blood Institute; WHO, The World Health Organization; NIH, National Institutes of Health; SPT, skin prick test to common aeroallergens; RAST, radioallergosorbent test; PCR, polymerase chain reaction; RFLP, restriction fragment length polymorphism; TaqMan-ASA, TaqMan allele-specific amplification method; NA, not available.</p

Hospitalization expenses by department in the sample hospital in 2013.

<p>Hospitalization expenses by department in the sample hospital in 2013.</p

Distribution of CHE in different types of insurance.

<p>Distribution of CHE in different types of insurance.</p

BHI system components in China.

<p>BHI system components in China.</p

Meta-analysis with a random-effects model for the association between asthma risk and the <i>CTLA-4</i> −318 C/T polymorphism (CC+CT vs. TT).

<p>Meta-analysis with a random-effects model for the association between asthma risk and the <i>CTLA-4</i> −318 C/T polymorphism (CC+CT vs. TT).</p