Financial protection and healthcare utilization for low-income populations under China’s multi-tiered health financing system: a cross-sectional study in an Eastern city

The findings suggest that within the studied context, the MTHFS, particularly the MAS, is associated with a reduction in the proportion of out-of-pocket payments for covered services among low-income populations. Despite progress, the limited benefit package of URRMI and reimbursement caps under MAS still leave vulnerable groups at risk of CHE.To mitigate CHE, policy measures should include expanding the benefit package to cover cost-effective innovations (e.g. newly launched anticancer drugs) and implementing income-linked out-of-pocket payment caps for low-income groups.