The Current Status And Influencing Factors Of Catastrophic Health Expenditure In Diabetic Patients Among Urban And Rural Residents: A Study In Shandong, China

BackgroundDiabetes Mellitus is one of the most serious and critical public health problem in China and the World,not only seriously affect the health of diabetic patients, but also bring a very heavy burden to the diabetic patients, families and society.Compared with non-diabetic patients, diabetic patients in low- and middle-income countries have higher out-of-pocket expenses and higher likelihood of incurring catastrophic health expenditure.Therefore, this article analyzes the current status and influential factors of catastrophic health expenditure in diabetic patients among urban and rural residents in Shandong Province, and thus avoid the economic risk of disease, reduce the incidence of catastrophic health expenditure due to Diabetes Mellitus and improve the fairness of health care.ObjectivesDescribe the current status of catastrophic health expenditure in diabetic patients among urban and rural residents in Shandong Province, analyze the influential factors of catastrophic health expenditure,assess the impact of different forms of health care on catastrophic health expenditure in diabetic patients, and adopt targeted policy to reduce the incidence of catastrophic health expenditure due to Diabetes Mellitus and improve the fairness of health care.Data resource and methodThe data of this study comes from field survey.A multi-stage stratified cluster sampling method was used.First,four rural counties and two urban districts were randomly selected from all the county(city?district) of Shandong province. Second,Township(street) in each selected county(city?district) were stratified into three levels according to their per capital GDP.From each ,and one township(street) were randomly selected from each level.Finally,we randomly selected selected two communities and two villages from each selected township(street) .In all, 12 communities and 24 villages were selected.All of the diabetic patients in each sample community/village were recruited for participation in our study.A total of 2223 diabetic patients were recruited,of which 2183 diabetes mellitus patients with complete data were included in the analysis.In this survey,the DM patients were interviewed face-to-face in the local with questionnaire,which include diabetic patients' demographic information(gender?age?education level?location?health insurance status?household expenditure and so on),diabetic patients'health behaviors (smoking?drinking?exercise behavior and so on) and diabetic patients'outpatient and inpatient health service utilization conditions. In our study ,the incidence of catastrophic health expenditure is calculated based on when OOP payments for diabetic care share of capacity to pay is exceed the threshold of 20%?30%?40%?50%?60%.In this study,Sensitivity analysis of the incidence and intensity of CHE for DM was applied using different thresholds across different household income groups.Chi-square tests were used to identify factors associated with CHE. Multivariate logistic regression was employed to assess the effects of explanatory analysis variables.ResultsThe incidence of catastrophic health expenditure in diabetic patients is 13.7%;At 20%,30%,50%,60% of the threshold,the incidence is 28.4%?19.1%?10.0%?7.9%respectively. According to the univariate analysis results, the influential factor of catastrophic health expenditure are the gender, age, marital status, insurance type,family size, and the total income of the diabetic patients, drinking behavior , exercise behavior, self-induced health status, physical examination condition, with or without diabetic complications, whether due to diabetes mellitus and its complications using outpatient, inpatient service. From the results of multivariate logistic regression analysis, we can see that the influential factors of catastrophic health expenditure are age,marital status ,total household income, physical examination condition, with or without diabetic complications, whether due to diabetes mellitus and its complications using outpatient, inpatient service .Diabetic patients who are older were more likely to incur catastrophic health expenditure; diabetic patients with single status are more likely to incur catastrophic health expenditure than diabetics in married states; the higher the total family income, the smaller the possibility of incurring catastrophic health expenditure; patients who had not undergone routine physical examination were more likely to incur catastrophic health expenditures than those who underwent routine physical examination; diabetic patients with diabetic complications are more likely to incur catastrophic health expenditures than those without complications;diabetic patients due to diabetes and its complications use outpatient and inpatient service are more likely to incur catastrophic health expenditures than did not use outpatient and inpatient service in the previous year .In the form of medical insurance,medical insurance for urban and rural residents and medical insurance system for urban workers and medical workers, to a certain extent, reduce the incidence and the gap of catastrophic health expenditure of Diabetic patients.Conclusions and recommendationsThe incidence of catastrophic health expenditure in diabetes mellitus patients among urban and rural residents in Shandong province is more serious,and the occurrence of catastrophic health expenditure in diabetic patients has low income tendency. The medical insurance system for urban and rural residents and the medical insurance system for urban workers have reduced the incidence and disparity of catastrophic health expenditure in diabetic patients in a certain extent. However, the compensation effect of medical insurance system for urban workers is better than The medical insurance system for urban and rural residents .we can see the influential factors of catastrophic health expenditure in diabetic patients are age, marital status ,total household income, physical examination condition, with or without diabetic complications,whether due to diabetes mellitus and its complications using outpatient, inpatient service.The government should give priority to low-income people, and strive for low-income people to provide a variety of employment opportunities to improve the income level; The government should strengthen the popularization of diabetes-related knowledge and help the high-risk groups to understand the importance of regular health examination. The government should appropriately expand the proportion of reimbursement of new rural cooperative medical system and Medical insurance for urban residents, raise the financing level of medical insurance,reduce the deductible and improve the cap line of medical insurance reimbursement;establish diabetes special outpatient and serious illness hospital medical insurance.