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Medical expenditure and its inequity for people with disabilities: Evidence from the CHARLS 2018 data
Shengxuan Jin1, Ying Sun2, Jun Tao1
1Institute of Healthy Jiangsu Development, Nanjing Medical University, Nanjing, China.
Insights
Medical expenses for people with disabilities in China disproportionately affect wealthier individuals, driven by income and education. Targeted health policies are crucial to reduce these socioeconomic disparities.
Area of Science:
- Public Health
- Health Economics
- Gerontology
Background:
- Disabilities can lead to significant medical expenses and exacerbate socioeconomic inequalities.
- There is a lack of comprehensive data on these financial burdens among older Chinese populations.
- Understanding these disparities is crucial for developing equitable healthcare policies.
Purpose of the Study:
- To quantify socioeconomic inequalities in medical expenses among Chinese adults aged 45 and older.
- To identify key determinants contributing to these inequalities across different disability categories.
- To inform policy interventions aimed at reducing financial burdens for individuals with disabilities.
Main Methods:
- Utilized data from the 2018 China Health and Retirement Longitudinal Study (CHARLS).
- Categorized disabilities into five groups: physical, intellectual, vision, hearing, and multiple disabilities.
- Employed a two-part model, concentration index (CI), and horizontal inequity index (HI) for analysis, with decomposition to identify determinants.
Main Results:
- Medical expenses, particularly self-treatment costs, showed positive concentration indices, indicating concentration among higher socioeconomic groups.
- Vision and intellectual disabilities exhibited the highest concentration and inequity indices for various medical expense categories.
- Income, education level, and rural residency were identified as primary drivers of horizontal inequity in medical expenses.
Conclusions:
- Medical expenses for individuals with disabilities in China are concentrated among wealthier segments of the population.
- Socioeconomic factors like income, education, and rural living significantly contribute to these inequalities.
- There is a pressing need for health policies to enhance medical care affordability and mitigate expenditure inequities for disabled individuals.
Introduction:
Disabilities may raise heavy medical expenses and rich-poor inequalities. However, data is lacking for the Chinese older populations. This study aimed to measure socioeconomic inequalities in medical expenses amongst the Chinese adult 45 years or older, and explored the main determinants among different disability categories.
Method:
Data from the 2018 China Health and Retirement Longitudinal Study (CHARLS) were used. Disabilities were divided into five categories: physical disabilities, intellectual disability, vision problems, hearing problems, and multiple disabilities. The two-part model was employed to identify the factors that are associated with medical expenditures. Socioeconomic inequalities were measured by the concentration index (CI), and the horizontal inequity index (HI) which adjusts for health needs. Decomposition analysis was further applied to evaluate the contribution of each determinant.
Results:
Two thousand four hundred nineteen people were included in this study. The CIs and HIs of the expenditure were both positive. Amongst the varied types of medical expenses, the highest CIs were found for self-treatment expenses (0.0262). Amongst the five categories of disabilities, the group with vision problem disability reported the highest CIs and HIs for outpatient expenses (CI = 0.0843, HI = 0.0751), self-treatment expenses (CI = 0.0958, HI = 0.1119), and total expenses (CI = 0.0622, HI = 0.0541). The group of intellectual disability reported the highest CI and HI (CI = 0.0707, HI = 0.0625). The decomposition analysis showed that income (80.32%), education (25.14%) and living in the rural areas (13.96%) were the main determinants of medical expenses for HI amongst all types of disabilities.
Conclusion:
For five types of disabilities, our data shows that medical expenses concentrated in the richer groups in China. Income, education, and rural areas factors were the main contributors to the economic-related inequalities. Health policies to improve the affordability of medical care are needed to decrease inequity of medical expenditures for people with disabilities.
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