Public health insurance and the labor market: Evidence from China's Urban Resident Basic Medical Insurance

The relationship between health insurance and economic performance: an empirical study based on meta-analysis

Health insurance stands as a pivotal facet of social wellbeing, with profound implications for the overarching landscape of economic development. The existing research, however, lacks consensus on the relationship between health insurance and economic performance and provides no evidence about the magnitude of the correlation. This lack of information seriously impedes the high-quality development of the healthcare system. Therefore, to scientifically elucidate the relationship between the two, this study involved a meta-analysis, analyzing 479 effect values derived from 34 independent research samples. The results reveal a strongly positive correlation between health insurance and economic performance [r = 0.429, 95% CI = (0.381, 0.475)]. Findings show that health insurance in developed countries more effectively fosters economic performance than in developing countries. Moreover, public health insurance exerts a stronger promoting effect on economic performance than commercial health insurance. The relationship between health insurance and economic performance is moderated by data type, research method, country of sample origin, literature type, journal impact factor, publication year, type of health insurance, and the research populations. Based on meta-analysis, this study not only scientifically responds to the controversy of the relationship between health insurance and economic performance, and the magnitude of a correlation, but also further reveals the inner conduction mechanism between the two. Our research findings are meaningful for policymakers to choose an appropriate healthcare strategy according to their unique attributes, propelling sustainable economic development.

Does basic medical insurance promote public health? Evidence from China family panel study

Background

To promote common prosperity, China government has devoted much financial resources to the basic medical insurance system, it is of great significance to improve the health level of the insured groups to prevent them from returning to poverty due to illness. Whether or not the basic medical insurance can improve health status is an important policy issue after China has win the absolute poverty alleviation movement.

Methods

Based on the data of China Family Panel Studies this paper constructs a strong balanced panel data with two levels information, which including variables from family level and personal level. This paper uses the panel data fixed effect model and propensity score matching model to analysis.

Results

This paper finds that after controlling the family and personal confounding variables, the basic medical insurance has positive effect toward health status. With propensity score matching model, this paper finds that there is causality between basic medical insurance and public health.

Conclusion

Basic medical insurance has a significant health effect, that is, basic medical insurance has a significant positive impact on individual self-rated health. Participating in basic medical insurance can significantly improve the ability of families to face risk shocks, promote the accumulation of health capital in families, promote the diversification of livelihood strategies, and effectively prevent the occurrence of returning to poverty due to illness.

Effects of multimorbidity patterns and socioeconomic status on catastrophic health expenditure of widowed older adults in China

Background

The high multimorbidity and lower socioeconomic status (SES) of older adults, can lead to catastrophic health expenditures (CHEs) for older adults' households. However, whether widowed older adults will bear such a financial burden has yet to be explored. The aim of this study was to investigate the influence of multimorbidity patterns and SES on CHE in Chinese widowed older adults.

Methods

Data was obtained from the 2018 China Health and Retirement Longitudinal Study (CHARLS). This is a cross-sectional study. A total of 1,721 widowed participants aged 60 years and older were enrolled in the study. Latent class analysis was performed based on 14 self-reported chronic diseases to identify multimorbidity patterns. The logistic model and Tobit model were used to analyze the influence of multimorbidity patterns and SES on the incidence and intensity of CHE, respectively.

Results

About 36.72% of widowed older adults generated CHE. The incidence and intensity of CHE were significantly higher in the cardiovascular class and multisystem class than in the minimal disease class in multimorbidity patterns (cardiovascular class, multisystem class, and minimal disease class). Among SES-related indicators (education, occupation and household per capita income), respondents with a middle school and above education level were more likely to generate CHE compared to those who were illiterate. Respondents who were in the unemployed group were more likely to generate CHE compared to agricultural workers. In addition, respondents aged 70-79 years old, geographically located in the east, having other medical insurance, or having fewer family members are more likely to generate CHE and have higher CHE intensity.

Conclusion

Widowed older adults are at high risk for CHE, especially those in the cardiovascular and multisystem disease classes, and those with low SES. Several mainstream health insurances do not provide significant relief. In addition, attention should be paid to the high-risk characteristics associated with CHE. It is necessary to carry out the popularization of chronic disease knowledge, improve the medical insurance system and medical service level, and provide more policy preferences and social support to widowed older adults.

The impact of medical insurance on family financial support: evidence from CHARLS in China

BACKGROUND

In China, public medical insurance has expanded rapidly in the past 20 years. Many studies have discussed the benefits of medical insurance in improving residents' health and financial stability, and increasing the utilization of medical services. Less attention is paid to the effect of medical insurance on family support between parents and children. This study focuses on the effect of medical insurance on promoting family financial support in China.

METHOD

Fifty-five thousand sixty-two individual samples were obtained from four waves of the China Health and Retirement Longitudinal Study (CHARLS): 2011, 2013, 2015 and 2018. Linear-regression model and propensity score matching are used to determine the relationship between medical insurance and family financial support. Then, mediation model is introduced to identify the mediation mechanisms. Also, moderation model is used to estimate the moderation effect of parental education and health.

RESULTS

Medical insurance has significantly increased family financial support between the insured parents and their children. Moreover, this positive effect is heterogeneous since only families living in rural areas were affected, and the direction of family financial support changed with the aging of the parents. The welfare of medical insurance on financial status have also been proven in this paper. The results indicate that medical insurance reduces the out-of-pocket ratio of medical expenses and increases health investment, which can perform as as two mediation mechanisms to affect family financial support. Besides, the education and health status of the insured parents play a role in moderating the effect of medical insurance.

Poverty Reduction Effects of Medical Insurance on Middle-Aged and Elderly Families under the Goal of Common Prosperity in China

Eliminating poverty due to illness is an important way for China to pursue common prosperity. The high medical expenditure caused by the aging population has brought severe challenges to governments and families of all countries, especially in China, where the entire population has just been lifted out of poverty in 2020 and then hit by COVID-19. How to prevent the possible return of poor boundary families to poverty in China has become a difficult research topic. Based on the latest data from the China Health and Retirement Longitudinal Survey, this paper discusses the poverty reduction effect of medical insurance on middle-aged and elderly families from the absolute index and relative index. Medical insurance had a poverty reduction effect on middle-aged and elderly families, especially the poor boundary families. For example, people who participated in medical insurance reduced their financial burden by 2.36% for middle-aged and older families compared to people who did not participate in medical insurance. Furthermore, the poverty reduction effect had heterogeneity in gender and age. This research brings some policy implications. For example, the government should give more protection to vulnerable groups such as the elderly and low-income families and improve the fairness and effectiveness of the medical insurance system.

Can decreased cost-sharing reduce the vulnerability of sick families to poverty? An analysis of the multi-level social health insurance scheme in China

In recent years, China has been increasing social health insurance benefits to alleviate poverty due to illness. In 2015, China introduced the Critical Illness Insurance for patients with high out-of-pocket expenses as supplementary to the social health insurance, which categorized patients with different medical expenses into different cost-sharing policies. We conducted a survey on households with high-cost patients in rural Shandong in 2019 and employed the instrumental variables estimation approach to determine how different cost-sharing measures affect households' poverty vulnerability. We found that cost-sharing reduction significantly decreases the vulnerability of sick families to poverty. Moreover, we found that the positive effect is attributed to a reduction in health burden and household livelihood capital shocks. The vulnerability to poverty is still exceptionally high owing to the heavy health burden in rural China and other developing countries. The results of our study provide insights into poverty alleviation by improving social health insurance in developing economies.

Effect of Health Insurance Policy on the Health Outcomes of the Middle-Aged and Elderly: Progress Toward Universal Health Coverage

This population-based study aims to explore the effect of the integration of the Urban and Rural Residents' Basic Medical Insurance (URRBMI) policy on the health outcomes of the middle-aged and elderly. A total of 13,360 participants in 2011 and 15,082 participants in 2018 were drawn from the China Health and Retirement Longitudinal Study. Health outcomes were evaluated using the prevalence of chronic diseases. A generalized linear mixed model was used to analyze the effect of the URRBMI policy on the prevalence of chronic disease. Prior to the introduction of the URRBMI policy, 67.09% of the rural participants and 73.00% of the urban participants had chronic diseases; after the policy's implementation, 43.66% of the rural participants and 45.48% of the urban participants had chronic diseases. When adjusting for the confounding factors, the generalized linear mixed model showed that the risk of having a chronic disease decreased by 81% [odds ratio (OR) = 0.19; 95% confidence interval (CI): 0.16, 0.23] after the introduction of the policy in the urban participants; in the rural participants, the risk of having a chronic disease was 30% lower (OR = 0.70; 95% CI: 0.60, 0.82) than the risk in the urban participants before the policy and 84% lower (OR = 0.16; 95% CI: 0.14, 0.19) after the implementation of the policy; the differences in the ORs decreased from 0.30 prior to the policy to 0.03 after the policy had been introduced between rural and urban participants when adjusting for the influence of socioeconomic factors on chronic diseases. This study provides evidence of the positive effects of the URRBMI policy on improving the rural population's health outcomes and reducing the gap in health outcomes between rural and urban populations, indicating that the implementation of the URRBMI policy has promoted the coverage of universal health.

Exploring perceived challenges of self-management in low-income older people with hypertension: A qualitative study

BACKGROUND

Hypertension is a public health problem globally. Understanding the perceived challenges of low-income older people populations with chronic disease is an obstacle the world is facing today.

AIM

To explore perceived challenges of self-management in low-income older people with hypertension.

METHODS

Data were collected in three communities from September 2019 to October 2019 by semi-structured interviews. Interviews were audio-taped by digital voice recorder and analysed according to Colaizzi's seven steps.

RESULTS

Participants demonstrated perceived challenges concerning hypertension self-management. Six themes were identified: hypertension belief bias, family dysfunction, deep-rooted habit, elder self-neglect, medical informatization and supportive health policy. Each theme was identified with several subthemes.

CONCLUSIONS

Findings implied that most of the low-income older people lacked self-management behaviours. Future research is needed to address perceived challenges related to self-management behaviour for patients with hypertension worldwide.

Initiatives Addressing Precarious Employment and Its Effects on Workers' Health and Well-Being: A Systematic Review

The prevalence of precarious employment has increased in recent decades and aspects such as employment insecurity and income inadequacy have intensified during the COVID-19 pandemic. The purpose of this systematic review was to identify, appraise, and synthesise existing evidence pertaining to implemented initiatives addressing precarious employment that have evaluated and reported health and well-being outcomes. We used the PRISMA framework to guide this review and identified 11 relevant initiatives through searches in PubMed, Scopus, Web of Science, and three sources of grey literature. We found very few evaluated interventions addressing precarious employment and its impact on the health and well-being of workers globally. Ten out of 11 initiatives were not purposefully designed to address precarious employment in general, nor specific dimensions of it. Seven out of 11 initiatives evaluated outcomes related to the occupational health and safety of precariously employed workers and six out of 11 evaluated worker health and well-being outcomes. Most initiatives showed the potential to improve the health of workers, although the evaluation component was often described with less detail than the initiative itself. Given the heterogeneity of the 11 initiatives regarding study design, sample size, implementation, evaluation, economic and political contexts, and target population, we found insufficient evidence to compare outcomes across types of initiatives, generalize findings, or make specific recommendations for the adoption of initiatives.

The Relationship Between "Protect People's Livelihood" and "Promote the Economy:" Provincial Evidence From China

This study focused on medical care in a single country (China) and in regions with different economic backgrounds and different economic development levels to determine the effect of healthcare expenditure on short- and long-term economic growth. The study supported some interesting conclusions: (1) For most areas of China, increasing healthcare expenditure has a negative impact on economic growth in the short term but promotes growth in the long run; (2) Under different levels of economic development within China, there is significant heterogeneity in the interaction between healthcare expenditure and economic growth; (3) The negative effects of healthcare expenditure on short-term economic growth are greater during periods of economic turbulence than during times of stability; and (4) Healthcare expenditure has a negative effect on underdeveloped areas through the accumulation of material capital, while in economically developed areas, this channel has the opposite effect. To improve the quality of medical and health protection and the quality of life and welfare, China needs to consider the development characteristics of different economic zones and establish a multilevel, systematic and diversified medical and health protection system.