Temporal trends and variation in out-of-pocket expenditures and patient cost sharing: evidence from a Chinese national survey 2011–2015

Qin, Vicky Mengqi; Zhang, Yuting; Chia, Kee Seng; McPake, Barbara; Zhao, Yang; Hulse, Emily S. G.; Legido-Quigley, Helena; Lee, John Tayu

doi:10.1186/s12939-021-01480-9

International Journal for Equity in Health

Table 3 Determinants of patient cost-sharing for outpatient and inpatient services from multilevel regression analysis

From: Temporal trends and variation in out-of-pocket expenditures and patient cost sharing: evidence from a Chinese national survey 2011–2015

	Outpatient				Inpatient
	Overall		Medicines only		Overall		Medicines only
	Regression coefficient	P value	Regression coefficient	P value	Regression coefficient	P value	Regression coefficient	P value
Insurance type (ref: no insurance)
NCMS	− 0.089 (− 0.127, − 0.051)	< 0.001	− 0.054(− 0.086, − 0.023)	0.001	− 0.281(− 0.334, − 0.229)	< 0.001	− 0.111(− 0.164, − 0.058)	< 0.001
URBMI	− 0.094 (− 0.144, − 0.043)	< 0.001	− 0.063(− 0.105, − 0.02)	0.004	− 0.316(− 0.382, − 0.25)	< 0.001	− 0.134(− 0.2, − 0.067)	< 0.001
UEBMI	−0.205 (− 0.252, − 0.158)	< 0.001	−0.171(− 0.211, − 0.131)	< 0.001	−0.453(− 0.513, − 0.393)	< 0.001	− 0.172(− 0.233, − 0.111)	< 0.001
Others	−0.282 (− 0.352, − 0.211)	< 0.001	−0.278(− 0.34, − 0.215)	< 0.001	−0.508(− 0.598, − 0.418)	< 0.001	−0.167(− 0.259, − 0.076)	< 0.001
PCE (ref: lowest 20%)
Lower 20%	− 0.022 (− 0.048, 0.004)	0.094	0.003(− 0.019, 0.025)	0.804	0.004(− 0.036, 0.044)	0.840	− 0.025(− 0.065, 0.015)	0.221
Middle 20%	−0.025 (− 0.05, 0)	0.053	− 0.015(− 0.036, 0.007)	0.185	− 0.036(− 0.074, 0.003)	0.071	− 0.021(− 0.06, 0.018)	0.297
Higher 20%	−0.015 (− 0.041, 0.01)	0.236	− 0.002(− 0.023, 0.02)	0.885	0.002(− 0.035, 0.039)	0.929	− 0.026(− 0.064, 0.011)	0.166
Highest 20%	− 0.02 (− 0.046, 0.006)	0.128	− 0.007(− 0.029, 0.015)	0.540	0.016(− 0.02, 0.053)	0.382	−0.055(− 0.092, − 0.018)	0.004
Employment status (ref: not working)
Retired	−0.091 (− 0.177, − 0.005)	0.038	−0.045(− 0.118, 0.028)	0.228	0.056(− 0.037, 0.15)	0.236	−0.033(− 0.128, 0.062)	0.495
Working	−0.064 (− 0.15, 0.021)	0.140	−0.026(− 0.099, 0.047)	0.488	0.046(− 0.048, 0.14)	0.335	−0.031(− 0.127, 0.064)	0.518
Education (ref: primary school or below)
Secondary school	−0.009 (− 0.03, 0.011)	0.369	−0.004(− 0.021, 0.013)	0.652	−0.028(− 0.055, − 0.002)	0.036	0.002(− 0.024, 0.029)	0.866
College and above	−0.164 (− 0.24, − 0.089)	< 0.001	−0.155(− 0.221, − 0.089)	< 0.001	0.005(− 0.086, 0.096)	0.913	−0.104(− 0.197, − 0.012)	0.027
Age (ref: 45–54 years)
55–64	− 0.025 (− 0.045, − 0.005)	0.013	−0.013(− 0.03, 0.004)	0.125	− 0.031(− 0.061, − 0.002)	0.035	−0.012(− 0.042, 0.017)	0.411
65–74	− 0.054 (− 0.078, − 0.03)	< 0.001	−0.037(− 0.058, − 0.017)	< 0.001	−0.053(− 0.086, − 0.02)	0.002	−0.028(− 0.061, 0.006)	0.105
75 and above	−0.078 (− 0.117, − 0.04)	< 0.001	−0.074(− 0.107, − 0.04)	< 0.001	−0.082(− 0.126, − 0.037)	< 0.001	−0.053(− 0.099, − 0.008)	0.022
Gender (ref: male)
Female	0.008 (−0.008, 0.025)	0.324	0.019 (0.004, 0.033)	0.010	0.031 (0.009, 0.053)	0.006	0.031 (0.009, 0.053)	0.007
Marital (ref: single or divorce or widowed)
Married or cohabitated	0.004 (−0.019, 0.027)	0.716	−0.018(− 0.037, 0.002)	0.076	0.038 (0.008, 0.069)	0.014	0.004(− 0.027, 0.035)	0.784
Comorbidity (ref: none)
1 NCD	0.004 (−0.023, 0.031)	0.763	0.005(−0.019, 0.028)	0.694	0.031(−0.01, 0.071)	0.138	−0.004(− 0.045, 0.037)	0.851
2 NCDs	0 (−0.027, 0.027)	0.995	0.011(− 0.013, 0.034)	0.364	0.015(− 0.024, 0.054)	0.452	−0.008(− 0.048, 0.032)	0.682
> 2 NCDs	−0.005 (− 0.032, 0.021)	0.702	0(− 0.023, 0.022)	0.976	0.007(− 0.03, 0.044)	0.696	− 0.014(− 0.051, 0.023)	0.464
Location (ref: urban)
Rural	0.013 (−0.011, 0.038)	0.290	0.003(− 0.017, 0.022)	0.774	0.045 (0.016, 0.073)	0.002	−0.018(− 0.046, 0.01)	0.210
GDP per capita (ref: low)
Middle	−0.015 (− 0.043, 0.013)	0.295	− 0.017(− 0.04, 0.007)	0.162	0.029(− 0.007, 0.065)	0.117	− 0.006(− 0.04, 0.028)	0.713
High	−0.09 (− 0.161, − 0.019)	0.013	−0.057(− 0.114, 0)	0.050	0.064(− 0.018, 0.145)	0.128	− 0.002(− 0.081, 0.076)	0.953
Year (ref: 2011)
2013	−0.019 (− 0.041, 0.003)	0.092	− 0.002(− 0.021, 0.017)		− 0.09(− 0.122, − 0.059)	< 0.001	0.013(− 0.018, 0.044)	0.399
2015	− 0.011 (− 0.035, 0.013)	0.372	− 0.018(− 0.039, 0.002)		− 0.079(− 0.112, − 0.046)	< 0.001	0.031(− 0.001, 0.064)	0.060
VPC, %
Province	1.5%		0.6%		0.0%		0.0%
City	1.6%		1.6%		2.7%		0.5%
Community	2.9%		1.4%		0.7%		1.8%
Individual	94.0%		96.3%		96.6%		97.7%

Note:
95% CI was displayed in parentheses after the regression coefficient
Respondents categorised in other insurance group were enrolled in insurance program other than the three major social health insurance, such as private insurance, government-funded insurance (Gong Fei) etc
Abbreviation: UEBMI Urban Employee Basic Medical Insurance, URBMI Urban Resident Basic Medical Insurance, NCMS New Rural Cooperative Medical Scheme, Others government health care, private medical insurance and others, PCE Per capita expenditure (Chinese Yuan), NCD Non-communicable disease, VPC Variance partition coefficient
A likelihood ratio test was conducted to compare the fully adjusted model with null model with only random intercept and multivariable linear model. Fully adjusted multilevel model is preferred (P < 0.01)

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