Health poverty reduction effect of medical insurance in China’s middle-aged and elderly populations: a cross-sectional study

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OBJECTIVES: In the context of demographic structure and disease spectrum changes: to study the role of the medical insurance system in providing protection and risk resilience for middle-aged and elderly vulnerable groups who are prone to impoverishment by medical expenses (IME), identify the vulnerable points and propose recommendations for improving the medical insurance system. SETTING: The research used data from the 2018 China Health and Retirement Longitudinal Study. PARTICIPANTS: 9184 households were included in the research ultimately. PRIMARY AND SECONDARY OUTCOME MEASURES: We use the WHO's recommended composite measure of disease-related poverty and algorithm to determine the occurrence of IME in households. Instrumental variable probit regression model was used to target the characteristics of vulnerable groups and the influencing factors with strong correlation with IME. RESULTS: The overall incidence of IME is 8.25% and the high incidence is concentrated in rural populations (9.79%). The risk of IME from stroke (13.17%) has been higher than cancer (7.38%). The incidence of IME is higher in families with five types of non-communicable diseases enrolled in Urban-Rural Integrated Medical Insurance (URRMI) (min 10.00%-max 14.29%) and New Rural Cooperative Medical Insurance Scheme (NRCMS) (min 8.97%-max 15.24%) health insurance than the overall IME incidence (8.25%). CONCLUSIONS: The medical insurance system has achieved the inclusive economic protection function for most people, but the risk resistance function for the middle-aged and older adults with multiple vulnerabilities still needs to be strengthened.,the.Finally, to address the benefit gap of the NRCMS, the next stage of medical insurance development should focus on improving the top-level design of the reimbursement framework for urban and rural resident medical insurance.

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