Does the critical illness insurance reduce patients’ financial burden and benefit the poor more: a comprehensive evaluation in rural area of China

Figures & data

Table 1. Patient characteristics before and after intervention (%).

	Baseline (n = 613)	Final (n = 834)
Variables	n (%)	n (%)	P value
Gender
Male	320 (52.2)	439 (52.6)	0.870^a
Female	293 (47.8)	395 (47.4)
Age
≤17	63 (10.3)	63 (7.6)	0.189^a
18–64	427 (69.7)	595 (71.3)
≥65	123 (20.0)	176 (21.1)
Marriage
Married	480 (78.3)	657 (78.8)	0.828^a
Others^d	133 (21.7)	177 (21.2)
Education level
None	130 (21.2)	192 (23.0)	0.687^a
Primary	244 (39.8)	309 (37.1)
Secondary	188 (30.7)	257 (30.8)
High school and above	51 (8.3)	76 (9.1)
Family member
≤2	163 (26.6)	242 (29.0)	0.537^a
3–5	355 (57.9)	460 (55.2)
≥6	95 (15.5)	132 (15.8)
Employment
Currently working	282 (46.0)	233 (27.9)	<0.001^a
Others^e	331 (54.0)	601 (72.1)
Income
Income	53,219.5 (53,120.5)^c	31,986.4 (39,363.8)	<0.001^b
Hospital level
In county	258 (42.1)	214 (25.7)	<0.001^a
Out county	355 (57.9)	620 (74.3)
Illness category
Acute illness	133 (21.7)	188 (22.5)	0.702^a
Chronic illness	480 (78.3)	646 (77.5)
Area
Xiantao	270 (44.0)	434 (52.0)	0.003^a
Yuqing	343 (56.0)	400 (48.0)

^a Chi-square tests.

^b Rank sum test.

^c Exchange rate = RMB 650 = US$100 at the end of 2017.

^d Others includes unmarried, divorced, and widowed.

^e Others includes unemployed, school students, and retired.

Table 2. Patients financial burden at baseline and final evaluation (by income group).

	Baseline	Final
Income level	Mean (SD)	Mean (SD)	Change	p-value
OOP(RMB)
Low	44,507.6 (44,507.5)	29,214.2 (22,345.4)	−15,293.4	<0.001^a
Middle	38,594.0 (27,424.9)	29,385.0 (27,783.9)	−9,209.0	<0.001^a
High	35,780.6 (29,182.0)	25,784.6 (16,324.5)	−9,996.0	<0.001^a
Total	39,363.2 (33,013.1)	28,426.1 (24,021.5)	−10,937.1	<0.001^a
OOP/Income (%)
Low	2,292.6 (13,811.1)	1,106.5 (1,350.5)	−1,186.1	0.275^a
Middle	103.3 (90.6)	164.6 (201.9)	61.3	<0.001^a
High	36.4 (38.1)	40.8 (32.0)	4.4	0.052^a
Total	582.7 (6625.4)	322.5 (741.1)	−260.2	0.019^a
CHE incidence (%)
Low	1 (0)	1 (0)	0	–
Middle	1 (0)	97.6 (15.4)	−2.4	0.006^b
High	90.9 (28.8)	90.5 (29.4)	−0.4	0.900^c
Total	97.7 (15.0)	96.4 (18.6)	−1.3	0.020^b
Average gap of CHE
Low	22.8 (138.1)	11.0 (13.5)	−11.8	0.275^a
Middle	0.9 (0.9)	1.6 (2.0)	0.7	<0.001^a
High	0.3 (0.4)	0.3 (0.3)	0	0.050^a
Total	5.7 (66.3)	3.1 (7.4)	−2.6	0.018^a
Relative gap of CHE
Low	22.8 (138.1)	11.0 (13.5)	−11.8	0.275^a
Middle	0.9 (0.9)	1.6 (2.0)	0.7	<0.001^a
High	0.3 (0.4)	0.3 (0.3)	0	0.019^a
Total	5.9 (67.0)	3.3 (7.5)	−2.6	0.003^a

Income was divided in three levels: min–Q25 was low income level, Q25–Q75 means middle income level; and Q75–max was high income level. Q means quantile.

^a Rank sum test.

^b Fisher’s exact probability.

^c Chi-square tests.

Table 3. Medical debt rate and amount at baseline and final evaluation (by income group).

	Baseline	Final
Income level	Mean (SD)	Mean (SD)	Change	p-value
Debt rate
Low	64.7 (47.9)	64.9 (47.8)	0.2	0.969^a
Middle	69.6 (46.1)	72.3 (44.8)	2.7	0.432^a
High	47.4 (50.1)	66.7 (47.3)	19.3	<0.001^a
Total	62.8 (48.4)	69.1 (46.3)	6.3	<0.001^a
Debt value
Low	48,883.6 (58,477.2)	41,146.0 (60,625.5)	−7,737.6	0.194^b
Middle	43,532.7 (53,443.7)	37,083.9 (46,985.0)	−6,448.8	0.504^b
High	38,583.2 (59,410.1)	30,463.3 (43,333.4)	−8,119.9	0.756^b
Total	43,624.8 (56,289.1)	36,415.4 (49,965.5)	−7,209.4	0.192^b

^a Chi-square test.

^b Rank sum test.

Table 4. Inpatient service utilization at baseline and final evaluation (by income group).

	Health service utilization, mean (SD)
Income level	Baseline	Second-line	Change	p-value
Frequency of hospital admissions
Low	2.8 (3.4)	4.6 (5.6)	1.8	0.001^a
Middle	2.5 (1.8)	5.1 (7.9)	2.6	<0.001^a
High	2.5 (2.1)	3.7 (5.3)	1.2	0.012^a
Total	2.6 (2.4)	4.6 (6.8)	2	<0.001^a
Length of stay (days)
Low	37.9 (48.8)	52.5 (70.6)	14.6	0.026^a
Middle	32.5 (35.9)	51.9 (68.4)	19.4	<0.001^a
High	29.2 (29.3)	41.0 (57.1)	11.8	0.020^a
Total	33.0 (38.2)	49.3 (66.5)	16.3	<0.001^a
Underuse of inpatient services (%)
Low	20.9 (40.8)	19.9 (40.0)	−1	0.778^b
Middle	16.7 (37.3)	15.6 (36.3)	−1.1	0.717^b
High	10.4 (30.6)	8.5 (28.1)	−1.9	0.546^b
Total	16.2 (36.8)	14.9 (35.6)	−1.3	0.445^b

^a t-test.

^b Chi-square tests.

Table 5. Concentration Index of indicators before and after the intervention.

	Baseline	Final	Change
OOP (RMB)	−0.045	−0.035	0.010
OOP/Income (%)	−0.843	−0.650	0.193
CHE incidence (%)	−0.022	−0.024	−0.002
Average gap	−0.858	−0.670	0.188
Relative gap	−0.854	−0.659	0.195
Debt rate	−0.053	0.006	0.059
Debt value	−0.038	−0.064	−0.026
Frequency of hospital admissions	−0.009	−0.031	−0.022
Length of stay (days)	−0.041	−0.035	0.006
Underuse of inpatient services (%)	−0.128	−0.138	−0.01

Table 6. The linear regression of log out-of-pocket and logit regression of CHE and debt incidence with random effect analysis upon area.

	OOP	CHE	Debt rate
	Coefficient	Coefficient	Coefficient
CII	−0.558***	−1.609***	−0.088
Gender
Female	0.034	0.365	0.073
Age
18–64	0.001	−1.548	0.670*
≥65	0.101	−1.371	−0.390
Marriage
Married	−0.056	−0.731	−0.076
Education level
Primary	0.137**	0.019	0.187
Secondary	0.136*	0.270	0.297
High school and above	0.056	−0.029	0.067
Family member
3–5	−0.004	−0.632	1.137***
≥6	−0.087	−0.386	1.335***
Employment
Currently working	−0.008	0.097	−0.404
Income
Middle	−0.049	−14.836	−0.081
High	−0.056	−16.919	−0.897***
Length of stay (LOS)	0.001**	0.001	0.001
Impatient frequency
2–4	0.152***	0.282	0.270
≥5	0.237***	1.547*	0.622**
Hospital level
Out of county	0.510***	1.210**	0.307*
Illness category
Chronic illness	−0.185***	−1.173*	−0.072
Cons	10.281	23.726	−0.773

*p < 0.05, **p < 0.01, ***p < 0.001.

Figure 1. Out-of-pocket payments at baseline and final evaluation (by CII durations).