Identifying Characteristics Associated with the Concentration and Persistence of Medical Expenses among Middle-Aged and Elderly Adults: Findings from the China Health and Retirement Longitudinal Survey
Abstract
:1. Background
2. Methods
2.1. Data Source
2.2. Data Analysis
2.2.1. Determining the Concentration of Medical Expenses among Middle-Aged and Elderly Participants
2.2.2. Determining the Persistence of High Medical Expenses among Middle-Aged and Elderly Participants
2.2.3. Descriptive Analysis
2.2.4. Regression Analysis of Medical Expenses among Middle-Aged and Elderly Participants
2.2.5. Variable Selection
Dependent Variables
Independent Variables
3. Results
3.1. The Concentration of Medical Expenses among Middle-Aged and Elderly Participants
3.2. The Characteristics of Middle-Aged and Elderly Participants with High Medical Expenses
3.3. Persistence of High Medical Expenses
3.4. Heckman Selection Model Regression
3.4.1. Incidence of Medical Expenses
3.4.2. Total Medical Expenses
4. Discussion
4.1. The Concentration of Medical Expenses among Middle-Aged and Elderly Participants
4.2. Persistence of High Medical Expenses among Middle-Aged and Elderly Participants
4.3. Characteristics of Middle-Aged and Elderly Participants with High Medical Expenses
4.4. Factors Associated with the Persistence of Total Medical Expenses
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
References
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Variable | Category | Indicator/Survey Question |
---|---|---|
Dependent variables | ||
Total medical expenses | CNY | Question: What was the total medical expenses during the past year? |
Incidence of medical expenses | =0, non-incurrence of medical expenses; =1, incurrence of medical expenses | Whether the total medical expenses were equal to zero. |
Independent variables | ||
Predisposing factors | ||
Sex | =0, male; =1, female | |
Age (years) | =0.45–55; =1.55–65; =2.65–75; =3, if ≥ 75 | |
Marital status | =0, not married; =1, married | Question: What is your marital status? (Separation, divorce, widowhood, and cohabitation belong to “not married”.) |
Retirement status | =0, not retired; =1, retired | Question: What is your retirement status? |
Education level | =0, less than lower secondary; =1, upper secondary, vocational training; =2, tertiary | Question: What is the highest level of education you have attained? |
Area of residence | =0, rural; =1, urban | Type of residence. |
Enabling factors | ||
Income level | =0, ≤CNY 8000; =1, CNY 8,000–15,600; =2, CNY 15,600–30,000; =3, ≥CNY 30,000 | Yearly household income divided by the number of household members. |
Social health insurance | =0, have no insurance; =1, have insurance | Question: Do you have any social health insurance? |
Type of outpatient medical facilities | =0, general hospital, specialized hospital, Chinese medicine hospital; =1, community healthcare center, township hospital, village clinic | Question: Which types of medical facilities have you visited in the last 4 weeks for outpatient treatment? |
Multi-type outpatient facility visits | =0, no multi-type out- patient facility visits; =1, muti-type outpatient facility visits | Whether attended multiple types of outpatient facilities. |
Number of outpatient visits | =0, ≤24; =1, 24–36; =2, ≥36 | Question: How many times did you visit/been visited by during the last month? |
Number of hospitalizations | =0, ≤1; =1, >1 | Question: How many times have you received inpatient care during the past year? |
Need factors | ||
Self-reported health status | =0, very good; =1, good; =2, fair; =3, poor | |
Comorbidity | =1, ≤1; =2, >1 | Number of chronic diseases. |
Hypertension | =0, no; =1, yes | |
Diabetes | =0, no; =1, yes | |
Cancer | =0, no; =1, yes | Excluding minor skin cancers |
Chronic lung diseases | =0, no; =1, yes | Excluding tumors or cancer |
Liver diseases | =0, no; =1, yes | Excluding fatty liver, tumors, cancer |
Heart diseases | =0, no; =1, yes | |
Kidney diseases | =0, no; =1, yes | Excluding tumors or cancer |
Stomach or other digestive diseases | =0, no; =1, yes | Excluding tumors or cancer |
Arthritis or rheumatism | =0, no; =1, yes |
Top 10% n = 1119 (5.63%) | Bottom 90% n = 18,750 (94.37%) | p | Top 20% n = 2180 (10.97%) | Bottom 80% n = 17,689 (89.03%) | p | |
---|---|---|---|---|---|---|
Predisposing factors | ||||||
Sex | 0.000 | 0.000 | ||||
Male | 43.16% | 49.14% | 42.89% | 49.53% | ||
Female | 56.84% | 50.86% | 57.11% | 50.47% | ||
Age (years) | 0.000 | 0.000 | ||||
45–55 | 23.77% | 28.79% | 25.28% | 28.91% | ||
55–65 | 38.25% | 40.12% | 38.53% | 40.20% | ||
65–75 | 28.42% | 23.73% | 26.51% | 23.69% | ||
≥75 | 9.56% | 7.35% | 9.68% | 7.20% | ||
Marital status | 0.817 | 0.374 | ||||
Not married | 11.80% | 11.57% | 12.16% | 11.51% | ||
Married | 88.20% | 88.43% | 87.84% | 88.49% | ||
Retirement status | 0.000 | 0.000 | ||||
Not retired | 82.66% | 90.34% | 83.62% | 90.68% | ||
Retired | 17.34% | 9.66% | 16.38% | 9.32% | ||
Education level | 0.000 | 0.002 | ||||
Less than lower secondary | 85.08% | 88.82% | 86.79% | 88.83% | ||
Upper secondary, vocational training | 13.85% | 10.74% | 12.39% | 10.74% | ||
Tertiary | 1.07% | 0.44% | 0.82% | 0.43% | ||
Area of residence | 0.000 | 0.000 | ||||
Rural | 71.22% | 77.50% | 71.74% | 77.81% | ||
Urban | 28.78% | 22.50% | 28.26% | 22.19% | ||
Enabling factors | ||||||
Income level | 0.000 | 0.000 | ||||
≤CNY 8000 | 83.20% | 76.41% | 81.19% | 76.25% | ||
CNY 8000–15,600 | 4.29% | 7.66% | 5.55% | 7.71% | ||
CNY 15,600–30,000 | 5.36% | 7.76% | 5.55% | 7.88% | ||
≥CNY 30,000 | 7.15% | 8.18% | 7.71% | 8.17% | ||
Social health insurance | 0.456 | 0.455 | ||||
Have no insurance | 1.97% | 2.31% | 2.06% | 2.32% | ||
Have insurance | 98.03% | 97.69% | 97.94% | 97.68% | ||
Type of outpatient medical facilities | 0.000 | 0.000 | ||||
General hospital, specialized hospital, Chinese medicine hospital | 58.18% | 19.71% | 48.46% | 13.87% | ||
Community healthcare center, township hospital, village clinic | 41.82% | 80.29% | 51.54% | 86.13% | ||
Multi-type outpatient facility visits | 0.000 | 0.000 | ||||
No multi-type outpatient facility visits | 91.33% | 99.49% | 93.39% | 99.72% | ||
Multi-type outpatient facility visits | 8.67% | 0.51% | 6.61% | 0.28% | ||
Number of outpatient visits | 0.000 | 0.000 | ||||
≤24 | 72.39% | 97.60% | 77.20% | 98.52% | ||
24–36 | 9.83% | 1.23% | 8.76% | 0.84% | ||
≥36 | 17.78% | 1.17% | 14.04% | 0.64% | ||
Number of hospitalizations | 0.000 | 0.000 | ||||
≤1 | 71.13% | 99.10% | 80.73% | 99.60% | ||
>1 | 28.87% | 0.90% | 19.27% | 0.40% | ||
Need factors | ||||||
Self-reported health status | 0.000 | 0.000 | ||||
Very good | 3.84% | 14.31% | 3.72% | 14.96% | ||
Good | 6.70% | 15.17% | 7.11% | 15.63% | ||
Fair | 39.59% | 53.00% | 44.54% | 53.20% | ||
Poor | 49.87% | 17.51% | 44.63% | 16.21% | ||
Comorbidity | 0.000 | 0.000 | ||||
Without comorbidity | 34.04% | 63.29% | 36.19% | 64.78% | ||
With comorbidity | 65.95% | 36.71% | 63.81% | 35.22% |
Top 10% n = 1119 (5.63%) | Bottom 90% n = 18,750 (94.37%) | p | Top 20% n = 2180 (10.97%) | Bottom 80% n = 17,689 (89.03%) | p | |
---|---|---|---|---|---|---|
Hypertension | 0.000 | 0.000 | ||||
No | 63.27% | 75.48% | 63.35% | 76.21% | ||
Yes | 36.73% | 24.52% | 36.65% | 23.79% | ||
Diabetes | 0.000 | 0.000 | ||||
No | 87.76% | 94.35% | 88.67% | 94.63% | ||
Yes | 12.24% | 5.65% | 11.33% | 5.37% | ||
Cancer | 0.000 | 0.000 | ||||
No | 97.14% | 99.03% | 97.71% | 99.08% | ||
Yes | 2.86% | 0.97% | 2.29% | 0.92% | ||
Chronic lung diseases | 0.000 | 0.000 | ||||
No | 80.52% | 91.00% | 82.25% | 91.41% | ||
Yes | 19.48% | 9.00% | 17.75% | 8.59% | ||
Liver diseases | 0.000 | 0.000 | ||||
No | 89.99% | 95.97% | 91.10% | 96.20% | ||
Yes | 10.01% | 4.03% | 8.90% | 3.80% | ||
Heart diseases | 0.000 | 0.000 | ||||
No | 70.69% | 88.65% | 74.17% | 90.43% | ||
Yes | 29.31% | 11.35% | 25.83% | 9.57% | ||
Kidney diseases | 0.000 | 0.000 | ||||
No | 87.04% | 94.33% | 87.57% | 94.70% | ||
Yes | 12.96% | 5.67% | 12.43% | 5.30% | ||
Stomach or other digestive diseases | 0.000 | 0.000 | ||||
No | 63.63% | 77.71% | 64.77% | 78.41% | ||
Yes | 36.37% | 22.29% | 35.23% | 21.59% | ||
Arthritis or rheumatism | 0.000 | 0.000 | ||||
No | 51.30% | 66.23% | 50.37% | 67.25% | ||
Yes | 48.70% | 33.77% | 49.63% | 32.75% |
Expense Ranking in 2013 | Expense Ranking in 2015 | Expense Ranking in 2018 | ||||
---|---|---|---|---|---|---|
Top 10% | Top 20% | Top 50% | Top 10% | Top 20% | Top 50% | |
Top 10% | 0 | 70.00% | 80.00% | 0 | 70.00% | 70.00% |
Top 20% | 0.26% | 30.82% | 55.03% | 0.40% | 26.46% | 55.29% |
Top 50% | 0.28% | 21.48% | 46.42% | 0.22% | 20.64% | 50.00% |
(1) | (2) | |||
---|---|---|---|---|
dy/dx | Std. Err. | dy/dx | Std. Err. | |
Lagging item of with or without expenses (ref. without) | ||||
L1 | 0.165 *** | 0.010 | 0.158 *** | 0.015 |
L2 | 0.117 *** | 0.015 | ||
Demographic variables | ||||
Age (ref. 45–55) | ||||
55–65 | −0.009 | 0.011 | −0.013 | 0.016 |
65–75 | 0.007 | 0.012 | 0.011 | 0.017 |
≥75 | 0.019 | 0.017 | 0.015 | 0.023 |
Gender (ref. male) | 0.033 *** | 0.008 | 0.027 ** | 0.012 |
Education (ref. less than lower secondary) | ||||
Upper secondary, vocational training | −0.012 | 0.014 | −0.022 | 0.020 |
Tertiary | −0.030 | 0.063 | −0.016 | 0.096 |
Marriage (ref. not) | −0.001 | 0.013 | −0.003 | 0.018 |
Employ (ref. not) | 0.006 | 0.014 | −0.021 | 0.019 |
Residence (ref. rural) | 0.008 | 0.012 | −0.017 | 0.018 |
Lagging item of with or without expenses*disease (ref. without) | ||||
L1*Hypertension | 0.102 *** | 0.014 | 0.069 *** | 0.025 |
L1*Diabetes | 0.098 *** | 0.030 | 0.071 | 0.053 |
L1*Cancer | 0.056 | 0.064 | 0.293 *** | 0.127 |
L1*Chronic lung diseases | 0.078 *** | 0.021 | 0.081 ** | 0.035 |
L1*Liver diseases | 0.049 * | 0.030 | −0.036 | 0.050 |
L1*Heart diseases | 0.074 *** | 0.020 | −0.009 | 0.036 |
L1*Kidney diseases | 0.089 *** | 0.026 | 0.115 *** | 0.044 |
L1*Stomach or other digestive diseases | 0.055 *** | 0.014 | 0.020 | 0.023 |
L1*Arthritis or rheumatism | 0.060 *** | 0.012 | 0.016 | 0.020 |
L2*Hypertension | 0.103 *** | 0.025 | ||
L2*Diabetes | 0.013 | 0.055 | ||
L2*Cancer | −0.037 | 0.108 | ||
L2*Chronic lung diseases | −0.018 | 0.037 | ||
L2*Liver diseases | 0.111 ** | 0.055 | ||
L2*Heart diseases | 0.020 | 0.038 | ||
L2*Kidney diseases | 0.014 | 0.047 | ||
L2*Stomach or other digestive diseases | 0.035 | 0.024 | ||
L2*Arthritis or rheumatism | 0.036 * | 0.021 |
(1) | (2) | |||
---|---|---|---|---|
Coefficient | Std. Err. | Coefficient | Std. Err. | |
Lagging item of medical expenses | ||||
L1 of medical exp. (ln) | 0.225 *** | 0.018 | 0.165 *** | 0.022 |
L2 of medical exp. (ln) | 0.113 *** | 0.021 | ||
Predisposing factors | ||||
Age (ref. 45–55) | ||||
55–65 | 0.023 | 0.101 | 0 100 | 0.179 |
65–75 | −0.002 | 0.113 | 0.229 | 0.187 |
≥75 | 0.088 | 0.160 | 0.447 * | 0249 |
Gender (ref. male) | 0.328 *** | 0.084 | 0.297 ** | 0.132 |
Education (ref. less than lower secondary) | ||||
Upper secondary, vocational training | 0.089 | 0.131 | −0.043 | 0.198 |
Tertiary | 0.637 | 0.622 | 0.904 | 1.289 |
Marriage (ref. not) | 0.258 ** | 0.123 | 0.252 | 0.189 |
Employ (ref. not) | −0.045 | 0.148 | −0.164 | 0.208 |
Residence (ref. rural) | 0.221 * | 0.124 | 0.155 | 0.206 |
Enabling factors | ||||
Number of outpatient visits (ref. ≤24) | ||||
24–36 | 0.331 *** | 0.097 | 0.203 | 0.152 |
≥36 | 0.827 *** | 0.097 | 0.684 *** | 0.150 |
Number of hospitalizations (ref. ≤1) | 1.067 *** | 0.142 | 0.911 *** | 0.224 |
Income (ref. ≤CNY 8000) | ||||
CNY 8000–15,600 | 0.042 | 0.157 | 0.009 | 0.254 |
CNY 15,600–30,000 | 0.284 * | 0.166 | 0.391 * | 0.227 |
≥CNY 30,000 | 0.307 * | 0.167 | 0.330 | 0.239 |
Health insurance (ref. no) | 2.734 *** | 0.294 | 2.012 *** | 0.344 |
Type of outpatient medical facilities (ref. general, specialized, Chinese medicine hospital) | ||||
Community healthcare center, township hospital, village clinic | −1.167 *** | 0.088 | −1.151 *** | 0.144 |
Multi-type outpatient facility visits (ref. no) | 0.050 | 0.126 | 0.317 | 0.194 |
Need factors | ||||
Hypertension | 0.383 *** | 0.103 | 0.315 ** | 0.154 |
Diabetes | 0.408 *** | 0.137 | 0.328 * | 0.173 |
Cancer | 0.088 | 0.320 | 0.535 | 0.489 |
Chronic lung diseases | 0.220 ** | 0.107 | −0.003 | 0.151 |
Liver diseases | 0.013 | 0.153 | −0.091 | 0.208 |
Heart diseases | 0.346 *** | 0.108 | 0.308 ** | 0.150 |
Kidney diseases | 0.204 | 0.134 | 0.024 | 0.181 |
Stomach or other digestive diseases | 0.057 | 0.095 | 0.029 | 0.144 |
Arthritis or rheumatism | 0.197 ** | 0.095 | 0.222 | 0.146 |
Comorbidity (ref. ≤1) | 0.274 ** | 0.131 | 0.654 *** | 0.197 |
Self-reported health status (ref. very good) | ||||
Good | 1.334 *** | 0.259 | 1.821 *** | 0.418 |
Fair | 1.149 *** | 0.202 | 1.784 *** | 0.353 |
Poor | 1.388 *** | 0.209 | 1.811 *** | 0.368 |
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Jiang, L.; Qiu, Q.; Zhu, L.; Wang, Z. Identifying Characteristics Associated with the Concentration and Persistence of Medical Expenses among Middle-Aged and Elderly Adults: Findings from the China Health and Retirement Longitudinal Survey. Int. J. Environ. Res. Public Health 2022, 19, 12843. https://doi.org/10.3390/ijerph191912843
Jiang L, Qiu Q, Zhu L, Wang Z. Identifying Characteristics Associated with the Concentration and Persistence of Medical Expenses among Middle-Aged and Elderly Adults: Findings from the China Health and Retirement Longitudinal Survey. International Journal of Environmental Research and Public Health. 2022; 19(19):12843. https://doi.org/10.3390/ijerph191912843
Chicago/Turabian StyleJiang, Luyan, Qianqian Qiu, Lin Zhu, and Zhonghua Wang. 2022. "Identifying Characteristics Associated with the Concentration and Persistence of Medical Expenses among Middle-Aged and Elderly Adults: Findings from the China Health and Retirement Longitudinal Survey" International Journal of Environmental Research and Public Health 19, no. 19: 12843. https://doi.org/10.3390/ijerph191912843