Association Between Major Non-communicable Diseases, Healthcare Use, Financial Burden and Socioeconomic Factors in China: A Cross-Sectional Study

Abstract

Background Four major noncommunicable diseases (NCDs)—cardiovascular diseases (CVD), diabetes, chronic respiratory diseases, and cancer—have become the leading causes of disability-adjusted life-years in China. Curbing these diseases is critical in the Healthy China 2030 plan, a national health promotion strategy. A key question is whether the plan will expand service capacity for people with NCDs, and also reduce the financial burden that people in China suffer in paying for those services. In order to inform this question, this study examined (i) the current use of healthcare services in China by people with different types of NCDs; (ii) the financial burden they experience in seeking such care; and (iii) whether socioeconomic status (SES) factors influence both their use of healthcare services and the financial burden of service use.Method We used data from the 2018 wave of a nationally representative survey, called China Health and Retirement Longitudinal Study (CHARLS). We included all participants who were interviewed in the 2018 survey. We examined three types of outcomes: perceived healthcare needs (measured by self-reported health), the use of healthcare services, and the financial burden of such use (as assessed by out-of-pocket expenses [OOP] and catastrophic health expenditure [CHE]). The indicators we used were four major NCDs, and SES factors (including education status, employment status, income level, residence status, and different health insurance schemes: Urban Employee Basic Medical Insurance [UEBMI], and Urban-Rural Resident Medical Insurance [URRMI]). Logistic regression models were used to assess effects of having four NCDs and SES factors on people’s perceived needs, healthcare service use, and CHE. Negative binomial models were performed to assess the effects of four major NCDs and SES factors on the number of times that healthcare services were used. Multiple linear regression models were adopted to examine the associations between four major NCDs, SES factors, the financial burden of service use, and the distance from the healthcare facility to home. Results A total of 20,813 respondents were included in our analyses. Compared with having one or more of the four major NCDs, there is some evidence that having no NCDs was associated with lower odds of having an outpatient visit in the last month (odds ratio [OR]=0.86), a hospitalization in the last year (OR=0.87) or taking purchased medicine in the last month (OR=0.82). People without NCDs may also have lower OOP for purchasing medicines in the last month compared with those with one or more of the four major NCDs (exponentiated β = 0.87). However, no evidence of differences was found in healthcare service use and the financial burden of the service use between people with four major NCDs and people with other types of NCDs. In relation to SES factors, (i) residency status: people living in rural areas may have higher baseline odds (OR = 1.11) of taking self-purchased medicine, more hospital admissions during the past year (IRR = 1.25), longer distance traveled from home to their last outpatient visit (exponentiated β = 1.28), and longer distance traveled from home to their last inpatient visit facility (exponentiated β = 1.25) than those who were in urban areas. (ii) health insurance type: some evidence showed that people without health insurance may have worse self-perceived health (OR = 1.53), lower odds of going to an outpatient visit in the last month (OR=0.71), and lower odds of an inpatient visit in the last year (OR=0.32) compared with people covered by UEBMI. People without health insurance also may travel further from home to an inpatient facility (exponentiated β = 3.39) and have higher odds of experiencing CHE (OR = 1.37) compared with people with UEBMI. People covered with URRMI may have poorer self-perceived health (OR = 1.21), lower odds of having an inpatient visit in the last year (OR=0.73), lower number of hospital admissions in the last year (IRR = 0.77) and lower OOP expenses for the last outpatient visit (exponentiated β = 0.77) than people with UEBMI. They also may travel longer distances from their home to an inpatient facility (exponentiated β = 2.06) than people with UEBMI. Conclusion There was no evidence showed that there were differences between having one or more of these four major NCDs versus having other types of NCDs in people’s self-perceived health, their use of healthcare services, and the financial burden of such service use, thus we should not overlook the prevention and management of other types of NCDs. In addition, continuous attention should be paid to the prevention and management of four major NCDs in China. Despite the Chinese government’s efforts to improve the health system to ensure universal health coverage in China, efforts should be further taken in providing financial protection to people in less-resourced settings (i.e., people living in rural areas and those without a health insurance plan) and to avoid inequality in healthcare service use that favors richer people.