Coping with the Costs of Severe Illness in Rural China

Abstract

Few studies have researched the impact of large medical expenditures on household livelihoods and
\nwell-being. This article provides a conceptual framework for understanding how households cope
\nwith the costs of severe illness and high medical fees. The aim is to identify possible strategies to
\nenable households to cope better. The utility of this framework is demonstrated by presenting the
\nfindings of a follow-up study of a household health expenditure survey in rural China. The study
\nused qualitative methods to examine how 24 households which had spent large proportions of their
\nannual income on medical fees had mobilised resources to cope with the costs of a major illness
\nepisode, and investigated the hypothesis that large medical fees lead to impoverishment. The study
\nfound that most households were able to finance medical fees without incurring catastrophic
\nopportunity costs, and were able to maintain production and income. Resources outside the
\nhousehold, particularly those accessed through social networks, were important sources of labour
\nand financial support. Many households were able to finance subsequent unanticipated
\nexpenditures. A small number of households were less able to cope. These tended to be constrained
\nin the options available. Households which disposed of core assets or lost access to social networks
\nwere less able to protect themselves against the impact of subsequent crises. The findings suggest
\nseveral possible mechanisms for protecting households against the risk of impoverishment which
\nsupport households’ own strategies.