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2025 ; 24
(1
): 288
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Can supplementary private health insurance reduce vulnerability to expected
poverty and catastrophic health expenditure in China?
#MMPMID41131536
Dong S
; Ma J
; Yu Z
; Li P
; Sun J
; Li J
Int J Equity Health
2025[Oct]; 24
(1
): 288
PMID41131536
show ga
BACKGROUND: In China, where social health insurance (SHI) covers over 95% of the
population, supplementary private health insurance (SPHI) primarily addresses
high out-of-pocket (OOP) payments that remain after SHI reimbursements. In line
with the policy objective of alleviating the OOP burden, this study aims to
evaluate the impact of SPHI on vulnerability to expected poverty (VEP) and
catastrophic health expenditure (CHE). METHODS: A cross-sectional dataset
consisting of 25,568 samples was obtained from the 2023 National Health Service
Survey (Shandong). Three-stage feasible generalized least squares (FGLS) method
was employed to estimate VEP. CHE was measured by OOP healthcare payments that
equalled or exceeded 40% of a household's capacity to pay. To address potential
endogeneity issues, the county-level average participation rate of SPHI was used
as an instrumental variable (IV). The probit and IV Probit models were applied to
assess how SPHI affects VEP and CHE. RESULTS: Among respondents covered by SHI,
only 13.87% individuals purchased SPHI. Those with SPHI exhibited a 11.96% lower
likelihood of VEP and experienced 8.06% fewer instances of CHE compared to those
without SPHI. The two-stage least squares regression results indicated that SPHI
significantly reduces the likelihood of VEP (coefficient: -2.897, P?0.01) and
CHE (coefficient: -1.930, P?0.01). Additionally, SPHI provided greater welfare
benefits, particularly for older adults, rural residents, and individuals with
chronic diseases. CONCLUSION: The findings suggest that SPHI can significantly
contribute to poverty reduction, even among populations already covered by SHI.
Therefore, we recommend that other low- and middle-income countries, where SHI
serves as the primary insurance system as in China, consider implementing SPHI
for vulnerable groups to reduce illness-induced impoverishment.
|*Catastrophic Illness/economics
[MESH]
|*Health Expenditures/statistics & numerical data
[MESH]