The Effect of Migration Duration on Treatment Delay Among Rural-to-Urban Migrants After the Integration of Urban and Rural Health Insurance in China: A Cross-Sectional Study

The positive association between internal migration and hospitalization among the older adults in China: Regional heterogeneity and chronic disease management

Background

Post-retirement migrants are rapidly increasing in China, but the impact of internal migration on hospitalization among older adults remains under-researched. Understanding this impact is essential for health policies development and improvement. This study aims to identify the most vulnerable population, evaluate the association between migration and hospitalization, and discuss potential causes of the association.

Methods

14,478 older adults were extracted from the 2018 to 2019 Chinese Longitudinal Healthy Longevity Survey (CLHLS) database and divided into four groups according to migration experience and age at migration: non-migrants, pre-adulthood migrants, pre-retirement migrants, and post-retirement migrants. Post-retirement migrants were key research subjects. We employed Pearson's chi-square test to compare group differences in outcome and covariates, and multivariate logistic regression analysis to examine the association between migration and hospitalization by regions and chronic conditions.

Results

Significant intergroup differences were observed in demographic characteristics, socioeconomic factors, health habits, and health-related factors. Post-retirement migrants displayed following characteristics: female predominance (61.6%; 1,472/2,391), tending toward urban areas (80.9%; 1,935/2,391), and the highest prevalence rate of chronic disease (46.7%; 1,116/2,391). Urban migrants in eastern China were more likely to be hospitalized (OR = 1.65; 95% CI: 1.27-2.15), especially those who were diagnosed with chronic disease (OR = 1.51; 95% CI: 1.04-2.19) or with unconfirmed chronic conditions (OR = 1.98; 95% CI: 1.36-2.89).

Conclusions

Internal migration is associated with the hospitalization of post-retirement migrants moving to eastern China. Improved chronic disease management and early interventions might lower the hospitalization. Effective policies should be formulated to reduce the disparity in primary care services across China, thereby facilitating the access of migrants to these services.

Interrupted time series analysis for the impact of integrated medical insurance on direct hospitalization expense of catastrophic illness

In 2016, China initiated the merge of the urban resident basic medical insurance scheme and new rural cooperative medical scheme into one unified health insurance scheme: the urban and rural resident basic medical insurance. This study investigates the impact of integrated insurance on the direct hospitalization cost of inpatients with catastrophic illnesses. An interrupted time series analysis was conducted based on a sample of 6174 inpatients with catastrophic illness from January 2014 to December 2018. The factors surveyed included per capita total inpatient expense, out-of-pocket expense, and reimbursement ratio. Univariate analysis indicated that after the implementation of the unified urban and rural medical insurance, the reimbursed expense increased from 9398 to 13,842 Yuan (P < 0.001), average reimbursement ratio increased from 0.57 to 0.59 (P < 0.05). Expenses on both western and traditional medicines increased, although the proportion of medicine expense decreased after the integration. Interrupted time series analysis showed that per capita total inpatient expense and per capita out-of-pocket expense increased but showed a gradually decreasing trend after the integration. After the integration of urban and rural medical insurance, the average reimbursement ratio increased slightly, which had limited effect on the alleviation of patients' financial burden. Furthermore, the integration effect on inpatient expense is offset by increased out-of-pocket medical expense due to suspected supplier-induced demand.

A Comparative Analysis of Impact of Universal Two-Child Policy on Maternity Insurance Fund in Jiangsu Province and Guangxi Zhuang AR

The maternity insurance fund in some provinces in China has accumulated unprecedented deficit levels. This imminent depletion can cause a catastrophic health crisis for maternal health. This study analyzed the post-policy impact of key factors on maternity insurance income inflow and outflow in Jiangsu Province and Guangxi Zhuang Autonomous Region (AR). We applied Pasera’s ARLD model and VECM Granger Causality Test to establish long- and short-term impact of selected factors that determines the income and expenditure of the maternity insurance fund in the two regions based on data from 2011 to 2019. Our results show that the addition of new births due to the universal two-child policy has increased the per capita utilization of the maternity insurance fund in both areas. We further observed that the impact of the maternity insurance contribution rate to the maternity insurance fund decays with time giving a long-run limited impact in both provinces. Thus the positive impact is stronger in the short term, but in the long term, its influence or contribution to stability of the funds reduces. The positive impact of interest from investment in the maternity insurance fund is however insignificant in both provinces, giving a major cause for concern on its role in maternity insurance fund income generation. In the short term, the contribution rate of the maternity insurance fund must be adjusted upward or the payment base expanded to receive additional contribution from all employees to avoid complete depletion of the fund. In the long term, we recommend the need to replenish the maternity insurance funds through proper investment options for the funds. We further recommend the need to look for other sources of funding social interventions based on existing practices in other countries.

Tracking the effects of COVID-19 in rural China over time

BACKGROUND

China issued strict nationwide guidelines to combat the COVID-19 outbreak in January 2020 and gradually loosened the restrictions on movement in early March. Little is known about how these disease control measures affected the 600 million people who live in rural China. The goal of this paper is to document the quarantine measures implemented in rural China outside the epicenter of Hubei Province and to assess the socioeconomic effect of the measures on rural communities over time.

METHODS

We conducted three rounds of interviews with informants from 726 villages in seven provinces, accounting for over 25% of China's overall rural population. The survey collected data on rural quarantine implementation; COVID-19 infections and deaths in the survey villages; and effects of the quarantine on employment, income, education, health care, and government policies to address any negative impacts. The empirical findings of the work established that strict quarantine measures were implemented in rural villages throughout China in February.

RESULTS

There was little spread of COVID-19 in rural communities: an infection rate of 0.001% and zero deaths reported in our sample. However, there were negative social and economic outcomes, including high rates of unemployment, falling household income, rising prices, and disrupted student learning. Health care was generally accessible, but many delayed their non-COVID-19 health care due to the quarantine measures. Only 20% of villagers received any form of local government aid, and only 11% of villages received financial subsidies. There were no reports of national government aid programs that targeted rural villagers in the sample areas.

CONCLUSIONS

By examining the economic and social effects of the COVID-19 restrictions in rural communities, this study will help to guide other middle- and low-income countries in their containment and restorative processes. Without consideration for economically vulnerable populations, economic hardships and poverty will likely continue to have a negative impact on the most susceptible communities.