TY - JOUR
T1 - Health care utilization and affordability among older people following China's 2009 health reform - Evidence from CHARLS pilot study
AU - Li, Jiajia
AU - Shi, Leiyu
AU - Liang, Hailun
AU - Ma, Chao
AU - Xu, Lingzhong
AU - Qin, Wen
N1 - Funding Information:
This study was supported by the National Natural Science Foundation of China (71673170& 71673169), and Shandong University (IFYT18031).
Publisher Copyright:
© 2019 The Author(s).
PY - 2019/5/3
Y1 - 2019/5/3
N2 - Background: In 2009, China unveiled an ambitious national health care reform program, with the goal of providing equitable and affordable basic health care for everyone. This study was intended to partially fill the knowledge gap in understanding of the demand-side impact on health care utilization and affordability among older people in Zhejiang and Gansu provinces of China. Methods: We used two waves of data from the pilot survey of CHARLS implemented in 2008 and 2012. Chi-square tests and t tests were performed to examine whether out-of-pocket (OOP) and pharmaceutical spending (PS), as a share of total health expenditures (THEs), have significantly changed following the health reform. Two-part model was employed to confirm these changes after controlling for confounding variables. All analyses were weighted and clustered the standard errors. Results: After controlling for confounding variables, older people in 2012 were 2.1 and 6.8% more likely to use outpatient and inpatient care than they did in 2008, respectively. Among those who have at least one outpatient visit, declines of OOP-to- THEs and PS-to-THEs percentage significantly reduced 0.998 (p < 0.1) and 2.324 (p < 0.01) from 2008 to 2012, respectively. However, conditional on having at least one inpatient stay, no significant reduction in terms of the OOP-to-THEs and even increase in terms of the PS-to-THEs percentage observed between 2008 and 2012. Compared to elderly people in Gansu, Zhejiang aged people had obviously better utilization, lighter inpatient OOP burden and lower inpatient PS proportion, but higher outpatient OOP burden and PS proportion. Conclusions: Although the OOP burden and PS portion had been reduced following the health reform, these impacts were still limited. Better results can be observed in outpatient care than in inpatient care, which provide a strong foundation for the next stage of reform.
AB - Background: In 2009, China unveiled an ambitious national health care reform program, with the goal of providing equitable and affordable basic health care for everyone. This study was intended to partially fill the knowledge gap in understanding of the demand-side impact on health care utilization and affordability among older people in Zhejiang and Gansu provinces of China. Methods: We used two waves of data from the pilot survey of CHARLS implemented in 2008 and 2012. Chi-square tests and t tests were performed to examine whether out-of-pocket (OOP) and pharmaceutical spending (PS), as a share of total health expenditures (THEs), have significantly changed following the health reform. Two-part model was employed to confirm these changes after controlling for confounding variables. All analyses were weighted and clustered the standard errors. Results: After controlling for confounding variables, older people in 2012 were 2.1 and 6.8% more likely to use outpatient and inpatient care than they did in 2008, respectively. Among those who have at least one outpatient visit, declines of OOP-to- THEs and PS-to-THEs percentage significantly reduced 0.998 (p < 0.1) and 2.324 (p < 0.01) from 2008 to 2012, respectively. However, conditional on having at least one inpatient stay, no significant reduction in terms of the OOP-to-THEs and even increase in terms of the PS-to-THEs percentage observed between 2008 and 2012. Compared to elderly people in Gansu, Zhejiang aged people had obviously better utilization, lighter inpatient OOP burden and lower inpatient PS proportion, but higher outpatient OOP burden and PS proportion. Conclusions: Although the OOP burden and PS portion had been reduced following the health reform, these impacts were still limited. Better results can be observed in outpatient care than in inpatient care, which provide a strong foundation for the next stage of reform.
KW - China's health reform
KW - Inpatient
KW - Out-of-pocket
KW - Outpatient
KW - Pharmaceutical spending
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U2 - 10.1186/s12939-019-0969-3
DO - 10.1186/s12939-019-0969-3
M3 - Article
C2 - 31053074
AN - SCOPUS:85065225375
SN - 1475-9276
VL - 18
JO - International journal for equity in health
JF - International journal for equity in health
IS - 1
M1 - 62
ER -