CAPTURING VULNERABILITY BEYOND EXPENDITURE BURDEN: A COMPARISON OF FINANCIAL RISK PROTECTION INDICATORS IN CHINA
Author(s)
Danyang Wei, Master student, Yifan Fu, Master student, MIN HU, PhD.
Fudan University, Shanghai, China.
Fudan University, Shanghai, China.
OBJECTIVES: Conventional financial risk protection indicators, such as catastrophic health expenditure (CHE), primarily reflect realized out-of-pocket burden, but may fail to capture financial vulnerability arising from limited residual capacity after health payments. As China advances UHC, this study examined whether the revised SDG 3.8.2 indicator identifies households differently from conventional measures
METHODS: We used repeated cross-sectional samples from six waves (2012-2022) of the nationally representative China Family Panel Studies, with 7,846-13,102 households per wave. We compared three indicators: (1) CHE, defined as out-of-pocket spending ≥40% of non-food expenditure; (2) impoverishing health expenditure (IHE), defined as being pushed below the poverty line after health payments; and (3) revised SDG 3.8.2 indicator, incorporating basic needs thresholds and post-payment capacity to pay. We estimated annual prevalence, concentration Indices (CIs) and cross-classification patterns. Between-group differences were assessed using t-tests and chi-square
RESULTS: The revised SDG 3.8.2 indicator yielded the highest prevalence, declining from 22.18% to 12.48% during 2012-2022, followed by CHE (13.05% to 9.65%) and IHE (3.94% to 1.42%).Pro-poor inequality increased for the revised indicator (CI: -0.231 to -0.448) and IHE (-0.272 to -0.727), but remained modest for CHE(-0.188 to -0.229). Cross-classification revealed substantial discordance: “Revised-only” households—captured only by the revised indicator, but not by CHE/IHE—declined from 10.30% to 4.92% but consistently exceeded “CHE-only” households (2.47%-3.49%), while IHE was almost entirely nested within the revised indicator. In 2022, revised-only households exhibited significantly lower median income (CNY 8,679 vs. CNY 25,717)and higher proportions of rural residents (77.45% vs. 31.80%), lowest-income quintile members (59.56% vs. 14.29%), and poor households (19.61% vs. 1.38%); patterns were generally consistent across years
CONCLUSIONS: While financial risk burdens declined in China, vulnerability remained non-negligible and concentrated among the socioeconomically disadvantaged.The revised SDG 3.8.2 indicator successfully captured a subgroup of vulnerable households missed by CHE and IHE, supporting more comprehensive UHC assessment and targeted financial protection
METHODS: We used repeated cross-sectional samples from six waves (2012-2022) of the nationally representative China Family Panel Studies, with 7,846-13,102 households per wave. We compared three indicators: (1) CHE, defined as out-of-pocket spending ≥40% of non-food expenditure; (2) impoverishing health expenditure (IHE), defined as being pushed below the poverty line after health payments; and (3) revised SDG 3.8.2 indicator, incorporating basic needs thresholds and post-payment capacity to pay. We estimated annual prevalence, concentration Indices (CIs) and cross-classification patterns. Between-group differences were assessed using t-tests and chi-square
RESULTS: The revised SDG 3.8.2 indicator yielded the highest prevalence, declining from 22.18% to 12.48% during 2012-2022, followed by CHE (13.05% to 9.65%) and IHE (3.94% to 1.42%).Pro-poor inequality increased for the revised indicator (CI: -0.231 to -0.448) and IHE (-0.272 to -0.727), but remained modest for CHE(-0.188 to -0.229). Cross-classification revealed substantial discordance: “Revised-only” households—captured only by the revised indicator, but not by CHE/IHE—declined from 10.30% to 4.92% but consistently exceeded “CHE-only” households (2.47%-3.49%), while IHE was almost entirely nested within the revised indicator. In 2022, revised-only households exhibited significantly lower median income (CNY 8,679 vs. CNY 25,717)and higher proportions of rural residents (77.45% vs. 31.80%), lowest-income quintile members (59.56% vs. 14.29%), and poor households (19.61% vs. 1.38%); patterns were generally consistent across years
CONCLUSIONS: While financial risk burdens declined in China, vulnerability remained non-negligible and concentrated among the socioeconomically disadvantaged.The revised SDG 3.8.2 indicator successfully captured a subgroup of vulnerable households missed by CHE and IHE, supporting more comprehensive UHC assessment and targeted financial protection
Conference/Value in Health Info
2026-09, ISPOR Asia Pacific 2026, Bangkok, Thailand
Value in Health, Volume 55, Issue S1
Code
HPR12
Topic
Health Policy & Regulatory
Topic Subcategory
Health Disparities & Equity
Disease
No Additional Disease & Conditions/Specialized Treatment Areas