Toward Universal Health Coverage: Regional Inequalities and Potential Solutions for Alleviating Catastrophic Health Expenditure in the Post-poverty Elimination Era of China

Background: This study took Beijing as an example to estimate the incidence and regional inequalities of catastrophic health expenditures (CHE) in a megacity of China. Methods: This study used data from the Health Services Survey Beijing (HSSB) 2018. Logistic regressions were used to investigate the risk factors for experiencing CHE, and concentration curves, the concentration index and its decomposition method based on probit models were used to estimate the inequalities in CHE. Results: CHE occurred in 25.51% of the households of the outer suburb villages, 6.78% of the households of the inner-city area communities, 17.10% of the households of the villages of the inner-city areas, and 11.91% of the households of the communities of the outer suburbs. In areas in the outer suburbs, households with private insurance coverage were associated with a lowered risk of CHE, and lower educational attainment and lower occupational class were related to an increasing risk of CHE. This study also discovered pro-rich financing disparities in CHE in Beijing, with the outer suburbs having the highest levels of CHE disparity. When it comes to the observed contributions of disparities in CHE, a significant portion of them is connected to the sorts of occupations, educational levels, and residential status. Conclusion: The impoverishment brought on by medical expenses and CHE must still be taken into account in the post-poverty elimination era. The megacity of China was discovered to have significant regional differences in the incidence of pro-rich financing inequity in CHE. Disparities in socioeconomic status (SES), one of the controllable variables, may be a key area to address to lower the risk and minimize CHE inequality in megacities towards the path to UHC. Additionally, it is important to consider the financial protection impact of inclusive supplementary medical insurance on lowering the likelihood of CHE in the periphery areas.