Data_Sheet_1_The Basic vs. Ability-to-Pay Approach: Evidence From China's Critical Illness Insurance on Whether Different Measurements of Catastrophic Health Expenditure Matter.pdf

Alleviating catastrophic health expenditure (CHE) is one of the vital objectives of health systems, as defined by the World Health Organization. However, no consensus has yet been reached on the measurement of CHE. With the aim of further relieving the adverse effects of CHE and alleviating the problem of illness-caused poverty, the Critical Illness Insurance (CII) program has been operational in China since 2012. In order to verify whether the different measurements of CHE matter under China's CII program, we compare the two-layer CII models built by using the basic approach and the ability-to-pay (ATP) approach at a range of thresholds. Exploiting the latest China family panel studies dataset, we demonstrate that the basic approach is more effective in relieving CHE for all insured households, while the ATP approach works better in reducing the severity of CHE in households facing it. These findings have meaningful implications for policymaking. The CII program should be promoted widely as a supplement to the current Social Basic Medical Insurance system. To improve the CII program's effectiveness, it should be based on the basic approach, and the threshold used to measure CHE should be determined by the goal pursued by the program.

缓解灾难性医疗支出（CHE）是卫生系统的一项重要目标，正如世界卫生组织所定义。然而，关于CHE的衡量方法尚未达成共识。旨在进一步缓解CHE的负面影响，并减轻疾病导致的贫困问题，自2012年以来，中国已实施重症疾病保险（CII）计划。为了验证在中国CII计划下，不同的CHE衡量方法是否具有意义，我们比较了在一系列阈值下，采用基本方法和支付能力（ATP）方法构建的两层CII模型。利用最新的中国家庭面板研究数据集，我们证明了基本方法在缓解所有投保家庭的CHE方面更为有效，而ATP方法在减轻面临CHE的家庭的严重程度方面表现更佳。这些发现对政策制定具有深刻的意义。CII计划应广泛推广，作为当前社会基本医疗保险系统的补充。为了提高CII计划的有效性，它应基于基本方法，而用于衡量CHE的阈值应由计划追求的目标来确定。