Definition methods and standards on medical assistance objects of catastrophic diseases systems based on catastrophic health expenditure perspective

Objective To explore the methods and standards of catastrophic health expenditure for China, and improve the operability in defining those impoverished due to diseases. Methods 600 households with inpatients were randomly sampled from 12 villages of three townships in City M in Hubei province for household survey.Literature review and expert consultation methods were used to measure and determine the threshold of catastrophic health expenditure(CHE)of City M, with improvements made by grouping. Results In a uniform standard, the CHE occurrence of the income method and expenditure method is lower than the non-existence expenditure method and WHO method, verifying theoretically that the standard set for the former should be higher than the latter.In addition, the income method and expenditure method present differently in China.Standards set should vary with different measurement methods, maintaining approximate CEH expenditure for the same region.For the income method and expenditure method, the recommended benchmark reference is 25%, with an adjustable range of 35%~45%.Mutual verifications of these methods can further determine a rational CHE value. Conclusions The CHE methods support the definition of people impoverished due to diseases beyond their household payment capacity.Different thresholds however should be set for different methods, and the relative standards should be translated into absolute standards by grouping. Key words: Catastrophic health expenditure; Catastrophic diseases; Medical assistance; Definition; Standards