Bulletin of the World Health Organization

Factors affecting catastrophic health expenditure and impoverishment from medical expenses in China: policy implications of universal health insurance

Ye Li, Qunhong Wu, Ling Xu, David Legge, Yanhua Hao, Lijun Gao, Ning Ning & Gang Wan

Volume 90, Number 9, September 2012, 664-671

Table 4. Determinants of catastrophic health expenditure,a China, 2008

Determinant β SE Wald P OR (95% CI)
Gender of household head (male vs female) −0.147 0.035 17.278 < 0.0001 0.863 (0.805–0.925)
Educational level of head of household
None vs university or above 1.073 0.141 57.600 < 0.0001 2.924 (2.216–3.857)
Primary school vs university or above 0.806 0.139 33.745 < 0.0001 2.239 (1.706–2.939)
Junior high school vs university or above 0.488 0.138 12.467 < 0.0001 1.629 (1.242–2.135)
Senior high school vs university or above 0.385 0.143 7.251 0.007 1.469 (1.110–1.943)
Technical secondary school vs university or above 0.385 0.161 5.681 0.017 1.469 (1.071–2.016)
Junior college vs university or above −0.090 0.177 0.259 0.611 0.914 (0.646–1.292)
Employment status of head of household
Employed vs unemployed −0.567 0.040 206.000 < 0.0001 0.567 (0.525–0.613)
Retired vs unemployed −0.119 0.068 3.089 0.079 0.888 (0.778–1.014)
Student vs unemployed −0.805 0.376 4.595 0.032 0.447 (0.214–0.933)
Insurance status of head of household
MIUE vs none −0.365 0.075 23.937 < 0.0001 0.694 (0.600–0.804)
MIUR vs none −0.462 0.105 19.514 < 0.0001 0.630 (0.513–0.773)
NCMS vs none 0.012 0.057 0.044 0.834 1.012 (0.905–1.131)
Other vs none −0.080 0.194 0.171 0.679 0.923 (0.631–1.35)
Household having:
Member with chronic disease (yes vs no) 1.047 0.030 1247.289 < 0.0001 2.848 (2.687–3.018)
Hospitalized member (yes vs no) 1.525 0.032 2248.972 < 0.0001 4.597 (4.316–4.896)
Member with tuberculosis (yes vs no) 0.575 0.109 27.697 < 0.0001 1.778 (1.435–2.203)
No. of household members (≥ 5 vs ≤ 4) −0.728 0.034 448.930 < 0.0001 0.483 (0.451–0.516)
Members aged > 60 years (yes vs no) 0.627 0.033 367.713 < 0.0001 1.872 (1.755–1.995)
Five or more members (yes vs no) −0.211 0.064 10.925 0.001 0.810 (0.715–0.918)
Area
Rural vs urban 0.054 0.007 54.468 < 0.0001 1.055 (1.040–1.07)
Expenditure quintileb
Quintile 1 vs 5 0.306 0.052 34.728 < 0.0001 1.358 (1.227–1.504)
Quintile 2 vs 5 0.269 0.052 27.084 < 0.0001 1.309 (1.183–1.449)
Quintile 3 vs 5 0.141 0.051 7.567 0.006 1.151 (1.041–1.272)
Quintile 4 vs 5 0.006 0.049 0.015 0.903 1.006 (0.914–1.108)

CI, confidence interval; MIUE, Medical Insurance for Urban Employees; MIUR, Medical Insurance for Urban Residents; NCMS, New Cooperative Medical Scheme; OR, odds ratio; SE, standard error.

a Out-of-pocket payment divided by capacity to pay ≥ 40%.

b Quintile 1 is the poorest and quintile 5 the wealthiest.