Study on the spatial and temporal differences and influencing factors of out-of-pocket payments as a share of total health expenditure in China
Abstract Background Globally, Out-of-pocket (OOP) payments as a share of Total Health Expenditure (THE) has always been a focus of attention in the field of health economics, which affects the economic burden of medical treatment for residents. At present, countries around the world have widely used...
Saved in:
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2025-03-01
|
| Series: | BMC Health Services Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12913-025-12631-x |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849392647555252224 |
|---|---|
| author | Xiaoyu Dong Huaizhi Cheng Ruotong Tian Lingxiao Gao Wenpei Lyu Jiaqi Zhang Doudou Huang Bin Guo |
| author_facet | Xiaoyu Dong Huaizhi Cheng Ruotong Tian Lingxiao Gao Wenpei Lyu Jiaqi Zhang Doudou Huang Bin Guo |
| author_sort | Xiaoyu Dong |
| collection | DOAJ |
| description | Abstract Background Globally, Out-of-pocket (OOP) payments as a share of Total Health Expenditure (THE) has always been a focus of attention in the field of health economics, which affects the economic burden of medical treatment for residents. At present, countries around the world have widely used spatial econometric models to conduct in-depth discussions and analyses of their own OOP, exploring the spatial distribution characteristics and influencing factors of OOP in different regions. However, in China, research in this area is relatively scarce, and few studies have been conducted from a macro perspective and space-time dimension. Methods Based on the panel data of 31 provinces in China, the spatiotemporal distribution characteristics of the proportion of OOP payments in China from 2013 to 2022 were analyzed using spatial autocorrelation. The spatial Durbin model (SDM) was employed to explore the factors influencing OOP payments as a share of THE in China. Results The results indicate that the proportion of OOP in China shows a decreasing trend, and there is a significant spatial positive correlation. The change in spatial agglomeration is relatively stable, and only some provinces have a slight change. SDM shows that the main factors affecting the inter-provincial differences in the OOP proportion in China include the elderly dependency ratio (direct effect − 0.181, indirect effect − 0.585), the child dependency ratio (direct effect 0.292, indirect effect 0.686), per capita GDP(direct effect 11.235), and the proportion of government health expenditure to fiscal expenditure (direct effect − 0.254, indirect effect − 0.994), the average number of medical visits per year (direct effect − 0.444), the expenditure of basic medical insurance (direct effect − 1.519, indirect effect − 3.940), and the average medical cost of outpatients (direct effect 3.142, indirect effect − 10.064). These factors collectively influence the spatial variation in OOP payments across provinces in China. Conclusion The spatial distribution difference of OOP proportion in China is obvious. Factors such as demographics, economics, policy, and health service utilization can all significantly influence OOP. The government should further implement differentiated medical security policies, optimize the allocation structure of health resources, enhance the capacity of primary medical services, promote cross-provincial medical cooperation, and ensure that local residents can enjoy equal access to high-quality medical services and reduce their medical burden. |
| format | Article |
| id | doaj-art-75cdcd6d705c4db68d8c60eaa7735f82 |
| institution | Kabale University |
| issn | 1472-6963 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj-art-75cdcd6d705c4db68d8c60eaa7735f822025-08-20T03:40:44ZengBMCBMC Health Services Research1472-69632025-03-0125111310.1186/s12913-025-12631-xStudy on the spatial and temporal differences and influencing factors of out-of-pocket payments as a share of total health expenditure in ChinaXiaoyu Dong0Huaizhi Cheng1Ruotong Tian2Lingxiao Gao3Wenpei Lyu4Jiaqi Zhang5Doudou Huang6Bin Guo7Harbin Medical University-DaqingHarbin Medical University-DaqingHarbin Medical University-DaqingHarbin Medical University-DaqingHarbin Medical University-DaqingHarbin Medical University-DaqingHarbin Medical University-DaqingHarbin Medical University-DaqingAbstract Background Globally, Out-of-pocket (OOP) payments as a share of Total Health Expenditure (THE) has always been a focus of attention in the field of health economics, which affects the economic burden of medical treatment for residents. At present, countries around the world have widely used spatial econometric models to conduct in-depth discussions and analyses of their own OOP, exploring the spatial distribution characteristics and influencing factors of OOP in different regions. However, in China, research in this area is relatively scarce, and few studies have been conducted from a macro perspective and space-time dimension. Methods Based on the panel data of 31 provinces in China, the spatiotemporal distribution characteristics of the proportion of OOP payments in China from 2013 to 2022 were analyzed using spatial autocorrelation. The spatial Durbin model (SDM) was employed to explore the factors influencing OOP payments as a share of THE in China. Results The results indicate that the proportion of OOP in China shows a decreasing trend, and there is a significant spatial positive correlation. The change in spatial agglomeration is relatively stable, and only some provinces have a slight change. SDM shows that the main factors affecting the inter-provincial differences in the OOP proportion in China include the elderly dependency ratio (direct effect − 0.181, indirect effect − 0.585), the child dependency ratio (direct effect 0.292, indirect effect 0.686), per capita GDP(direct effect 11.235), and the proportion of government health expenditure to fiscal expenditure (direct effect − 0.254, indirect effect − 0.994), the average number of medical visits per year (direct effect − 0.444), the expenditure of basic medical insurance (direct effect − 1.519, indirect effect − 3.940), and the average medical cost of outpatients (direct effect 3.142, indirect effect − 10.064). These factors collectively influence the spatial variation in OOP payments across provinces in China. Conclusion The spatial distribution difference of OOP proportion in China is obvious. Factors such as demographics, economics, policy, and health service utilization can all significantly influence OOP. The government should further implement differentiated medical security policies, optimize the allocation structure of health resources, enhance the capacity of primary medical services, promote cross-provincial medical cooperation, and ensure that local residents can enjoy equal access to high-quality medical services and reduce their medical burden.https://doi.org/10.1186/s12913-025-12631-xOut-of-pocket paymentsSpatial-temporal differenceInfluencing factorSpatial dubin modelChina |
| spellingShingle | Xiaoyu Dong Huaizhi Cheng Ruotong Tian Lingxiao Gao Wenpei Lyu Jiaqi Zhang Doudou Huang Bin Guo Study on the spatial and temporal differences and influencing factors of out-of-pocket payments as a share of total health expenditure in China BMC Health Services Research Out-of-pocket payments Spatial-temporal difference Influencing factor Spatial dubin model China |
| title | Study on the spatial and temporal differences and influencing factors of out-of-pocket payments as a share of total health expenditure in China |
| title_full | Study on the spatial and temporal differences and influencing factors of out-of-pocket payments as a share of total health expenditure in China |
| title_fullStr | Study on the spatial and temporal differences and influencing factors of out-of-pocket payments as a share of total health expenditure in China |
| title_full_unstemmed | Study on the spatial and temporal differences and influencing factors of out-of-pocket payments as a share of total health expenditure in China |
| title_short | Study on the spatial and temporal differences and influencing factors of out-of-pocket payments as a share of total health expenditure in China |
| title_sort | study on the spatial and temporal differences and influencing factors of out of pocket payments as a share of total health expenditure in china |
| topic | Out-of-pocket payments Spatial-temporal difference Influencing factor Spatial dubin model China |
| url | https://doi.org/10.1186/s12913-025-12631-x |
| work_keys_str_mv | AT xiaoyudong studyonthespatialandtemporaldifferencesandinfluencingfactorsofoutofpocketpaymentsasashareoftotalhealthexpenditureinchina AT huaizhicheng studyonthespatialandtemporaldifferencesandinfluencingfactorsofoutofpocketpaymentsasashareoftotalhealthexpenditureinchina AT ruotongtian studyonthespatialandtemporaldifferencesandinfluencingfactorsofoutofpocketpaymentsasashareoftotalhealthexpenditureinchina AT lingxiaogao studyonthespatialandtemporaldifferencesandinfluencingfactorsofoutofpocketpaymentsasashareoftotalhealthexpenditureinchina AT wenpeilyu studyonthespatialandtemporaldifferencesandinfluencingfactorsofoutofpocketpaymentsasashareoftotalhealthexpenditureinchina AT jiaqizhang studyonthespatialandtemporaldifferencesandinfluencingfactorsofoutofpocketpaymentsasashareoftotalhealthexpenditureinchina AT doudouhuang studyonthespatialandtemporaldifferencesandinfluencingfactorsofoutofpocketpaymentsasashareoftotalhealthexpenditureinchina AT binguo studyonthespatialandtemporaldifferencesandinfluencingfactorsofoutofpocketpaymentsasashareoftotalhealthexpenditureinchina |