A Study On The Determinants Of The Health Care Expenditure Of Rural Families Of Disabled Elders

With the fast aging of population, the proportion and size of the disabled elderly has increased unceasingly. The problem of disabled elders has attracted a lot of attention from the society. The disabled elders have greater risk in exposure to chronic diseases and need much more health care expenditure than others. The family members of the disabled elders have to spend more time and energy to take care of them, and thus face more health risks. Therefore, the families of the disabled elders pay more on health care expenditure than other families. With the dual social system of urban and rural long-term carried, the income level and the insurance level of the rural families are inferior to the urban families. Furthermore, without a medical assistance policy which should focus on supporting rural families of the disabled elders, the rural families of disabled elders face more vulnerability.This study focuses on the health care expenditure of the disabled elders' family in rural area of China. The family's health care expenditure was influenced by family level charactors and regional factors and analyzed with hierarchical linear models.The results shows that the majority of difference in health care expenditure among rural families of the disabled elders is explained by family and individual factors. In the family level, family income, family engel coefficient, self-care ability, household size and marriage status of the disabled elders all have significant association with the dependent variable. Whether taking part in the New RuralCo-operative Medical System (NCMS) has no significant association with the dependent variable. In the regional level, firstly, the research finds that the regional difference can explain a part of difference in health care expenditure among rural families of the disabled elders. Although the proportion is small, it is statistically significant. Secondly, medical price variables and natural condition will excert significant impact on the mean of health care expenditure of rural families of disabled elders in the same district. The research, besides, finds that the disparity of health care expenditure between families of different engel coefficients will be lager if the district of these families has higher reimbursement ratio of NCMS. Similarly, the disparity of health care expenditure between families of different level of income will be larger if the district of these families has more medical beds and health workers. Based on the analysis of family level, the study shows that the rural families of disabled elders have not fully shared the fruits of the economic development. There is also a lack of medical assistance policy which focus on supporting rural families of the disabled elders. How much they spend on health care depends on individual and family factors. At present, the rural families have to shoulder high proportion of out-of-pocket of health care expenditure. The financial status of the families is a key factor in meeting their health care need. The reason why the poor family spend less than the rich family was not because they need less. It was because of financial burden. On the condition that they cannot or just meet the primary needs for surviving, they have no choice but to ignore the health care need and put down health care expenditure. Besides, if the disabled elders have lost the ability to take care of themselves, the families have to face a greater financial burden on health care expenditure. However, some social enabled factors such as insurance, pension, living allowance and community service for the disabled have not played a significant role in protecting rural families of disabled elders. The result gained from the regional level prove that in the area of higher reimbursement ratio of NCMS or of ampler medical supply, the problem of the fairness of heath resources utilization may be more serious. However, these findings do not aim to deny the benefits of improving reimbursement ratio of NCMS and increasing medical supply. It is aim to highlight the importance of establishing medical assistance system for the disadvantaged during the course of improving reimbursement ratio of NCMS and increasing medical supply.Based on the multilevel analysis of the health expenditure of the rural families of the diabled elders, the study finally suggests that:Firstly, we should consider regional difference in formulating the policies of medical assistance. Secondly, we should improve the reimbursement level of the new rural cooperative system in order to reduce rural residents' medical burden. Last but not the least, we should work out policies of medical assistance to meet the different needs of more vulnerable families such as poor families or families which have to take care of the elders who have lost the ability of caring themselves so as to improve the equality in utilization of medical resources.