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Effect of household and village characteristics on financial catastrophe and impoverishment due to health care spending in Western and Central Rural China: A multilevel analysis

机译：中西部农村居民家庭特征对医疗卫生支出造成的金融灾难和贫困的影响：多层次分析

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Objective: The study aimed to examine the effect of household and community characteristics on financial catastrophe and impoverishment due to health payment in Western and Central Rural China.Methods: A household survey was conducted in 2008 in Hebei and Shaanxi provinces and the Inner Mongolia Autonomous Region using a multi-stage sampling technique. Independent variables included village characteristics, household income, chronic illness status, health care use and health spending. A composite contextual variable, named village deprivation, was derived from socio-economic status and availability of health care facilities in each village using factor analysis. Dependent variables were whether household health payment was more than 40% of household’s capacity to pay (catastrophic health payment) and whether household per capita income was put under Chinese national poverty line (1067 Yuan income per year) after health spending (impoverishment). Mixed effects logistic regression was used to assess the effect of the independent variables on the two outcomes.Results: Households with low per capita income, having elderly, hospitalized or chronically ill members, and whose head was unemployed were more likely to incur financial catastrophe and impoverishment due to health expenditure. Both catastrophic and impoverishing health payments increased with increased village deprivation. However, the presence of a village health clinic had no effect on the two outcomes, nor did household enrollment in the New Rural Cooperative Medical Scheme (national health insurance).Conclusions: Village deprivation independently increases the risk for financial hardship due to health payment after adjusting for known household-level factors. This suggests that policy makers need to view the individual, household and village as separate units for policy targeting.
机译：目的：本研究旨在探讨家庭和社区特征对中国中西部农村地区因医疗费用支付造成的金融灾难和贫困的影响。方法：2008年在河北，陕西和内蒙古自治区进行了一项家庭调查使用多阶段采样技术。自变量包括村庄特征，家庭收入，慢性病状况，医疗保健使用和医疗保健支出。使用因子分析从每个村庄的社会经济地位和医疗设施的可用性中得出一个综合的上下文变量，称为村庄剥夺。相关变量包括家庭健康支出是否超过家庭支付能力（灾难性健康支出）的40％，以及在健康支出（贫困）之后，家庭人均收入是否被置于中国国家贫困线（每年1067元人民币）以下。结果：低收入家庭，人均年长，住院或长期病患者，失业的家庭，人均收入较低的家庭更有可能发生金融灾难，由于卫生支出而造成的贫困。随着村庄被剥夺的增加，灾难性和贫困的医疗费用都增加了。但是，村卫生所的存在对这两个结果都没有影响，新农村合作医疗计划（国家健康保险）的家庭入学也没有影响。结论：村庄被剥夺独立地增加了因支付健康费用后出现财务困难的风险根据已知的家庭因素进行调整。这表明政策制定者需要将个人，家庭和村庄视为政策目标的单独单元。

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