Coping with the Costs of Severe Illness in Rural China

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