TY - JOUR
T1 - Public expenditure on health care and the incidence of non-communicable diseases (NCDs) in China from 2008 to 2018
AU - Feng, Zhixin
AU - Liu, Xiaoting
AU - Yang, Wei
AU - Phillips, David R.
N1 - Funding Information:
This research was supported by the WUN Research Development Fund, National Natural Science Foundation of China (71490733), and Zhejiang Social Science Foundation (19YSXK02ZD).
Funding Information:
Since 1978, the whole health insurance landscape in China has been reshaped by significant changes. Only the civil servants remained fully financed by the public budget from central and local governments, whereas urban workers were introduced to the Urban Employee Basic Medical Insurance (UEBMI) initiated in 1998, jointly funded by employers (6 % of gross payroll) and employees (at 2 % of their salary) [ 13 ]. For rural residents, the New Cooperative Medical System (NCMS) was launched in 2003, funded by government subsidies (2/3 of premium) and participants' household (1/3 of premium), and saw its coverage increase from 12.6 % in 2003 to 92.5 % in 2008. Urban non-employed persons, such as students, children, and older adults not involved in formal employment (such as the self-employed) before their retirement were not covered by any SHI until 2009.
Publisher Copyright:
© 2024 Elsevier B.V.
PY - 2024/5
Y1 - 2024/5
N2 - Objectives: This study investigates whether differences in individual-level and provincial-level health funding could explain or mitigate health inequalities among older people in terms of non-communicable diseases within a population served by fragmented health insurance schemes. Study design: A national repeated cross-sectional analysis was done of the 2008, 2011, 2014, and 2018 Chinese Longitudinal Healthy Longevity Surveys. These provided a total of 44,623 persons aged 60 and over. Main outcome measures: Respondents were asked whether they had been diagnosed with any types of non-communicable diseases by doctors. A dichotomous outcome variable was constructed to indicate whether older people had any diagnosed non-communicable diseases. Results: Compared with uninsured older persons, those who were enrolled in social health insurance schemes designed for civil servants as cadres, urban employees and urban residents were more likely to report a higher incidence of non-communicable diseases. There were no significant differences in the prevalence of non-communicable diseases between uninsured older people and those in the New Rural Cooperative Medical Scheme. Although the incidence of non-communicable diseases among older persons increased over the study period, greater health expenditure was significantly associated with a lower risk of non-communicable diseases. The interaction results between individual social health insurance schemes and public health expenditure indicate that disparities in the incidence of non-communicable diseases among different health insurance schemes diminish as public health expenditure increases. Older individuals with Public Free Medical Services benefited the most in provinces with higher public health expenditure compared with other health insurance schemes. Conclusions: Given the evidence of the beneficial effects of universal health coverage on non-communicable diseases among older persons, these results should encourage policy makers to increase public health funding and to raise the overall benefit packages for social health insurance schemes.
AB - Objectives: This study investigates whether differences in individual-level and provincial-level health funding could explain or mitigate health inequalities among older people in terms of non-communicable diseases within a population served by fragmented health insurance schemes. Study design: A national repeated cross-sectional analysis was done of the 2008, 2011, 2014, and 2018 Chinese Longitudinal Healthy Longevity Surveys. These provided a total of 44,623 persons aged 60 and over. Main outcome measures: Respondents were asked whether they had been diagnosed with any types of non-communicable diseases by doctors. A dichotomous outcome variable was constructed to indicate whether older people had any diagnosed non-communicable diseases. Results: Compared with uninsured older persons, those who were enrolled in social health insurance schemes designed for civil servants as cadres, urban employees and urban residents were more likely to report a higher incidence of non-communicable diseases. There were no significant differences in the prevalence of non-communicable diseases between uninsured older people and those in the New Rural Cooperative Medical Scheme. Although the incidence of non-communicable diseases among older persons increased over the study period, greater health expenditure was significantly associated with a lower risk of non-communicable diseases. The interaction results between individual social health insurance schemes and public health expenditure indicate that disparities in the incidence of non-communicable diseases among different health insurance schemes diminish as public health expenditure increases. Older individuals with Public Free Medical Services benefited the most in provinces with higher public health expenditure compared with other health insurance schemes. Conclusions: Given the evidence of the beneficial effects of universal health coverage on non-communicable diseases among older persons, these results should encourage policy makers to increase public health funding and to raise the overall benefit packages for social health insurance schemes.
KW - Non-communicable diseases
KW - Public expenditure on health care
KW - Social health insurance
KW - Universal health coverage
UR - http://www.scopus.com/inward/record.url?scp=85187522517&partnerID=8YFLogxK
U2 - 10.1016/j.maturitas.2024.107963
DO - 10.1016/j.maturitas.2024.107963
M3 - Article
C2 - 38471332
AN - SCOPUS:85187522517
SN - 0378-5122
VL - 183
JO - Maturitas
JF - Maturitas
M1 - 107963
ER -
