{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T01:36:39Z","timestamp":1790300199411,"version":"4.1.0"},"reference-count":49,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,5,16]],"date-time":"2024-05-16T00:00:00Z","timestamp":1715817600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004735","name":"Natural Science Foundation of Hunan Province","doi-asserted-by":"publisher","award":["2023JJ40472"],"award-info":[{"award-number":["2023JJ40472"]}],"id":[{"id":"10.13039\/501100004735","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>This study investigates the determinants of medical impoverishment among China's rural near-poor, aiming to enhance public health services and establish preventative and monitoring systems.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Using China Family Panel Studies and World Bank methods, we categorized rural populations and calculated their 2020 Poverty Incidence (PI) and Poverty Gap (PG), with impoverishing health expenditures (IHE) as the primary indicator. We analyzed the data from 2016 to 2020 using a conditional fixed-effects multinomial logit model and 2020 logistic regression to identify factors influencing medical impoverishment risk.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>(1) In 2020, the near-poor in China faced a PI of 16.65% post-health expenditures, 8.63 times greater than the non-poor's PI of 1.93%. The near-poor's Average Poverty Gap (APG) was CNY 1,920.67, notably surpassing the non-poor's figure of CNY 485.58. Health expenses disproportionately affected low-income groups, with the near-poor more prone to medical impoverishment. (2) Disparities in medical impoverishment between different economic household statuses were significant (<jats:italic>P<\/jats:italic> &amp;lt; 0.001), with the near-poor being particularly vulnerable. (3) For rural near-poor households in China, those with over six members faced a lower risk of medical impoverishment compared to those with three or fewer. Unmarried individuals had a 7.1% reduced risk of medical impoverishment relative to married\/cohabiting counterparts. Unemployment was associated with a 9% increased risk. A better self-rated health status was linked to a lower probability of IHE, with the \u201cvery healthy\u201d reporting a 25.8% lower risk than those \u201cunhealthy.\u201d Chronic disease sufferers in the near-poor and non-poor categories were at an increased risk of 12 and 1.4%, respectively. Other surveyed factors, including migrant status, age, insurance type, gender, educational level, and recent smoking or drinking, were not statistically significant (<jats:italic>P<\/jats:italic> &amp;gt; 0.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Rural near-poor in China are much more susceptible to medical impoverishment, influenced by specific socio-economic factors. The findings advocate for policy enhancements and health system reforms to mitigate health poverty. Further research should extend to urban areas for comprehensive health poverty strategy development.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2024.1412536","type":"journal-article","created":{"date-parts":[[2024,5,16]],"date-time":"2024-05-16T04:28:32Z","timestamp":1715833712000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["Analysis of medical impoverishment and its influencing factors among China's rural near-poor, 2016\u20132020"],"prefix":"10.3389","volume":"12","author":[{"given":"Qiwei","family":"Feng","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Che","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuying","family":"Yi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinbin","family":"Xia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,5,16]]},"reference":[{"key":"B1","unstructured":"NationsU\n          Transforming Our World: The 2030 Agenda for Sustainable Development2015"},{"key":"B2","unstructured":"NationsU\n          The Sustainable Development Goals Report 2023: Special Edition2023"},{"key":"B3","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1016\/j.socscimed.2016.01.040","article-title":"Poverty dynamics in Germany: evidence on the relationship between persistent poverty and health behavior","volume":"153","author":"Aue","year":"2016","journal-title":"Soc Sci Med."},{"key":"B4","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12939-020-1121-0","article-title":"Health, income and poverty: evidence from China's rural household survey","volume":"19","author":"Zhou","year":"2020","journal-title":"Int J Equity Health."},{"key":"B5","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1086\/259880","article-title":"On the concept of health capital and the demand for health","volume":"80","author":"Grossman","year":"1972","journal-title":"J Polit Econ."},{"key":"B6","doi-asserted-by":"publisher","first-page":"512143","DOI":"10.3389\/fpubh.2020.00231","article-title":"Socioeconomic status and access to healthcare: interrelated drivers for healthy aging","volume":"8","author":"McMaughan","year":"2020","journal-title":"Front Public Health."},{"key":"B7","unstructured":"Tracking Universal Health Coverage: 2023 Global Monitoring Report: Executive Summary2023"},{"key":"B8","first-page":"1","volume-title":"Health Care Access and Utilization Among Adults Aged 18\u201364, by Poverty Level: United States, 2013\u20132015. 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