Effect of Major Illness Insurance on Vulnerability to Poverty: Evidence From China

Analysis the status and spatio-temporal characteristics of the synergistic development of China's multi-level medical insurance system

Examined the synergistic development and spatio-temporal evolution of China's multi-level medical insurance system (MMIS) on a macroscopic level. We assess the comprehensive development of the MMIS across China's 31 provinces from 2011 to 2020 by constructing a comprehensive indicators evaluation model. Subsequently, a coupling coordination index (CCI) model is employed to provide precise insights into the coupling coordination effects among various medical insurance schemes comprising MMIS. Lastly, spatial autocorrelation analysis is conducted to evaluate both the global and local spatio-temporal evolutionary characteristics of MMIS. The CCI of MMIS at the national average level exhibited a fluctuating upward trend, progressing from the moderate disorder recession degree (0.287) in 2011 to the well-coordinated degree (0.887) in 2020. However, the majority of provinces (83.87%) still lingered within the realm of barely coordinated degree ([0.500-0.600]). Specifically, the CCI within the eastern coastal region surpassed that of the western and central regions, with the central region showing the most pronounced increase in CCI. Over the past decade, MMIS demonstrated significant spatial agglomeration, as evidenced by the global Moran's I ranging from [0.1668-0.3037]. Furthermore, findings from local spatial autocorrelation analysis suggest a gradual attenuation in the spatial clustering disparity of CCI across various provinces. Government ought to focus on the spatio-temporal evolution patterns of MMIS, and strengthen cooperation between the government and market in health governance, while utilizing information technology and data sharing to improve the overall quality of medical insurance benefits.

Rural patients' satisfaction with humanistic nursing care in Chinese Public Tertiary Hospitals: a national cross-sectional study

Background

The provision of high-quality healthcare services and patient satisfaction are fundamental objectives in modern healthcare. Humanistic nursing care, which emphasizes empathy, respect for individuality, and cultural sensitivity, aims to build trust and improve the overall experience for patients. This approach is especially relevant for rural patients in China, who often face additional challenges in accessing care in large tertiary hospitals.

Methods

A multistage, stratified sampling method was employed to collect data from 8,263 patients aged 18 years or older in large public tertiary hospitals. Humanistic care satisfaction scores were measured using the Nurse Caring Instrument (NCI) questionnaire, a validated tool for assessing patient satisfaction with nursing care.

Results

Satisfaction with nursing humanistic care among rural Chinese patients attending large tertiary public hospitals was low with the overall mean satisfaction score 81.62 ± 16.85. Significant differences in satisfaction were found based on age, marital status, number of children, educational attainment, occupation, monthly household income, department visited, type of medical insurance, and first-time visitor. A multivariate analysis revealed positive correlations with satisfaction for factors such as having children, higher education, higher family monthly income, and first-time visitor, and negative correlations for factors such as older age, being widowed, department visited, and region.

Conclusion

Older adults, widowed individuals, and first-time patients expressed lower levels of satisfaction, highlighting the need for tailored interventions. The findings provide insights into the impact of humanistic nursing care for rural patients and emphasize the importance of culturally sensitive approaches to improve patient satisfaction in rural China. This study has several limitations. The cross-sectional design restricts the ability to establish causal relationships, and there is a potential for selection bias, as participants who completed the survey may have higher educational and economic levels, possibly leading to an overestimation of satisfaction. Lastly, as this study focused on rural patients in large public tertiary hospitals in China, the findings may not be generalizable to other settings or patient groups. Future studies should address these limitations for broader applicability and insight.

Healthcare utilisation patterns and contributory factors among middle-aged adults: a scoping review

BACKGROUND

Middle-aged adults, defined as individuals between the ages of 45 and 64, represent a significant yet under researched group of healthcare service users. This scoping review aimed to provide a comprehensive overview of the patterns of healthcare utilisation and the factors contributing to them within this demographic.

METHODS

Following PRISMA-ScR guidelines and the framework proposed by Arksey and O'Malley, a systematic literature search was conducted across PubMed, EMBASE, and the Cochrane Library databases from their inception until July 2023. Key search terms such as "healthcare utilisation" and "middle-aged" were used to identify relevant studies. Articles were included if they were original cohort, case-control, or cross-sectional studies published in English. The findings were then synthesised narratively, by identifying recurring concepts and grouping them into broader themes. The themes were categorised according to the Andersen healthcare utilisation model's three factors: predisposing factors, enabling factors, and need-related factors.

RESULTS

After screening 4,810 records, a total of 25 articles were selected for final analysis, comprising 15 from developed countries and 10 from developing countries. Consistent factors influencing healthcare utilisation included multimorbidity, socioeconomic status, and poor health behaviours. Differences emerged across contexts: in developed countries, healthcare utilisation was influenced by lifestyle behaviours and access to private care, while in developing countries, socioeconomic inequalities and limited insurance coverage played more dominant roles. Healthcare system structures likely shaped utilisation patterns.

CONCLUSION

Healthcare utilisation among middle-aged adults is driven by an interplay of medical, social, and economic factors that vary across contexts. Common contributors, such as multimorbidity and poor health behaviours, highlight the need for targeted interventions and policies focusing on primary and preventive care to address the long-term burden of healthcare utilisation. This demographic faces unique challenges in managing healthcare decisions amidst varying systemic and individual-level challenges, which should be further studied.

Does younger children's social health insurance alleviate household impoverishment due to illness?

BACKGROUND

The ambitious expansion of social health insurance in China has played a crucial role in preventing and alleviating poverty caused by illness. However, there is no government-sponsored health insurance program specifically for younger children and inequities are more pronounced in healthcare utilization, medical expenditure, and satisfaction in some households with severely ill children. This study assessed the effectiveness of child health insurance in terms of alleviating poverty caused by illness.

METHODS

Data were collected from two rounds of follow-up surveys using the China Family Panel Studies 2016 and 2018 child questionnaires to investigate the relationship between child health insurance and household medical impoverishment (MI). Impoverishing health expenditure (IHE) and catastrophic health expenditure (CHE) were measured to quantify "poverty due to illness" in terms of absolute and relative poverty, respectively. Propensity score matching with the difference-in-differences (PSM-DID) method, robustness tests, and heterogeneity analysis were conducted to address endogeneity issues.

RESULTS

Social health insurance for children significantly reduced household impoverishment due to illness. Under the shock of illness, the incidences of IHE and CHE were significantly lower in households with insured children. The poverty alleviation mechanism transmitted by children enrolled in social health insurance was primarily driven by hospitalization reimbursements and the proportion of out-of-pocket medical payments among the total medical expenditure for children.

CONCLUSIONS

Children's possession of social health insurance significantly reduced the likelihood of household poverty due to illness. The poverty-reducing effect of social medical insurance is most significant in rural areas, low-income families, no-left-behind children, and infants. Targeted poverty alleviation strategies for marginalized groups and areas would ensure the equity and efficiency of health system reforms, contributing to the goal of universal health insurance coverage in China.

Family poverty and adolescents' cognitive and noncognitive outcomes: Evidence from China

Using data from the China Education Panel Survey (CEPS) during the 2013-2014 academic year, this paper examines the effects of family poverty on adolescents' cognitive and noncognitive outcomes. We find that family poverty is detrimental to adolescent development. Children from poor families have poorer academic performance and noncognitive abilities. We also find that the negative effects of family poverty are more pronounced among children with urban hukou, boys, and children from one-child families. Furthermore, we find that there are multiple channels behind the estimated effects, including parental educational expectations, parental education investments, and parent-child relationship. This paper opens up the "black box" of family poverty affecting children's development, which can provide reference for governments to design measures aimed at eliminating poverty trap.

Relationship between the health poverty vulnerability and multimorbidity patterns identified with latent class analysis aged 45 years or more adults in Northwestern China: A cross-section study

This study aims to identify multimorbidity patterns and examine whether health poverty vulnerability (HPV) varies among adults aged 45 years or more. Data from 4338 participants were extracted from a Chinese cross-sectional study. Latent class analysis was used to identify multimorbidity patterns based on 11 self-reported chronic diseases. A 3-stage feasible generalized least-squares method was used to measure the HPV. The associations and influencing factors were analyzed using the Tobit model. The mean HPV values were 0.105 ± 0.225 and 0.329 ± 0.357, based on extreme poverty and those of low- and middle-income countries' poverty line, respectively. Four latent multimorbidity patterns were identified, comprising hypertension (57.33%), cardiovascular diseases (19.94%), the musculoskeletal system (13.09%), and spine (9.64%). The HPV value from hypertension (coefficient [Coef] =0.03, 95% confidence interval (CI) = 0.00-0.05) was significantly higher than that of the musculoskeletal system based on extreme poverty. In addition, the HPV values for hypertension (Coef =0.08, 95% CI = 0.05-0.11), spine (Coef =0.06, 95% CI = 0.02-0.11), and cardiovascular diseases (Coef =0.07, 95% CI = 0.03-0.11) were significantly high based on low- and middle-income countries' poverty line. Age ≥75 years, registered poor households, catastrophic medical expenditure, and toilet style were major risk factors. Although the multimorbidity pattern-induced HPV has been significant improved on extreme poverty, it still poses a very serious challenge with regard to low- to middle-income countries' poverty line. The sensitivity analysis proved the robustness of the results. Policymakers should focus on adults with 3 multimorbidity patterns, namely, registered poor households, age ≥75 years, and catastrophic health expenditure, to adopt targeted interventions to prevent and eliminate HPV.

Perspectives and evaluation on the effect of financial burden relief of medical insurance for people with catastrophic diseases and its influencing factors

Background

Catastrophic disease sufferers face a heavy financial burden and are more likely to fall victim to the "illness-poverty-illness" cycle. Deeper reform of the medical insurance system is urgently required to alleviate the financial burden of individuals with catastrophic diseases.

Methods

Data were obtained from a cross-sectional questionnaire survey conducted in Heilongjiang in 2021, and logistic regression and restricted cubic spline model was used to predict the core factors related to medical insurance that alleviate the financial burden of people with catastrophic diseases.

Results

Overall, 997 (50.92%) medical insurance-related professionals negatively viewed financial burden relief for people with catastrophic diseases. Factors influencing its effectiveness in relieving the financial burden were: whether or not effective control of omissions from medical insurance coverage (OR = 4.04), fund supervision (OR = 2.47) and degree of participation of stakeholders (OR = 1.91). Besides, the reimbursement standards and the regional and population benefit package gap also played a role. The likelihood of financial burden relief increased by 21 percentage points for each unit increase in the level of stakeholder discourse power in reform.

Conclusion

China's current medical insurance policies have not yet fully addressed the needs of vulnerable populations, especially the need to reduce their financial burden continuously. Future reform should focus on addressing core issues by reducing the uninsured, enhancing the width and depth of medical insurance coverage, improving the level and capacity of medical insurance governance that provides more discourse power for the vulnerable population, and building a more responsive and participatory medical insurance governance system.

Healthcare Expenditures among the Elderly in China: The Role of Catastrophic Medical Insurance

China has been piloting the catastrophic medical insurance (CMI) program since 2012 and rolled it out nationally in 2016 to reduce the incidence of catastrophic health expenditure among Chinese residents. Few studies have been conducted to determine its effect on healthcare expenditures, particularly among the elderly. The purpose of this study is to examine the effect of CMI on healthcare expenditures among China's elderly population. The data for this study were derived from 4 waves of the Chinese Longitudinal Healthy Longevity Survey, which included 344 and 1199 individuals in the treatment and control groups, respectively. To examine the effect of CMI on healthcare expenditures among the elderly, we used difference-in-differences and fixed-effects models. Additionally, a heterogeneity analysis was used to examine the differences in the impact of CMI on different groups. Finally, we confirmed the robustness of the results using robustness and placebo tests. CMI increased total health and out-of-pocket expenditures significantly, as well as inpatient and corresponding out-of-pocket expenditures. The reassults of the heterogeneity analysis indicated that CMI had a greater impact on elderly residents of rural areas. Economic burden protection has been enhanced for low-income groups and patients with serious diseases over the last two years. Our research indicated that CMI can promote the use of inpatient medical services for the elderly to a certain extent. Targeted measures such as expanding the CMI compensation list, establishing a more precise compensation scheme, and specific diseases associated with high healthcare expenditures can be considered in the practice of CMI implementation.

The Effect of the "Triple-Layer Medical Security" Policy on the Vulnerability as Expected Poverty of Rural Households: Evidence from Yunnan Province, China

China launched the "critical battle against poverty" nationwide in 2012. As its main battlefield, Yunnan province promulgated the "triple medical security" (TMS) policy in 2017. This study, based on the pooled cross-section database of 2015-2020 of registered poor households in Yunnan province, employed the logit model to examine the effect of TMS on the vulnerability as expected poverty (VEP) of these households. It found that increasing the reimbursement rates for overall medical expenses and inpatient expenses and decreasing the proportion of out-of-pocket medical payment to income reduced the VEP; increases in the number of sick people in the family increased its VEP, and although the increase in the reimbursement rate for overall medical expenses or for inpatient expenses partially offset the VEP caused by the increase in the number of chronically ill people in the family, the VEP caused by the increase in the number of critically ill people would increase in the short term with the increase in the reimbursement rate for overall medical expenses or for inpatient expenses. The findings help improve policies concerning the medical security and health of the rural poor population, providing theoretical reference and practical guidance for future research.

Evaluation of the vulnerability to public health events in the Guangdong-Hong Kong-Macao Greater Bay Area

With the continuous improvement in the integration of urban agglomeration, a multi-functional, socialized, and complex dynamic system, effective prevention and control of emergent public health events have become increasingly important. Based on the Public-Health Vulnerability-Assessment-System of Urban Agglomeration (PVUA), the temporal and spatial differentiation characteristics of vulnerability in the Guangdong-Hong Kong-Macao Greater Bay Area (GBA) for the period of 2015-2019 are explored, and the vulnerable cities to public health events are identified in this area. The results can be summarized as follows: (1) The overall vulnerability to public health events in GBA decreases in the investigated period. (2) In the temporal dimension, accompanied by social and economic development, the sensitivity to public health events increases in GBA, and the coping capacity change from stable fluctuation to rapid improvement. (3) From the spatial dimension, the sensitivity level in GBA is low in the west, relatively high in the middle, and high in the southeast; the coping capacity is high in the southeast and low in the northwest; the collaborative governance capacity presents a spatial pattern of being low in the south and high in the north. (4) In the period of study, the vulnerability to public health events in Guangzhou and Jiangmen is stable at the lowest level, while that in Zhaoqing, Foshan, and Hong Kong SAR (Special Administrative Region) gradually reduces; the vulnerability in Shenzhen, Zhuhai, and Dongguan is fluctuating, and that in Huizhou, Zhongshan, and Macao SAR is continually maintained at a higher and the highest level.