What fragile factors hinder the pace of China’s alleviation efforts of poverty-stricken population?
Authors: Li Ye , Qi Xinye , Shan Linghan , Tan Xiao , Wang Jiahui , Kang Zheng , Ning Ning , Liang Libo , Gao Lijun , Jiao Mingli , Cui Yu , Hao Yanhua , Wu Qunhong 
Published: August 2020

Abstract
Objective: China has made remarkable achievements in poverty alleviation. However, with the change in economic development and age structure, the population stricken by poverty due to medical expenses and disability accounted for 42.3% and 14.4% of the total poverty-stricken population, respectively. The efforts to reduce the catastrophic health expenditure among Chinese residents are not optimistic. Poverty alleviation efforts might only focus on the people who are currently poor but ignores the increase in poverty that may occur. Accordingly, it is crucial to accurately pinpoint the characteristics of people who are about to become poor due to illness. Therefore, we prospectively analyzed the incidence of impoverishment by medical expense at the provincial, family, and different medical insurance scheme levels to identify the precise groups that are vulnerable to medical-related poverty.Method: This study obtained the data from the Chinese government’s Fifth National Health Service Survey for 2013. This survey is conducted every five years and has the most nationally representative sample obtained through a multi-stage, stratified, and random sampling method. To clean the data, we excluded incomplete records and those with logic errors, leaving 93,570 households (273,626 people) for the final sample. The method recommended by World Health Organization (WHO) was adopted to calculate impoverishment by medical expense, and logistic regression was adopted to evaluate its determinants.Results: The poverty rates in western region had much higher poverty rates than the other two regions, and the eastern region had the lowest. The rate of medical impoverishment (MI) was higher in the western region (7.2%) than that in the central (6.5%) and eastern (5.1%) regions. Compared with people enrolled in other medical insurance schemes, those enrolled in the Medical Insurance for Urban Employees Scheme (UE-BMI) and a mixture of schemes had better capacity to deal with the burden brought by diseases. The New Cooperative Medical Scheme (NCMS)was associated with the highest rate (9.1%) of MI cases. A comparison of the MI groups revealed that the top three diseases associated with MI were malignant tumor, congenital heart disease, and mental disease. Households with members suffering from NCDs, and with members who were inpatients were all more likely to suffer from MI. NCMS-enrolled households had greater exposure to the risk of MI, at 1.84 times that of UE-BM-enrolled households. Poorer households were 15.8 times more likely to suffer from MI than richer households.Conclusion: The joint roles of economic development, health service utilization, and welfare policies result in medical impoverishment for different regions. Poverty and health service utilization are indicative of households with high incidence of medical impoverishment. Chronic diseases lead to medical impoverishment. The inequity existing in different medical insurance schemes leads to different degrees of risk of MI. A combined strategy to precise target multiple vulnerabilities of poor population should be more effective.