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What contributes to medical debt? Evidence from patients in rural China

Published version
Peer-reviewed

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Authors

Xin, Yanjiao 
Jiang, Junnan 
Chen, Shanquan 
Gong, Fangxu 
Xiang, Li 

Abstract

Abstract: Background: Rural households in developing countries usually have severe medical debt due to high out-of-pocket (OOP) payments, which contributes to bankruptcy. China implemented the critical illness insurance (CII) in 2012 to decrease patients’ medical expenditure. This paper aimed to explore the medical debt of rural Chinese patients and its influencing factors. Methods: A questionnaire survey of health expenditures and medical debt was conducted in two counties of Central and Western China in 2017. Patients who received CII were used as the sample on the basis of multi-stage stratified cluster sampling. Descriptive statistics and multivariate analysis of variance were used in all data. A two-part model was used to evaluate the occurrence and extent of medical debt. Results: A total of 826 rural patients with CII were surveyed. The percentages of patients incurring medical debt exceeded 50% and the median debt load was 20,000 Chinese yuan (CNY, 650 CNY = US$100). Financial assistance from kin (P < 0.001) decreased the likelihood of medical debt. High inpatient expenses (IEs, P < 0.01), CII reimbursement ratio (P < 0.001), and non-direct medical costs (P < 0.001) resulted in increased medical debt load. Conclusions: Medical debt is still one of the biggest problems in rural China. High IEs, CII reimbursement ratio, municipal or high-level hospitals were the risk determinants of medical debt load. Financial assistance from kin and household income were the protective factors. Increasing service capability of hospitals in counties could leave more patiemts in county-level and township hospitals. Improving CII with increased reimbursement rate may also be issues of concern.

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Keywords

Research Article, Utilization, expenditure, economics and financing systems, Rural China, Medical debt, Critical illness insurance, Social support, Two-part model

Journal Title

BMC Health Services Research

Conference Name

Journal ISSN

1472-6963

Volume Title

20

Publisher

BioMed Central
Sponsorship
National Natural Science Foundation of China (71573095)