{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T17:23:39Z","timestamp":1784049819703,"version":"3.55.0"},"reference-count":64,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2025,9,16]],"date-time":"2025-09-16T00:00:00Z","timestamp":1757980800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"China Postdoctoral Science Fund\u2014General Fund","award":["2024M751590"],"award-info":[{"award-number":["2024M751590"]}]},{"name":"China Postdoctoral Science Fund\u2014General Fund","award":["2024TSG06402"],"award-info":[{"award-number":["2024TSG06402"]}]},{"name":"China Postdoctoral Science Fund\u2014General Fund","award":["72441022"],"award-info":[{"award-number":["72441022"]}]},{"name":"Shui Mu Tsinghua Scholar Program, Tsinghua Strategy for Heightening Arts, Humanities and Social Sciences Plateaus &amp; Peaks","award":["2024M751590"],"award-info":[{"award-number":["2024M751590"]}]},{"name":"Shui Mu Tsinghua Scholar Program, Tsinghua Strategy for Heightening Arts, Humanities and Social Sciences Plateaus &amp; Peaks","award":["2024TSG06402"],"award-info":[{"award-number":["2024TSG06402"]}]},{"name":"Shui Mu Tsinghua Scholar Program, Tsinghua Strategy for Heightening Arts, Humanities and Social Sciences Plateaus &amp; Peaks","award":["72441022"],"award-info":[{"award-number":["72441022"]}]},{"name":"China National Natural Science Foundation","award":["2024M751590"],"award-info":[{"award-number":["2024M751590"]}]},{"name":"China National Natural Science Foundation","award":["2024TSG06402"],"award-info":[{"award-number":["2024TSG06402"]}]},{"name":"China National Natural Science Foundation","award":["72441022"],"award-info":[{"award-number":["72441022"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Systems"],"abstract":"<jats:p>Background: The intersection of aging and disability is an important social issue. The rehabilitation system of older adults with disabilities is a complex social system including various social units. This study aims to investigate the impact of the \u201cinclusion of rehabilitation services in basic medical insurance\u201d (IRSMI) policy on the utilization of rehabilitation services and annual household healthcare expenditure among older adults with disabilities. Methods: Using the data of China Disabled Persons\u2019 Condition Monitoring Survey (2009\u20132012), this study employed the difference-in-differences method to analyze the impact of IRSMI on rehabilitation services utilization and household healthcare expenditure, and further examined the differential effects of the policy on service utilization across subpopulations with different demographic characteristics, including gender, age, and disability severity. The Heckman two-stage model corrects for sample selection bias caused by the share of households with zero health expenditures. Event-study specification was applied to assess the validity of the parallel trends assumption in the DID framework. Baron &amp; Kenny\u2019s three-step method was used to explore the potential mediating mechanism. Results: (1) IRSMI significantly increased the likelihood of utilizing rehabilitation services among older adults with disabilities (OR = 1.349), but this kind of promotive effect mainly focus on males (OR = 1.530), middle-aged and older disabled individuals (OR = 1.423), and those with mild disabilities (OR = 1.444). (2) The implementation of IRSMI contributed to an approximately 20.3% increase in annual healthcare expenditures for households with older adults with disabilities (\u03b2 = 0.185). (3) IRSMI significantly promoted the increase in household healthcare expenditures for high-income older adults with disabilities (\u03b2 = 0.181), but had limited impact on low- and middle-income groups. (4) Rehabilitation services utilization played a mediating role in the relationship between IRSMI and household healthcare expenditure, with about 19.0% of the increase in annual household healthcare expenditures attributable to the enhanced utilization of rehabilitation services. Conclusions: In the complex social system of rehabilitation for older adults with disabilities, the IRSMI policy significantly increases the likelihood of rehabilitation services utilization and substantially raises annual household healthcare expenditures. However, the heterogeneous effects across gender, age, disability severity, and income levels reflect structural inequities embedded in the rehabilitation system, underscoring the need for adaptive and equity-oriented interventions.<\/jats:p>","DOI":"10.3390\/systems13090812","type":"journal-article","created":{"date-parts":[[2025,9,17]],"date-time":"2025-09-17T05:59:51Z","timestamp":1758088791000},"page":"812","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The Impact of the \u201cInclusion of Rehabilitation Services in Basic Medical Insurance\u201d Policy on the Utilization of Rehabilitation Services and Household Healthcare Expenditure Among Older Adults with Disabilities: Evidence from China"],"prefix":"10.3390","volume":"13","author":[{"given":"Yiran","family":"Wang","sequence":"first","affiliation":[{"name":"Vanke School of Public Health, Tsinghua University, Beijing 100084, China"},{"name":"Institute for Healthy China, Tsinghua University, Beijing 100084, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lu","family":"Tan","sequence":"additional","affiliation":[{"name":"School of Media and Communication, Shanghai Jiao Tong University, Shanghai 200240, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaodong","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Sociology, People\u2019s Public Security University of China, Beijing 100038, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoqian","family":"Yan","sequence":"additional","affiliation":[{"name":"School of Nursing and Rehabilitation, Shandong University, Jinan 250014, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Le","family":"Wang","sequence":"additional","affiliation":[{"name":"Vanke School of Public Health, Tsinghua University, Beijing 100084, China"},{"name":"Institute for Healthy China, Tsinghua University, Beijing 100084, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chenyu","family":"Yan","sequence":"additional","affiliation":[{"name":"Vanke School of Public Health, Tsinghua University, Beijing 100084, China"},{"name":"Institute for Healthy China, Tsinghua University, Beijing 100084, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yichunzi","family":"Zhang","sequence":"additional","affiliation":[{"name":"Vanke School of Public Health, Tsinghua University, Beijing 100084, China"},{"name":"Institute for Healthy China, Tsinghua University, Beijing 100084, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tianran","family":"Wang","sequence":"additional","affiliation":[{"name":"Vanke School of Public Health, Tsinghua University, Beijing 100084, China"},{"name":"Institute for Healthy China, Tsinghua University, Beijing 100084, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sijiu","family":"Wang","sequence":"additional","affiliation":[{"name":"Vanke School of Public Health, Tsinghua University, Beijing 100084, China"},{"name":"Institute for Healthy China, Tsinghua University, Beijing 100084, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wannian","family":"Liang","sequence":"additional","affiliation":[{"name":"Vanke School of Public Health, Tsinghua University, Beijing 100084, China"},{"name":"Institute for Healthy China, Tsinghua University, Beijing 100084, China"},{"name":"College of General Practice, Southern University of Science and Technology, Shenzhen 518000, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,16]]},"reference":[{"key":"ref_1","first-page":"16","article-title":"WHO Rehabilitation in Health System: Background, Framework and Approach, Contents and Implementation","volume":"26","author":"Qiu","year":"2020","journal-title":"Chin. J. Rehabil. Theory Pract."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"593","DOI":"10.46234\/ccdcw2021.158","article-title":"Trends and challenges for population and health during population aging\u2014China, 2015\u20132050","volume":"3","author":"Luo","year":"2021","journal-title":"CCDC Weekly"},{"key":"ref_3","unstructured":"Quah, S.R. (2016). Western Europe, health systems of. International Encyclopedia of Public Health, Academic Press."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1146\/annurev.soc.28.110601.141117","article-title":"From Factors to Actors: Computational Sociology and Agent-Based Modeling","volume":"28","author":"Macy","year":"2002","journal-title":"Annu. Rev. Sociol."},{"key":"ref_5","unstructured":"Xinhua News Agency (2025, September 09). China Releases the Main Data Bulletin of the Second National Sampling Survey of Disabled Persons, Available online: http:\/\/www.gov.cn\/jrzg\/2007-05\/28\/content_628517.htm."},{"key":"ref_6","first-page":"21","article-title":"The impact of Urban Residents\u2019 Medical Insurance on health service utilization\u2014Policy effect and robustness test","volume":"5","author":"Hu","year":"2012","journal-title":"J. Zhong Univ. Econ. Law."},{"key":"ref_7","unstructured":"General Office of the State Council of the People\u2019s Republic of China (2025, September 09). National Action Plan for Disability Prevention (2021\u20132025), Available online: https:\/\/www.gov.cn\/gongbao\/content\/2022\/content_5669420.htm."},{"key":"ref_8","first-page":"155","article-title":"The World Health Organization \u201cRehabilitation 2030: A call for action\u201d","volume":"53","author":"Gimigliano","year":"2017","journal-title":"Eur. J. Phys. Rehab. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2006","DOI":"10.1016\/S0140-6736(20)32340-0","article-title":"Global estimates of the need for rehabilitation based on the Global Burden of Disease Study 2019: A systematic analysis for the Global Burden of Disease Study 2019","volume":"396","author":"Cieza","year":"2020","journal-title":"Lancet"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1111\/j.1447-0594.2008.00466.x","article-title":"In-depth descriptive analysis of trends in prevalence of long-term care in Japan","volume":"8","author":"Fukuda","year":"2008","journal-title":"Geriatr. Gerontol. Int."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1186\/s13561-022-00407-6","article-title":"Rehabilitation in the long-term care insurance domain: A scoping review","volume":"12","author":"Shinohara","year":"2022","journal-title":"Health Econ. Rev."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2242114","DOI":"10.1080\/23288604.2023.2242114","article-title":"Improving access to and coverage of rehabilitation services through the implementation of rehabilitation in primary health care: A case study from Chile","volume":"9","author":"Seijas","year":"2023","journal-title":"Health Syst. Reform."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Gupta, N., Castillo-Laborde, C., and Landry, M.D. (2011). Health-related rehabilitation services: Assessing the global supply of and need for human resources. BMC Health Serv. Res., 11.","DOI":"10.1186\/1472-6963-11-276"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Garg, A., Skempes, D., and Bickenbach, J. (2020). Legal and regulatory approaches to rehabilitation planning: A concise overview of current laws and policies addressing access to rehabilitation in five European countries. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17124363"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"167","DOI":"10.2471\/BLT.17.191809","article-title":"Strengthening health systems to provide rehabilitation services","volume":"95","author":"Krug","year":"2017","journal-title":"Bull. World Health Organ."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1383","DOI":"10.1007\/s10198-022-01550-x","article-title":"Insurance coverage, long-term care utilization, and health outcomes","volume":"24","author":"Takahashi","year":"2023","journal-title":"Eur. J. Health Econ."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Cheng, Q., Fattah, R.A., Susilo, D., Satrya, A., Haemmerli, M., Kosen, S., Novitasari, D., Puteri, G.C., Adawiyah, E., and Hayen, Y. (2025). Determinants of healthcare utilization under the Indonesian national health insurance system: A cross-sectional study. BMC Health Serv. Res., 25.","DOI":"10.1186\/s12913-024-11951-8"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2331","DOI":"10.2147\/JMDH.S454985","article-title":"Understanding care needs of older adults with disabilities: A scoping review","volume":"18","author":"Zhou","year":"2024","journal-title":"J. Multidiscip. Healthc."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"882","DOI":"10.1016\/S0140-6736(17)31280-1","article-title":"Statutory health insurance in Germany: A health system shaped by 135 years of solidarity, self-governance, and competition","volume":"390","author":"Busse","year":"2017","journal-title":"Lancet"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Bachani, A.M., Bentley, J.A., Kautsar, H., Neill, R., and Trujillo, A.J. (2024). Suggesting global insights to local challenges: Expanding financing of rehabilitation services in low- and middle-income countries. Front. Rehabil. Sci., 5.","DOI":"10.3389\/fresc.2024.1305033"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1186\/s12939-017-0690-z","article-title":"Health financing and integration of urban and rural residents\u2032 basic medical insurance systems in China","volume":"16","author":"Zhu","year":"2017","journal-title":"Int. J. Equity Health"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Wang, P., Li, S., Wang, Z., Jiao, M., Zhang, Y., Huang, W., Ning, N., Gao, L., Shan, L., and Li, Y. (2023). Perceptions of the benefits of the basic medical insurance system among the insured: A mixed-methods study in a northern city of China. Front. Public Health, 11.","DOI":"10.3389\/fpubh.2023.1043153"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e1025","DOI":"10.1016\/S2468-2667(23)00254-2","article-title":"Universal health coverage in China part 1: Progress and gaps","volume":"8","author":"Yip","year":"2023","journal-title":"Lancet Public Health"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1016\/j.puhe.2024.04.025","article-title":"Association between health insurance programs and rehabilitation services utilisation among people with disabilities: Evidence from China","volume":"232","author":"Zhang","year":"2024","journal-title":"Public Health"},{"key":"ref_25","unstructured":"Luo, Y. (2019). Study on Socioeconomic Risk Factors of Severe Mental Disability in Chinese Population. [Ph.D. Thesis, Peking University]."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2408","DOI":"10.1016\/j.apmr.2017.05.007","article-title":"Trends in rehabilitation services use in Chinese children and adolescents with intellectual disabilities: 2007\u20132013","volume":"98","author":"He","year":"2017","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_27","first-page":"6","article-title":"Relationship Between Utilization Status of Rehabilitation Services and Socioeconomic Position Among the Elderly with Physical Disabilities","volume":"36","author":"Wang","year":"2023","journal-title":"Med. Soc."},{"key":"ref_28","unstructured":"(2011). Classification and Grading Criteria of Disability. General Administration of Quality Supervision, Inspection and Quarantine of the People\u2019s Republic of China (Standard No. GB\/T 26341-2010). Available online: http:\/\/files.anshan.gov.cn\/files\/ueditor\/ASSCL\/jsp\/upload\/file\/20230815\/1692067790671006554.pdf."},{"key":"ref_29","unstructured":"Huang, X., and Yan, T. (2019). Rehabilitation Medicine, People\u2019s Health Publishing House."},{"key":"ref_30","unstructured":"Zhao, C. (2020). General Rehabilitation Medicine: Theoretical and Clinical Practice Exploration, China Science and Technology Press."},{"key":"ref_31","first-page":"85","article-title":"Heckman Two-stage Analysis on the R&D Investment Behavior of Enterprises\u2014An Empirical Study Based on the Panel Data of Chinese Industrial Enterprises","volume":"05","author":"Bai","year":"2014","journal-title":"J. Bus. Econ."},{"key":"ref_32","first-page":"1389","article-title":"Impact of the Adjustment of the New Rural Cooperative Medical Scheme on the Utilization of Health Services by Rural Residents","volume":"37","author":"Li","year":"2021","journal-title":"Chin. J. Public Health"},{"key":"ref_33","first-page":"57","article-title":"Medical Insurance\u2019s Impacts on Elders\u2019 Health Service Utilization: Based on the Counterfactual Estimation of the Propensity Score Matching","volume":"02","author":"Hu","year":"2012","journal-title":"Chin. J. Popul. Sci."},{"key":"ref_34","first-page":"4","article-title":"Medical Insurance, Health Services Utilization and Excessive Demands for Medical Services\u2014The Impact of Medical Insurance on Utilization of Health Service of the Elderly","volume":"37","author":"Hu","year":"2015","journal-title":"J. Shanxi Univ. Financ. Econ."},{"key":"ref_35","first-page":"666","article-title":"A Scoping Review of the Impact of Medical Insurance Enrollment Location on the Health Service Utilization and Health Status of the Migrants Population in China and Its Countermeasures","volume":"39","author":"Yao","year":"2022","journal-title":"Chin. Health Serv. Manag."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1605521","DOI":"10.3389\/ijph.2023.1605521","article-title":"Effects of urban and rural resident basic medical insurance on healthcare utilization inequality in China","volume":"68","author":"Chen","year":"2023","journal-title":"Int. J. Public Health"},{"key":"ref_37","first-page":"130","article-title":"Does medical insurance promote health\u2014Empirical analysis based on basic medical insurance for urban residents in China","volume":"39","author":"Pan","year":"2013","journal-title":"Econ. Res. J."},{"key":"ref_38","unstructured":"WHO (2019, April 04). Uneven Access to Health Services Drives Life Expectancy Gaps. Available online: https:\/\/www.who.int\/zh\/news\/item\/04-04-2019-uneven-access-to-health-services-drives-life-expectancy-gaps-who."},{"key":"ref_39","unstructured":"Hooyman, N.R. (2008). Social Gerontology: A Multidisciplinary Perspective, Pearson."},{"key":"ref_40","first-page":"1","article-title":"The Orientation and Significance of Confucian Gender Culture for Women","volume":"10","author":"Bian","year":"2023","journal-title":"Open Access Libr. J."},{"key":"ref_41","first-page":"114","article-title":"Dilemmas and paths of male participation in family care under the universal two-child policy","volume":"37","author":"Li","year":"2018","journal-title":"J Shenzhen Univ. Humanit. Soc. Sci."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1177\/109019818401100101","article-title":"The health belief model: A decade later","volume":"11","author":"Janz","year":"1984","journal-title":"Health Educ. Q."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1188","DOI":"10.1093\/geront\/gnab116","article-title":"Socioemotional selectivity theory: The role of perceived endings in human motivation","volume":"61","author":"Carstensen","year":"2021","journal-title":"Gerontologist"},{"key":"ref_44","unstructured":"Yu, J., Li, J., Ma, Z., and Niu, Y. (2011, January 21). Positivity Effect in Older Adults Occurred in the Late Time Window. Proceedings of the 90th Anniversary Conference of the Chinese Psychological Society and the 14th National Psychology Academic Conference, Xi\u2019an, China."},{"key":"ref_45","unstructured":"Meishan News Network (2024, June 20). Why Don\u2019t Elderly People Like to Go to the Hospital. Available online: https:\/\/www.mshw.net\/wstt\/202001\/t20200119_469034.html."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Babik, I., and Gardner, E.S. (2021). Factors affecting the perception of disability: A developmental perspective. Front. Psychol., 12, (In Chinese).","DOI":"10.3389\/fpsyg.2021.702166"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1007\/s10754-012-9110-5","article-title":"State health insurance and out-of-pocket health expenditures in Andhra Pradesh, India","volume":"12","author":"Fan","year":"2012","journal-title":"Int. J. Health Care Financ. Econ."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1086\/669263","article-title":"Effects of subsidized health insurance on newborn health in a developing country","volume":"61","author":"Camacho","year":"2013","journal-title":"Econ. Dev. Cult. Change"},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Bernal Lobato, N., Carpio, M., and Klein, T. (2015, August 25). IZA DP No. 8213: The Effects of Access to Health Insurance for Informally Employed Individuals in Peru. Available online: https:\/\/papers.ssrn.com\/sol3\/papers.cfm?abstract_id=2649928.","DOI":"10.2139\/ssrn.2649928"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jdeveco.2015.10.008","article-title":"Insuring health or insuring wealth? An experimental evaluation of health insurance in rural Cambodia","volume":"119","author":"Levine","year":"2016","journal-title":"J. Dev. Econ."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1007\/s10754-021-09306-5","article-title":"Impacts of insurance expansion on health cost, health access, and health behaviors: Evidence from the medicaid expansion in the US","volume":"21","author":"De","year":"2021","journal-title":"Int. J. Health Econ. Manag."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1186\/s13561-022-00400-z","article-title":"Health shock, medical insurance and financial asset allocation: Evidence from CHFS in China","volume":"12","author":"Liu","year":"2022","journal-title":"Health Econ. Rev."},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Alemayehu, Y.K., Dessie, E., Medhin, G., Birhanu, N., Hotchkiss, D.R., Teklu, A.M., and Kiros, M. (2023). The impact of community-based health insurance on health service utilization and financial risk protection in Ethiopia. BMC Health Serv. Res., 23.","DOI":"10.1186\/s12913-022-09019-6"},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Zhang, T., Hu, Z., Zhang, K., and Li, X. (2025). The impact of long-term care insurance on household expenditures of the elderly: Evidence from China. PLoS ONE, 20.","DOI":"10.1371\/journal.pone.0316758"},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Yuan, X., Yang, X., and Zhou, X. (2025). The poverty prevention effects of health insurance: Evidence from China\u2019s basic medical insurance program. Front. Public Health, 13.","DOI":"10.3389\/fpubh.2025.1576146"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1111\/cwe.12517","article-title":"Effects of the Resident Basic Medical Insurance reform on household consumption in China","volume":"32","author":"Yu","year":"2024","journal-title":"China World Econ."},{"key":"ref_57","doi-asserted-by":"crossref","unstructured":"Al-Hanawi, M., Mwale, M., and Qattan, A. (2021). Health insurance and out-of-pocket expenditure on health and medicine: Heterogeneities along income. Front. Pharmacol., 12.","DOI":"10.3389\/fphar.2021.638035"},{"key":"ref_58","first-page":"31","article-title":"Rehabilitation service utilization and its associated factors among the elderly with disability in China","volume":"15","author":"Fan","year":"2022","journal-title":"Chin. J. Health Policy"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1186\/s13561-019-0227-9","article-title":"Out-of-pocket healthcare expenditure in Australia: Trends, inequalities and the impact on household living standards in a high-income country with a universal health care system","volume":"9","author":"Callander","year":"2019","journal-title":"Health Econ. Rev."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1186\/s12939-023-02008-z","article-title":"Catastrophic health expenditure and its association with socioeconomic status in China: Evidence from the 2011-2018 China Health and Retirement Longitudinal Study","volume":"22","author":"Li","year":"2023","journal-title":"Int. J. Equity Health"},{"key":"ref_61","first-page":"23","article-title":"Who took away the dividends of healthcare reform","volume":"6","author":"Tan","year":"2015","journal-title":"China Health Insur."},{"key":"ref_62","first-page":"24","article-title":"The medical security for disadvantaged groups needs to clarify what the problem is and what the answer is","volume":"6","author":"Zhou","year":"2015","journal-title":"China Health Insur."},{"key":"ref_63","first-page":"135","article-title":"Insurance policy and Chinese-style poverty alleviation: Experience, dilemma and path optimization","volume":"35","author":"Huang","year":"2019","journal-title":"Manag. World"},{"key":"ref_64","first-page":"10","article-title":"Study on Poverty Reduction Effect and Path Optimization of Inclined Medical Insurance Poverty Alleviation Policy","volume":"4","author":"Liu","year":"2020","journal-title":"Soc. Secur. Stud."}],"container-title":["Systems"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-8954\/13\/9\/812\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:46:43Z","timestamp":1760035603000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-8954\/13\/9\/812"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,16]]},"references-count":64,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["systems13090812"],"URL":"https:\/\/doi.org\/10.3390\/systems13090812","relation":{},"ISSN":["2079-8954"],"issn-type":[{"value":"2079-8954","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,16]]}}}