This paper provides a conceptual framework for understanding how households cope with the costs of severe illness and high medical fees. It presents 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. However, those 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.