Strengthening financial protection through multitiered health coverage: evidence from 667 055 low-income households in China.

IF 6.1 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

BMJ Global Health Pub Date : 2025-09-10 DOI:10.1136/bmjgh-2025-019440

Guanping Liu, Zhongliang Zhou, Yangling Ren, Xiaohui Zhai, Yan Zhuang, Zhichao Wang, Ruifeng Cui

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引用次数: 0

Abstract

Introduction: Low-income households face disproportionate out-of-pocket hardship when accessing healthcare, undermining equity and universal health coverage. To address these challenges, China implemented a three-tiered health coverage system-basic medical insurance, catastrophic medical insurance and medical assistance-but its comprehensive impact on the financial protection remains underexplored.

Methods: We analysed Shaanxi Province's Medical Assistance database (2013-2016) to evaluate the impact of China's multitiered health coverage system on financial protection by: (1) estimating the incidence of catastrophic health expenditure (out-of-pocket payments> 25% of annual income) and medical impoverishment (postpayment income

Results: A total of 667 055 households were included. After reimbursement, the incidence of catastrophic health expenditure fell from 58.59% (95% CI: 58.47 to 58.70) to 17.89% (95% CI: 17.79 to 17.97) and medical impoverishment from 41.43% (95% CI: 41.30 to 41.54) to 13.47% (95% CI: 13.38 to 13.55), driven mainly by basic medical insurance and medical assistance. Rural households received larger absolute declines yet remained higher than urban counterparts. Financial protection inequity worsened: the Horizontal Inequity Index for catastrophic health expenditure shifted from -0.0890 (95% CI: -0.0902 to -0.0879) to -0.1717 (95% CI: -0.1746 to -0.1689) and for medical impoverishment from -0.2653 (95% CI: -0.2669 to -0.2640) to -0.5251 (95% CI: -0.5280 to -0.5222), a pattern observed in both urban and rural areas.

Conclusion: Our findings underscore the need for a three‑tiered health coverage system-including targeted, equitable reimbursement-to advance universal health coverage. Emerging tools such as big data analytics and artificial intelligence offer new ways to monitor and optimise equity; it is timely to extend equity considerations beyond funding mobilisation to reimbursement.

查看原文本刊更多论文

通过多层次健康保险加强财务保护：来自中国667055个低收入家庭的证据。

导言：低收入家庭在获得医疗保健服务时面临着不成比例的自付困难，损害了公平和全民健康覆盖。为了应对这些挑战，中国实施了三级医疗保险体系——基本医疗保险、巨灾医疗保险和医疗援助——但其对财务保障的综合影响仍未得到充分探索。方法：分析陕西省医疗救助数据库（2013-2016年），通过估算灾难性医疗支出（自费支出> 占年收入的25%）和医疗贫困（缴费后收入）的发生率，评估中国多层次医疗保险制度对财务保障的影响。报销后，灾难性医疗支出发生率从58.59% （95% CI: 58.47 ~ 58.70）下降到17.89% (95% CI: 17.79 ~ 17.97)，医疗贫困发生率从41.43% （95% CI: 41.30 ~ 41.54）下降到13.47% (95% CI: 13.38 ~ 13.55)，主要由基本医疗保险和医疗救助驱动。农村家庭的绝对降幅较大，但仍高于城市家庭。财务保护不平等恶化：灾难性卫生支出的横向不平等指数从-0.0890 （95% CI: -0.0902至-0.0879）变为-0.1717 (95% CI: -0.1746至-0.1689)，医疗贫困的横向不平等指数从-0.2653 （95% CI: -0.2669至-0.2640）变为-0.5251 (95% CI: -0.5280至-0.5222)，这一模式在城市和农村地区都可以观察到。结论：我们的研究结果强调了三级医疗保险体系的必要性，包括有针对性的、公平的报销，以推进全民医疗保险。大数据分析和人工智能等新兴工具为监测和优化股权提供了新途径；将公平考虑从资金调动扩大到偿还是及时的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

BMJ Global Health Medicine-Health Policy

CiteScore

11.40

自引率

4.90%

发文量

429

审稿时长

18 weeks

期刊介绍： BMJ Global Health is an online Open Access journal from BMJ that focuses on publishing high-quality peer-reviewed content pertinent to individuals engaged in global health, including policy makers, funders, researchers, clinicians, and frontline healthcare workers. The journal encompasses all facets of global health, with a special emphasis on submissions addressing underfunded areas such as non-communicable diseases (NCDs). It welcomes research across all study phases and designs, from study protocols to phase I trials to meta-analyses, including small or specialized studies. The journal also encourages opinionated discussions on controversial topics.