Problem drinking as intentional risky behavior: Examining the association between state health insurance coverage and excessive alcohol consumption

A Thermodynamic and Kinetic Study on Electrochemical Esterification in Aroma-Enhanced Distilled Liquor (Baijiu)

The development of low-alcohol Baijiu is consistent with demand for the industry’s sustainable development. However, the ester aroma of low-alcohol Baijiu is insipid and unstable—mainly due to the hydrolysis of esters during shelf life—thus reducing the industry scale of low-alcohol Baijiu to a significantly small range. An electrochemical method for improving low-alcohol Baijiu’s ester concentration and stability was investigated from the aspects of thermodynamics and kinetics. The key finding is that the new Baijiu’s ester content obtained through distillation is relatively high, exceeding its content in the thermodynamic equilibrium state. Thus, the ester will be hydrolyzed during shelf life. The idea of applying electrochemical catalytic esterification technology to the production of low-alcohol Baijiu in this study is directly derived from the production practice of Baijiu factories; it provides a direction for the further optimization of low-alcohol Baijiu to facilitate the production of an alternative product that will contribute to public health.

Does state repeal of alcohol exclusion laws increase problem drinking?

BACKGROUND

For decades, alcohol exclusion laws (AELs) have allowed insurance companies to reject claims for physical injuries caused by alcohol consumption, including injuries from impaired driving. A central premise of AELs is that they function as a deterrent to risk-taking behaviors, such as excessive drinking. If this assumption is correct, state repeal of these laws should result in increased drinking. This study examines whether the repeal of AELs by some states affects drinking behaviors.

METHODS

Data were obtained from the 1993 to 2017 Behavioral Risk Factor Surveillance System nationwide survey. Exploiting the natural experiment presented by state repeal of AELs, we assessed the impact on current drinking and binge drinking. We used a rigorous quasi-experimental difference-in-differences analysis and conducted a battery of sensitivity analyses to assure robust findings.

RESULTS

Overall, the study found no discernable impact of state repeal of AELs on alcohol consumption. While the repeal of AELs significantly decreased the odds of reporting drinking in the past 30 days compared to those living in states with AELs or that never had AELs, the effects were small (aOR = 0.98, 95% CI = 0.96, 0.99). Likewise, there were higher odds of binge drinking among individuals living in states that repealed AELs compared to those living in states without AELs, yet with small effects (aOR = 1.03, 95% CI = 1.01, 1.05). After additionally adjusting for state-varying characteristics and state-specific time trends, no significant effects were identified regarding current and binge drinking. Findings from the sensitivity analyses were largely consistent with the main analysis.

CONCLUSION

This study found no evidence supporting the idea that repealing AELs increased alcohol consumption or binge drinking. Future studies should consider other state-specific dimensions within the Uniform Accident and Sickness Policy Provision Law.

The impact of health insurance on self-protection of Chinese rural residents

Purpose

Health insurance lowers the price of medical services, which reduces the insured's demand for self-protection (such as, live a healthy lifestyle or invest in disease prevention) that could help reduce the probability of getting sick, then ex ante moral hazard happens. The purpose of this study is to examine the impact and its heterogeneity of health insurance on the self-protection of Chinese rural residents.

Method

This study firstly builds a theoretical model of health insurance and self-protection. Then, based on the data from the 2004 to 2015 China Health and Nutrition Survey (CHNS), we adopt ordinary least squares model (OLS), probit model, and instrumental variable (IV) method to empirically investigate the impact of health insurance on Chinese rural residents' self-protection.

Results

After addressing the endogeneity problem, the study finds that participating in health insurance exerts a significant negative impact on the demand for self-protection. Specifically, health insurance participation not only increases residents' tendency toward drinking liquor by 3.4%, and that of having general obesity by 3.7%, but also reduces residents' preventive medical expenditure (PME) by 1.057%, increasing Body Mass Index (BMI) by 0.784 kg/m². Further analysis shows that there is heterogeneity between groups, as health insurance participation reduces PME of people who are female, younger, and high-educated, and increases the tendency toward drinking liquor of people who are younger and low-educated.

Conclusions

To reduce the impact of ex ante moral hazard induced by health insurance, our findings suggest that it is necessary to improve the disease prevention function of health insurance and introduce a risk adjustment mechanism into the premium or co-payment design of health insurance.

Does Health Insurance Reduce the Alcohol Consumption? Evidence from China Health and Nutrition Survey

Whether health insurance reduces alcohol consumption has been debated. To identify it, the authors used three-wave balance panel data from China Health and Nutrition Survey and applied a two-way fixed-effect model. The authors found that (1) health insurance reduces alcohol consumption, (2) the effect would be deducted when they have been diagnosed with diabetes, (3) the heterogeneity existed between old and young individuals as well as rural and urban areas, those old individuals would behave more cautious, and urban individuals would consume more alcohol. This study identified the effects of health insurance and the moderating effect of diabetes, which were helpful for policymakers to optimize health insurance policy to ensure the sustainability of health insurance and suggested that primary medical staff should assist patients to establish healthy living habits and reduce their risky behaviors.