Xiaojuan Zhang ^1* Kun Zhu ²

• ¹ The Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
• ² Chinese Academy of Fiscal Science, Beijing, China

Background:Since their establishment, the two predominant social health insurance schemes in China, Urban Employee Medical Insurance (UEMIS) and Urban and Rural Residents' Medical Insurance(URRMS), have primarily focused on covering non-inpatient expenditure, while costs associated with outpatient care and pharmaceutical purchases have been largely excluded from the insurance benefit package. This study intends to analyze the distribution of non-hospitalization expenditure and assess resulting financial risks, with an objective to reform the health insurance benefit package by including coverage for non-hospitalization costs.Methods: The primary data were obtained from the 2018 wave of CHARLS, encompassing a total of 12,914 individuals for analysis. Assess the financial risk associated with non-hospitalization expenses through catastrophic health expenditures and examine the determinants of CHE using logistic regression analysis.Results: Over 60% of the participants availed non-inpatient services in the month preceding the investigation. A smaller proportion (14.26% and 14.28% for UEMIS and URRMS enrollee, respectively) utilized outpatient services provided by medical institutions, while a larger proportion (54.20% and 56.91% for UEMIS and URRMS enrollee, respectively) purchased medication from pharmacies.The study reveals a distinct subgroup of participants ( 8.91% and 6.82% for UEMIS and URRMS enrollee, respectively)who incurs substantial out-of-pocket non-inpatient expenditure, surpassing 1,000 RMB per month. However, reimbursement for non-inpatient expenditures is significantly limited under the two predominant health insurance schemes, and there is minimal disparity in the distribution of non-inpatient expenses before and after insurance reimbursement.The prevalence of catastrophic health expenditures (CHE) resulting from non-inpatient costs was substantial, particularly among participants enrolled in URRMS(14.78% ) compared to those enrolled in UEMIS(9.87%). The presence of chronic diseases, advanced age, and limited financial resources are all determinants contributing to the occurrence of CHE.The incorporation of non-inpatient expenses into China's fundamental health insurance plan remains a contentious issue, given the limited available evidence. This study presents empirical evidence underscoring the significance of non-inpatient expenditures as a determinant of financial risk, thereby emphasizing the imperative to adjust China's fundamental health insurance benefit package in order to address risks associated with non-inpatient costs, particularly among individuals with chronic illnesses and limited income.