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Table 4 Determinants of the amount of OOPE 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
  Log of OOPE Log of OOPE for Prescription drugs Log of OOPE Log of OOPE for Prescription drugs
  Regression coefficient P value Regression coefficient P value Regression coefficient P value Regression coefficient P value
Insurance type (ref: no insurance)
 NCMS − 0.094(− 0.339, 0.152) 0.455 − 0.071(− 0.295, 0.152) 0.532 − 0.08(− 0.427, 0.267) 0.652 − 0.065(− 0.443, 0.314) 0.738
 URBMI 0.012(− 0.312, 0.337) 0.941 0.111(− 0.186, 0.408) 0.465 − 0.021(− 0.454, 0.412) 0.925 − 0.065(− 0.538, 0.408) 0.788
 UEBMI − 0.338(− 0.642, − 0.035) 0.029 − 0.266(− 0.544, 0.011) 0.060 − 0.002(− 0.401, 0.398) 0.993 0.035(− 0.4, 0.469) 0.876
 Others −1.173(− 1.626, − 0.72) < 0.001 −1.333(− 1.761, − 0.905) < 0.001 −1.101(− 1.686, − 0.516) < 0.001 − 0.347(− 0.991, 0.298) 0.292
PCE (ref: lowest 20%)
 Lower 20% −0.141(− 0.306, 0.024) 0.093 − 0.048(− 0.199, 0.104) 0.538 0.115(− 0.14, 0.371) 0.376 −0.085(− 0.366, 0.197) 0.556
 Middle 20% 0.092(−0.07, 0.254) 0.264 0.081(−0.067, 0.23) 0.283 0.182(− 0.066, 0.43) 0.151 0.097(−0.177, 0.372) 0.486
 Higher 20% 0.112(−0.051, 0.275) 0.178 0.131(−0.018, 0.28) 0.085 0.493 (0.255, 0.732) < 0.001 0.222(−0.04, 0.484) 0.097
 Highest 20% 0.391 (0.226, 0.556) < 0.001 0.361 (0.21, 0.512) < 0.001 0.759 (0.523, 0.995) < 0.001 0.326 (0.066, 0.586) 0.014
Employment status (ref: not working)
 Retired −0.156(− 0.712, 0.4) 0.582 −0.102(− 0.611, 0.408) 0.696 0.202(− 0.402, 0.806) 0.513 − 0.466(−1.127, 0.195) 0.167
 Working − 0.444(− 0.998, 0.109) 0.116 −0.407(− 0.915, 0.1) 0.116 −0.158(− 0.765, 0.448) 0.608 −0.739(− 1.401, − 0.077) 0.029
Education (ref: primary school or below)
 Secondary school − 0.001(− 0.13, 0.128) 0.988 0.011(− 0.107, 0.129) 0.859 −0.096(− 0.271, 0.079) 0.282 0.071(− 0.115, 0.257) 0.456
 College and above −0.802(− 1.275, − 0.328) 0.001 −0.488(− 0.941, − 0.036) 0.035 −0.056(− 0.654, 0.541) 0.853 −0.78(− 1.42, − 0.14) 0.017
Age (ref: 45–54 years)
 55–64 − 0.13(− 0.257, − 0.002) 0.046 −0.108(− 0.224, 0.008) 0.069 − 0.163(− 0.354, 0.027) 0.093 −0.162(− 0.368, 0.043) 0.121
 65–74 − 0.208(− 0.361, − 0.056) 0.008 −0.145(− 0.285, − 0.005) 0.042 −0.425(− 0.64, − 0.21) < 0.001 −0.356(− 0.588, − 0.124) 0.003
 75 and above −0.482(− 0.727, − 0.237) < 0.001 −0.381(− 0.608, − 0.154) 0.001 −0.74(− 1.033, − 0.447) < 0.001 −0.498(− 0.814, − 0.181) 0.002
Gender (ref: male)
 Female 0.036(−0.071, 0.143) 0.508 0.021(−0.077, 0.119) 0.680 −0.129(− 0.273, 0.016) 0.081 −0.106(− 0.261, 0.048) 0.177
Marital (ref: single or divorce or widowed)
 Married or cohabitated 0.212 (0.066, 0.357) 0.004 0.075(−0.059, 0.209) 0.273 0.482 (0.283, 0.681) < 0.001 0.145(−0.069, 0.359) 0.185
Comorbidity (ref: none)
 1 NCD 0.268 (0.095, 0.44) 0.002 0.273 (0.115, 0.432) 0.001 0.159(−0.103, 0.421) 0.233 0.114(−0.172, 0.4) 0.435
 2 NCDs 0.417 (0.243, 0.59) < 0.001 0.425 (0.265, 0.585) < 0.001 0.071(−0.184, 0.326) 0.584 −0.005(− 0.283, 0.272) 0.971
  > 2 NCDs 0.46 (0.291, 0.628) < 0.001 0.431 (0.276, 0.586) < 0.001 0.129(−0.111, 0.369) 0.291 0.021(−0.24, 0.281) 0.877
Location (ref: urban)
 Rural 0.091(−0.061, 0.243) 0.240 0.049(−0.084, 0.183) 0.469 0.001(−0.184, 0.187) 0.988 −0.349(− 0.554, − 0.144) 0.001
GDP per capita (ref: low)
 Middle −0.131(− 0.312, 0.05) 0.157 − 0.104(− 0.273, 0.064) 0.225 0.236(− 0.004, 0.476) 0.054 0.146(− 0.103, 0.395) 0.251
 High − 0.208(− 0.669, 0.254) 0.378 −0.064(− 0.498, 0.371) 0.773 0.649 (0.094, 1.204) 0.022 0.605 (0.011, 1.2) 0.046
Year (ref: 2011)
 2013 0.212 (0.07, 0.354) 0.003 0.137 (0.006, 0.269) 0.041 −0.096(−0.297, 0.104) 0.347 0.049(−0.174, 0.272) 0.664
 2015 0.447 (0.292, 0.602) < 0.001 0.155 (0.011, 0.299) 0.035 −0.039(− 0.252, 0.175) 0.723 0.136(− 0.1, 0.371) 0.258
VPC, %
 Province 2.0%   3.0%   1.1%   0.3%  
 City 2.3%   2.4%   0.6%   0.0%  
 Community 1.8%   1.1%   1.9%   3.8%  
 Individual 93.9%   93.5%   96.4%   95.9%  
  1. Note:
  2. 95% CI was displayed in parentheses after the regression coefficient
  3. 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
  4. 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, OOPE Out-of-pocket expenditure, PCE Per capita expenditure (Chinese Yuan), VPC Variance partition coefficient
  5. 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)
  6. OOPE was log-transformed to normalise the distribution. Patients with zero OOPE were replaced by 1 for a mathematically meaningful log-transformation