An Analysis Of The Changes And Reasons For Catastrophic Health Expenditures Of Residents In Hunan Province In 2013 And 2018

Objectives:To evaluate the changes and reasons of catastrophic health expenditures among residents in Hunan Province in 2013 and 2018,providing scientific base for promoting the healthcare-system reform and improving health equity in Hunan Province.Methods:Using data from the two rounds health service surveys conducted in 2013 and 2018 in Hunan Province,China,we first analyzed the changes of catastrophic health expenditures by comparing the incidence of catastrophic health expenditures in 2013 and in 2018.Then,we explored the reasons for changes in catastrophic health expenditures by comparing medical expense per capita and non food expense per capita in 2013 and in 2018.Finally,we compared the indicators of health service utilization(including two-week visit rate and 12-month hospitalization rate)and medical expense related to the utilization of health services(including two-week indirect cost of medical visits,two-week self-purchasing drug costs,and direct cost of hospitalization)in 2013 and 2018.Chi-square test and t test were used for statistical comparison.All analyses were realized by the complex sampling calculation module in the statistical software SAS 9.4,and the test level was α=0.05.Results:There were 24,282 and 22,530 residents who completed face-to face interviews in 2013 and 2018,respectively.The incidence of catastrophic health expenditures among residents in Hunan Province increased from 11.71%(95%CI:8.00%-15.41%)to 30.77%(95%CI:25.31%-36.23%)between 2013 and 2018,OR=3.35(95%CI:2.28-4.92).By analyzing the reasons for the change in catastrophic health expenditures,we found that medical expense per capita increased more than non-food expense per capita from 2013 to 2018.The medical expense per capita was $ 1,058.5 in 2013,and ￥ 1,967.3 in 2018,which increased by 85.9%(P<0.05).The non-food expense per capita was ￥5,895.7 in 2013,and ￥8,408.3 in 2018,which increased by 42.6%(P<0.05).By further analyzing the reasons for the changes in medical expense,between 2013 and 2018,we found that the two-week visit rate increased from 7.81%(95%CI:5.43%-10.18%)to 18.63%(95%CI:16.30%-20.97%),OR=2.49(95%CI:1.44-4.32).The 12-month hospitalization rate increased from 8.92%(95%CI:6.75%-11.10%)to 15.54%(95%CI:12.78%-18.31%),OR=1.87(95%CI:1.38-2.54).The two-week indirect cost of medical visits increased from ￥642.6 to ￥ 1,841.5(P<0.05),and two-week self-purchasing drug costs increased from ￥2.7 to ￥240.1(P<0.05).The direct cost of hospitalization was ￥3,453.2 in 2013 and ￥3,430.6 in 2018,and the difference was not statistically significant.Conclusions:The incidence of catastrophic health expenditures increased significantly from 2013 to 2018 in Hunan Province,which was due to the fast growth of medical expense.The fast growth of medical expense was not only related to the increase in the utilization rate of health services,but also related to the fast growth of two-week indirect cost of medical visits and two-week self-purchasing drug costs.Interventions should be taken by the government to curb the rapid growth of medical expense and reduce the risk of catastrophic health expenditures among residents in Hunan province.