Rural-urban disparity in risk exposure to involuntary social health insurance transition in China: An investigation of chronic disease patients' mental health problems

How provider payment methods affect health expenditure of depressive patients? Empirical study from national claims data in China from 2013 to 2017

BACKGROUND

This study aimed to investigate the associations between provider payment methods and expenditure of depressive patients, stratified by service types and hospital levels.

METHODS

We used a 5 % random sample of urban claims data in China (2013-2017), collected by China Health Insurance Research Association. Provider payment methods (fee-for-services, global budget, capitation, case-based and per-diem payments) were the explanatory variables. A generalized linear model was fitted for the associations between provider payment methods and expenditure. All analyses were adjusted for patient"cioeconomic and health-related characteristics.

RESULTS

In total, 64,615 depressive patient visits were included, 59,459 for outpatients and 5156 for inpatients. Female patients accounted for 63.00 %. The total and out-of-pocket (OOP) expenditure significantly differentiated by provider payments. Among outpatient services, when comparing with fee-for-services, capitation payment was associated with substantial marginal reduction in total and OOP expenditure (-$34.18, -$9.71) in primary institutes, yet increases ($27.26, $24.11) in secondary hospitals. Similarly, global budget was associated with lower total and OOP expenditure (-$13.51, -$1.61) in secondary hospitals, while higher total and OOP expenditure ($7.43, $32.27) in tertiary hospitals than fee-for-services. For inpatients, total and OOP expenditures under per-diem (-$857.65, -$283.48) and case-based payments (-$997.93, -$137.56) were remarkably smaller than those under fee-for-services in primary and secondary hospitals, respectively. Besides, case-base payment was only linked with the largest reduction in OOP expense (-$239.39) in inpatient services of tertiary hospitals.

LIMITATION

Only urban claims data was included in this study, and investigations for rural population still warrant. And updated data are needed for future studies.

CONCLUSIONS

There were varying correlations between provider payment methods and expenditure, which differed by service types and hospital levels. These findings provided empirical evidence for optimizing the mixed payment methods for depression in China.

Policy interplay among social health insurance system, pension system, delayed retirement initiative and implications for the self-rated health status of older workers

Delayed retirement initiative proposed in China attaches greater importance to the sustainability of pension systems and the labour shortage, but less to the health status of older people. The existing social health insurance and pension system are not well established to match this initiative. This study investigates the policy mix of delayed retirement, employment-based social health insurance, social pension participation for health status of older people. Results of the data from the China Health and Retirement Longitudinal Study (CHARLS-2018) show that late retirement could benefit health status among older adults. Moreover, such effect of late retirement appears more salient for those uninsured by employment-based social health insurance and those still in the pension contribution phase upon reaching the statutory retirement age. Hence, in countries with inadequate health insurance and pension systems, such as China, delayed retirement may serve as an important alternative to social security for the health of older people.

On-call work and depressive mood: A cross-sectional survey among rural migrant workers in China

Introduction

With the rapid development of China's "gig economy," the on-call work model has grown increasingly prevalent in China and has attracted a large number of rural migrant workers with its low employment threshold. However, this irregular employment mode may negatively impact the mental health of workers.

Methods

This paper uses an ordinal logistic regression model to study the relationship between Chinese rural migrant workers' on-call work and their depression.

Results

The results showed that after controlling for relevant variables, the odds ratio of depressive mood among rural migrant workers engaged in on-call work was 1.22 (95% CI 1.04-1.43) compared with rural migrant workers who did not need to be on call. In further heterogeneity research, we found that on-call work is more likely to aggravate the depression risk of rural migrant workers who are highly dependent on the internet and have low-wage incomes.

Discussion

This research suggests that appropriate measures should be taken to mitigate the negative impact of on-call work on the mental health of rural migrant workers, and more attention needs to be paid to the mental health of lower salaried and gig workers. This paper provides a valuable sample of Chinese rural migrant workers for theoretical research on the relationship between on-call work and mental health and confirms the relationship between the two. These results contribute new ideas to the theory and practice of psychological crisis intervention aimed at Chinese rural migrant workers.

Chronic patients as retirement-aged workers: the impact of employment-based health insurance and chronic conditions on health-related working capacity and late-life career participation

Retirement-aged workers with chronic conditions are increasingly engaged in late-life careers in the policy context of delayed retirement initiative. However, it remains uncertain as to how chronic conditions and employment-based social health insurance interact to affect health-related working capacity and late career participation in this group of people. Using data from the China Health and Retirement Longitudinal Study (CHARLS) and the discrete choice model, this study finds that chronic conditions are negatively associated with health-related working capacity (- 0.400, p < 0.01) and late-life career participation (- 0.170, p < 0.01). Employment-based health insurance is positively associated with health-related working capacity of retirement-aged workers (0.432, p < 0.01), but is negatively associated with their late-life career participation (- 1.027, p < 0.01). Moreover, employment-based health insurance could weaken the negative associations between chronic conditions and health-related working capacity (interaction = 0.285, p < 0.05) and late-life career participation (interaction = 0.251, p < 0.05). More fine-grained policies for delayed retirement are needed to focus on the long-neglected health of retirement-aged workers with chronic conditions.

Travel experience and health service amongst older people from the perspective of social exclusion: Policy implications of alleviating transport deprivation

The vulnerable population are often faced with the transport deprivation resulting in social exclusion (e.g. lack of access to healthcare service or suffering from lower health service quality). The disparity in travel experience can lead to different results of healthcare service seeking amongst the vulnerable population such as older adults with and without disabilities. This study applies Heckman's two-stage procedure and the data from China Health and Retirement Longitudinal Study. Based on having controlled the influence of individual financial situation and self-rated health, results show that longer travel time is observed in older adults who have paid the visit to the higher class healthcare facilities (HHCF). Besides, the visit to HHCF is negatively associated with disability and positively with travel mode with less discomfort. Further, the relationship between disability and the class of visited healthcare facilities is found to be conditioned on the travel time and travel mode, wherein such relationship could be intensified by longer travel time and be alleviated by travel mode with less discomfort. Therefore, social policies to alleviate transport deprivation are critical for accessing better healthcare services amongst older people with disabilities.

The impact of medical insurance reimbursement on postoperative inflammation reaction in distinct cardiac surgery from a single center

Background

Evidences shows that socioeconomic status is reversely associated with the risk of morbidity and mortality for people with cardiovascular disease via pro-inflammation mechanism, but the population profile is not deeply defined on. We aimed to investigate the impact of medical insurance coverage on postoperative systemic inflammatory reaction in two kinds of disease populations undergoing distinct cardiac procedures.

Methods

A total of 515 patients receiving open mitral valve procedure with high-total expense from May 2013 through May 2021 in Sichuan Provincial People’s Hospital were retrospectively collected and stratified according to medical insurance reimbursement: low coverage with high out-pocket (< 30%), medium coverage (≤ 60%, but ≥ 30%), and high coverage (> 60%). Another 118 cases undergoing atrium septum defect (ASD) or patent foramen ovale (PFO) occlusion and taking on consistent low-total expense and low-coverage (< 30%) were also classified according to their insured conditions. The postoperative systemic inflammatory response indexes were high sensitivity C-reactive protein (hs-CRP) and the neutrophil–lymphocyte ratio (NLR).

Results

Low insurance reimbursement population undergoing open mitral valve procedure had a higher level of hs-CRP and NLR but not troponin I protein or lactate within 48 h postoperatively, and higher thoracic drainage, longer ventilation use and stay in intensive care unit. No significant difference in inflammatory indexes existed among diverse medical insurance coverage in population undergoing ASD/PFO occlusion.

Conclusions

Higher inflammatory reaction and weaker clinical recovery was associated with lower insurance coverage population undergoing open mitral valve procedure but not ASD/PFO interventional occlusion procedure.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-07920-8.

Health Insurances and the Health-Related Work Capacity of Retirement-Aged Workers: A Comparative Investigation

OBJECTIVE

This study is to investigate the health-related work capacity of retirement-aged workers under the beneficiary status of different health insurance schemes in China.

METHOD

Using the data from CHARLS program, we investigate the health-related work capacity of retirement-aged workers in China (more than 60/55 years-old for men/women respectively). Multivariate regressions and robustness checks (Heckman two-stage procedures, chronological design, etc) are conducted.

RESULTS

(1) Late-life career participation could reduce the risk of declining work capacity due to health problems; (2) different social health insurances affect health-related work capacity among retirement-aged workers differently; (3) social health insurances influence the role of late-life career participation in reducing the risk of health-related work capacity, with different schemes displaying different effects (mitigate or strengthen).

CONCLUSIONS

Systematic inequity in benefit across health insurances may result in contrasting health outcomes of retirement-aged workers.

The interaction of delayed retirement initiative and the multilevel social health insurance system on physical health of older people in China

With many social challenges posed by an ageing population, the delayed retirement initiative has received wide attention from policymakers. However, China's current multi-level social health insurance system seems not perfect and not ready for the delayed retirement initiative. The public are generally concerned that the benefits of late retirees cannot be well guaranteed. Using data from China Health and Retirement Longitudinal Study (CHARLS) and the chorological design (CHARLS-2015 and -2018 waves), this study finds that (1) late retirement could be beneficial for physical health among older adults; (2) there have disparities between the effects of different social health insurances on physical health among older adults; (3) social health insurances could weaken the benefits of late retirement to physical health among older adults. Results imply that China's current multi-level social medical insurance system may lag behind the proposed delayed retirement initiative and have policy limitations for late retirees.

Catastrophic health expenditure and mental health in the older Chinese population: The moderating role of social health insurance

OBJECTIVES

Catastrophic health expenditure (CHE) has considerable effects on household living standards, but little is known regarding the relationships between CHE and people's mental health. Using China as an example, this study examines the association between CHE and mental health and investigates whether the association differs between those with and without social health insurance (SHI).

METHODS

The data came from three waves of the China Health and Retirement Longitudinal Study (CHARLS 2011, 2013, and 2015, N = 13,166). We focused on older people aged 60 and above. We built panel data regression and quantile regression models to analyse the data.

RESULTS

Incurring CHE is significantly associated with poor mental health. The association is weakened among older people receiving SHI, which indicates that SHI has a protective effect. Moreover, the association between CHE and mental health and the protective effect of SHI are stronger among those with mild or moderate mental health problems.

DISCUSSION

Our findings provide empirical evidence that encourages the integration of psychologically informed approaches in health services. We also urge governments in low- and middle-income countries to consider more generous health financing mechanisms for older people with greater healthcare needs.

The influence of late retirement on health outcomes among older adults in the policy context of delayed retirement initiative: an empirical attempt of clarifying identification bias

Background

The deepening population aging is urging policy makers to launch delayed retirement initiative, when the society is faced with unprecedented challenges of shrinking labor supply, heavier pension burdens and slowing economic growth. However, the health outcomes of late retirees receive scarce attention due to the intrinsic identification difficulties (i.e., (1) self-selection bias – older adults with predetermined ill-health are less likely to delay retirement. (2) there can be situations where the status of late retirement has terminated at the time of interview, although he/she has ever delayed retirement). To fill in this research gap, this study examines the effect of late retirement on the difficulty in physical functioning and problems of cognitive status among older adults.

Method

Using the data from China Health and Retirement Longitudinal Study (CHARLS-2015 harmonized, and CHARLS-2018), this study investigates the influence of late retirement (year 2015) on the difficulty in physical functioning and problems of cognitive status (year 2018) among older adults. A series of robustness checks are also conducted.

Results

Empirical results show that late retirement is associated with better physical functioning and cognitive status. The influence remains robust after considering potential self-selection bias and the sensitivity of including/excluding older adults who have past late retirement experience but have no longer been late retirees at the time of survey.

Conclusion

This study suggests that older adults might benefit from the engagement in late careers in their physical and cognitive functioning.