{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T15:28:18Z","timestamp":1787239698029,"version":"build-2736575974"},"reference-count":39,"publisher":"BMJ","issue":"8","license":[{"start":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T00:00:00Z","timestamp":1787184000000},"content-version":"unspecified","delay-in-days":19,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Shaanxi Provincial Social Science Fund of China","award":["2024R034"],"award-info":[{"award-number":["2024R034"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,6,30]]},"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Kashin\u2013Beck disease (KBD) is a chronic, endemic osteoarthropathy that imposed a heavy financial burden on patients and their households. This study aimed to measure the incidence of catastrophic health expenditure (CHE), and compare its differences between KBD-suffered households with and without access to the Free Surgery Policy in China.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A cross-sectional survey was conducted between 2023 and 2024 in Shaanxi Province of China.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>The study was carried out in four KBD-endemic counties (Linyou, Qishan, Huanglong and Yongshou) of Shaanxi Province, China.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>A two-stage probability sampling method was used to select 709 households having at least one patient diagnosed with KBD. Households were divided into policy recipients and non-recipients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome measures<\/jats:title>\n                    <jats:p>The primary outcome was incidence of CHE, defined as out-of-pocket health expenditures accounting for 40% or more of a household\u2019s capacity to pay.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The overall incidence of CHE was 38.93% among KBD households. A statistically significant difference in CHE incidence was observed between policy recipients and non-recipients, with the former presenting a lower incidence (35.35% vs 45.04%, p=0.011). After coarsened exact matching, the odds of CHE in policy-recipient households were 0.651 times that of non-recipient households (p&lt;0.001). Subgroup analysis showed that low-income and middle-income households receiving the policy showed significantly lower CHE incidence compared with their non-recipient counterparts (Low: OR=0.491, p&lt;0.01; Middle: OR=0.320, p&lt;0.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>KBD households experience high CHE incidence. Policy-recipient households demonstrate a lower incidence of CHE compared with non-recipient households, with the comparative advantage of the Free Surgery Policy being more pronounced in low-income and middle-income groups. These comparative findings provide empirical support for healthcare providers and policymakers to consider expanding the coverage of the policy and optimising its reimbursement process, thereby mitigating CHE incidence in their households.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-114845","type":"journal-article","created":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T14:45:51Z","timestamp":1787237151000},"page":"e114845","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Catastrophic health expenditure among households with Kashin\u2013Beck disease patients in the context of free surgery policy: a comparative study from Shaanxi province in China"],"prefix":"10.1136","volume":"16","author":[{"given":"Yongjian","family":"Xu","sequence":"first","affiliation":[{"name":"School of Public Policy and Administration, Xi\u2019an Jiaotong University, Xi\u2019an, Shaanxi, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-1724-0077","authenticated-orcid":false,"given":"Yazhuo","family":"Liu","sequence":"additional","affiliation":[{"name":"School of Public Policy and Administration, Xi\u2019an Jiaotong University, Xi\u2019an, Shaanxi, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jia","family":"Wu","sequence":"additional","affiliation":[{"name":"School of Public Policy and Administration, Xi\u2019an Jiaotong University, Xi\u2019an, Shaanxi, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Li","sequence":"additional","affiliation":[{"name":"School of Public Policy and Administration, Xi\u2019an Jiaotong University, Xi\u2019an, Shaanxi, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiaxin","family":"Sun","sequence":"additional","affiliation":[{"name":"School of Public Policy and Administration, Xi\u2019an Jiaotong University, Xi\u2019an, Shaanxi, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xueyan","family":"Han","sequence":"additional","affiliation":[{"name":"School of Public Policy and Administration, Xi\u2019an Jiaotong University, Xi\u2019an, Shaanxi, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Zhang","sequence":"additional","affiliation":[{"name":"Shaanxi Provincial Center for Disease Control and Prevention, Xi\u2019an, Shaanxi, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming","family":"Chen","sequence":"additional","affiliation":[{"name":"Shaanxi Provincial Center for Disease Control and Prevention, Xi\u2019an, Shaanxi, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yunlong","family":"Song","sequence":"additional","affiliation":[{"name":"Shaanxi Provincial Center for Disease Control and Prevention, Xi\u2019an, Shaanxi, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liang","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Health Service Management and Medical Education, School of Public Health, Fourth Military Medical University, Xi\u2019an, Shaanxi, China"},{"name":"The Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, Xi\u2019an, Shaanxi, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,8,20]]},"reference":[{"key":"2026082007453073000_16.8.e114845.1","doi-asserted-by":"crossref","first-page":"1536","DOI":"10.1016\/B978-0-323-09138-1.00185-6","article-title":"Rare osteoarthritis: Ochronosis and Kashin-Beck disease","volume":"2","author":"Kraus","year":"2015","journal-title":"Rheumatology"},{"key":"2026082007453073000_16.8.e114845.2","first-page":"97","article-title":"Pattern of joints involvement in Kashin-Beck disease: a local osteochondropathy in China","volume":"22","author":"Farooq","year":"2010","journal-title":"J Ayub Med Coll Abbottabad"},{"key":"2026082007453073000_16.8.e114845.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.joca.2014.07.023"},{"key":"2026082007453073000_16.8.e114845.4","doi-asserted-by":"crossref","unstructured":"Guo X , Ning Y , Wang X . 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