The Impact of Dependency Burden on Urban Household Health Expenditure and Its Regional Heterogeneity in China: Based on Quantile Regression Method

Study on the spatial and temporal differences and influencing factors of out-of-pocket payments as a share of total health expenditure in China

BACKGROUND

Globally, Out-of-pocket (OOP) payments as a share of Total Health Expenditure (THE) has always been a focus of attention in the field of health economics, which affects the economic burden of medical treatment for residents. At present, countries around the world have widely used spatial econometric models to conduct in-depth discussions and analyses of their own OOP, exploring the spatial distribution characteristics and influencing factors of OOP in different regions. However, in China, research in this area is relatively scarce, and few studies have been conducted from a macro perspective and space-time dimension.

METHODS

Based on the panel data of 31 provinces in China, the spatiotemporal distribution characteristics of the proportion of OOP payments in China from 2013 to 2022 were analyzed using spatial autocorrelation. The spatial Durbin model (SDM) was employed to explore the factors influencing OOP payments as a share of THE in China.

RESULTS

The results indicate that the proportion of OOP in China shows a decreasing trend, and there is a significant spatial positive correlation. The change in spatial agglomeration is relatively stable, and only some provinces have a slight change. SDM shows that the main factors affecting the inter-provincial differences in the OOP proportion in China include the elderly dependency ratio (direct effect - 0.181, indirect effect - 0.585), the child dependency ratio (direct effect 0.292, indirect effect 0.686), per capita GDP(direct effect 11.235), and the proportion of government health expenditure to fiscal expenditure (direct effect - 0.254, indirect effect - 0.994), the average number of medical visits per year (direct effect - 0.444), the expenditure of basic medical insurance (direct effect - 1.519, indirect effect - 3.940), and the average medical cost of outpatients (direct effect 3.142, indirect effect - 10.064). These factors collectively influence the spatial variation in OOP payments across provinces in China.

CONCLUSION

The spatial distribution difference of OOP proportion in China is obvious. Factors such as demographics, economics, policy, and health service utilization can all significantly influence OOP. The government should further implement differentiated medical security policies, optimize the allocation structure of health resources, enhance the capacity of primary medical services, promote cross-provincial medical cooperation, and ensure that local residents can enjoy equal access to high-quality medical services and reduce their medical burden.

Health behavior and medical insurance under the healthy China strategy: a moral hazard perspective

Introduction

High medical expenditure is one of the major obstacles to achieving common prosperity in China. As a health risk compensation and protection mechanism, medical insurance has played a good role in alleviating the economic burden of patients. However, due to the existence of moral hazard, medical insurance may also lead to the occurrence of psychological deviation and overtreatment of patients or hospitals' health treatment expectations, thus generating unnecessary pressure on public financial expenditure.

Methods

Using the China Health and Retirement Longitudinal Survey (CHARLS) and Heckman model, this paper discusses the difference in the impact of medical insurance on outpatient and hospitalization costs. The change of the proportion of out-of-pocket medical expenditure is further analyzed.

Results

The study found that while medical insurance reduced the probability of outpatient visits and increased the probability of hospitalization, it increased the cost of outpatient visits and hospitalization. Further, it reduces the share of out-of-pocket medical expenditure.

Discussion

This shows that medical insurance does play a role in alleviating the financial pressure of patients, but the overtreatment caused by moral hazard cannot be ignored, especially the over-examination and over-prescribing of drugs in the outpatient process.

Implications for household health expenditure in China's ageing population: based on Red Herring hypothesis

The rising healthcare costs due to population aging present a complex issue, with debate centering on whether these costs are driven by aging or end-of-life care. This study examines healthcare expenditures in Chinese households using data from the 2005 and 2018 Chinese Longitudinal Healthy Longevity Survey. By applying the Heckman select model and a two-part model, the research innovatively includes time to death, income, social security and health level in the benchmark regression in order to validate the recent some new Red Herring hypothesis. The findings show that time to death is the primary determinant of healthcare expenditures, while the effect of aging is minimal. Income, social security, and health status also significantly influence health expenditure, but they do not function as Red Herring variables.

Research on the Operational Efficiency of Basic Medical Insurance for Urban Employees in China-Based on Three-Stage DEA Model

Purpose

To conduct a three-stage data envelopment analysis (DEA) of the operational efficiency of urban employee basic medical insurance (UEBMI) across 31 provinces in China from 2012 to 2021.

Methods

Utilized a three-stage DEA model, this study measured and evaluated the operational efficiency of urban employee basic medical insurance within China's 31 provinces.

Results

The operational efficiency of urban employee basic medical insurance in China was notably low, displaying significant disparities across different regions and periods. Substantial room for improvement exists. Environmental factors, including urbanization level and unemployment rate, wielded a pronounced influence on the operational efficiency of China's employee medical insurance. Conversely, the fiscal revenue and expenditure ratio hindered the enhancement of employee medical insurance efficiency.

Conclusion

This study held valuable insights for enhancing the operational efficiency of China's urban employee basic medical insurance. To effectively improve insurance efficiency, the following recommendations are put forth: firstly, relevant departments should escalate resource investments and optimize resource utilization based on rational allocation; secondly, enhance legislation and regulations, fortify fund oversight, and ensure equitable and judicious utilization of the medical insurance fund; finally, leveraging modern high-tech advancements can comprehensively elevate the operational efficiency of the employee medical insurance fund. Ultimately, with the advent of cutting-edge technology, the operational efficiency of employee medical insurance fund can be comprehensively elevated.

Relationships between the Physical Activity Intensity and the Medical Expenditure of Middle-Aged and Elderly People: Parsing from the CHARLS Database

There are many studies on the impact of physical activity on health but few studies on the relationship between physical activity and medical expenditure among the elderly. Based on the China Health and Retirement Longitudinal Survey (CHARLS) database and selected 4456 valid samples, this paper used a two-part model to analyze the effects of high, moderate, and low physical activity intensity on medical expenditure. It is found that the intensity of physical activity was negatively correlated with medical expenditure, and the medical expenditure of the high physical activity intensity group was significantly lower than that of the low physical activity intensity group. For example, compared to people with no physical activity, the total medical expenditure decreased by 22.4%, 40.4%, and 62.5% per week in those with low, moderate, and high physical activity intensity. Thus, the government should provide more places for the elderly to exercise, planning special exercise areas for the elderly in community playgrounds, such as a dancing square, which will also help the elderly to increase their amount of exercise per week and develop a daily exercise habit.

Risk factors associated with attendance at postpartum blood pressure follow-up visit in discharged patients with hypertensive disorders of pregnancy

BACKGROUND

This study aims to investigate the risk factors for not returning to postpartum blood pressure (BP) follow-up visit at different time points in postpartum discharged hypertensive disorders of pregnancy (HDP) patients. Likewise, females with HDP in China should have a BP evaluation continuously for at least 42 days postpartum and have BP, urine routine, and lipid and glucose screening for 3 months postpartum.

METHODS

This study is a prospective cohort study of postpartum discharged HDP patients. Telephone follow-up was conducted at 6 weeks and 12 weeks postpartum, the maternal demographic characteristics, details of labor and delivery, laboratory test results of patients at admission, and adherence to BP follow-up visits postpartum were collected. While logistic regression analysis was used to analyze the factors associated with not returning to postpartum BP follow-up visit at 6 weeks and 12 weeks after delivery, the receiver operating characteristic (ROC) curve was drawn to evaluate the model's predictive value for predicting not returning to postpartum BP visit at each follow-up time point.

RESULTS

In this study, 272 females met the inclusion criteria. 66 (24.26%) and 137 (50.37%) patients did not return for postpartum BP visit at 6 and 12 weeks after delivery. A multivariate logistic regression analysis identified education level of high school or below (OR = 3.71; 95% CI = 2.01-6.85; p = 0.000), maximum diastolic BP during pregnancy (OR = 0.97; 95% CI = 0.94-0.99; p = 0.0230)and delivery gestational age (OR = 1.12; 95% CI = 1.005-1.244; p = 0.040)as independent risk factors in predicting not returning to postpartum BP follow-up visit at 6 weeks postpartum, and education level of high school or below (OR = 3.20; 95% CI = 1.805-5.67; p = 0.000), maximum diastolic BP during pregnancy (OR = 0.95; 95% CI = 0.92-0.97; p = 0.000), delivery gestational age (OR = 1.13; 95% CI = 1.04-1.24; p = 0.006) and parity (OR = 1.63; 95% CI = 1.06-2.51; p = 0.026) as risk factors for not returning to postpartum BP follow-up visit at 12 weeks postpartum. The ROC curve analysis indicated that the logistic regression models had a significant predictive value for identify not returning to BP follow-up visit at 6 and 12 weeks postpartum with the area under the curve (AUC) 0.746 and 0.761, respectively.

CONCLUSION

Attendance at postpartum BP follow-up visit declined with time for postpartum HDP patients after discharge. Education at or below high school, maximum diastolic BP during pregnancy and gestational age at delivery were the common risk factors for not returning for BP follow-up visit at 6 and 12 weeks postpartum in postpartum HDP patients.

Analytical method development, validation and study on behaviour of ipfencarbazone in paddy (rice)

Supervised field trial was conducted to study persistence of a pre-emergent herbicide, ipfencarbazone (25% SC) on rice crop. Single application of two different doses, 156.25 g a.i.ha^-1/625 mL formulationha^-1 and 312.50 g a.i.ha^-1/1250 mL formulationha^-1, was applied. Method was validated to analyse ipfencarbazone in rice samples (leaf/plant, grain, straw and husk) and in soil. Initial accumulation of ipfencarbazone in rice plants was 6.72 and 14.71 mg kg^-1 in standard and double dose, respectively. The residues decreased linearly with r² values of 0.92 and 0.98 in different doses and reached below limit of quantitation (LOQ) of 0.01 μg kg^-1 (for rice plant/leaf) and 0.05 μg kg^-1 (for rice grain, husk, straw) on 30th and 97th (harvest) day respectively after application in both the doses. An average half-life of ipfencarbazone was approximately 4 days. Less than LOQ levels at harvest and short half-life suggest that the use of ipfencarbazone is safe, provided good agricultural practices (GAP) are followed. The data can be used by regulatory authorities like Food Safety and Standards Authority of India (FSSAI) and CODEX for establishing maximum residue limits (MRLs) of ipfencarbazone.

Risk Characteristics of Catastrophic Health Expenditure in Multidimensional Borderline Poor Households in China

Background

Ending poverty and realizing common prosperity are the essential requirements for the localization of Marxism in China. The ongoing COVID-19 pandemic in the post-poverty era further aggravates the risk of catastrophic health expenditure for borderline poor households and increases the uncertainty of returning to poverty due to illness, potentially undermining decades of hard-won efforts to eradicate poverty in China.

Methods

Based on the latest data released by China Health and Retirement Longitudinal Survey (CHARLS) database, this paper uses the Logit model to empirically explore the risk characteristics of catastrophic health expenditure of multidimensional borderline poor households based on identifying multidimensional borderline poor households.

Results

The results show that factors such as family income level, child support, and medical insurance have different impacts on catastrophic health expenditure, and the risk of catastrophic health expenditure of multidimensional borderline poor households is much higher than that of non- multidimensional borderline poor households, and there is a certain difference between urban and rural areas.

Discussion

The government should strengthen and improve the social security system and health service system, such as medical insurance, and more resources should be allocated to multidimensional borderline poor households, especially in rural areas.

Configurations of the driving factors promoting China's commercial health insurance: A comparative qualitative analysis based on the technology–organization–environment framework

With the nation's remarkable improvement in living standards, China's health insurance system cannot satisfy people's higher demands; therefore, it is necessary to promote the supply of commercial health insurance (CHI) in China. Based on the technology–organization–environment (TOE) framework, this study constructs a novel analysis framework to investigate the driving path of China's CHI. Employing the data of 31 provincial regions of China in 2018, a fuzzy-set qualitative comparative analysis is conducted to analyze configurations. We also adopt a necessary condition analysis in the robustness check to examine the necessary conditions, determining that no necessary relationship exists between possible conditions and the performance of CHI. More particularly, three sufficient configurations, TOE strategy, government attention (GA)–environment adaptability (EA)–citizen demand (CD) strategy, and dual EA–CD strategy are demonstrated to achieve high performance, and the other three configurations of technological management capability (TMC)–EA-CD strategy, technological infrastructure (TI)–EA strategy, and combined TI–TMC–EA strategy do not result in high performance. In addition, technological conditions (TI and TMC) and EA are relatively more important than the other configurations. Notably, government departments' financial expenditure is found to have a negative effect on CHI promotion.

Self-Medication Behaviors of Chinese Residents and Consideration Related to Drug Prices and Medical Insurance Reimbursement When Self-Medicating: A Cross-Sectional Study

BACKGROUND

Self-medication has become a common phenomenon. Economic factors are important factors that affect the self-medication of residents. This study aimed to investigate the current status of self-medication behaviors in China and explored the related factors affecting considerations associated with medical insurance reimbursement or drug price in self-medication.

METHODS

A national cross-sectional investigation was conducted among Chinese people over 18 years old under a multi-stage sampling method through a questionnaire, which includes demographic sociological characteristics, self-medication behaviors and scales. The Chi-square test was used to analyze whether the respondents consider medical insurance reimbursement or drug price as an important factor when purchasing over-the-counter (OTC) drugs. Logistic regression was used to examine the associated factors of considering medical insurance reimbursement or drug price.

RESULTS

In total, 9256 respondents were included in this study; 37.52% of the respondents regarded drug prices as an important consideration, and 28.53% of the respondents attached great importance to medical insurance reimbursement. Elderly respondents who lived in the central region, had medical insurance, and had lower levels of health literacy were more likely to consider the medical insurance reimbursement, while respondents with high monthly family income as well as students were less likely to consider the same issue (p < 0.05). Respondents settled in the central and western regions, students, those without fixed occupations, those who suffered from chronic diseases, or those with lower health literacy were more likely to consider drug prices, while the respondents with bachelor degrees, urban population and high per capita monthly income were less likely to consider the drug prices (p < 0.05).

CONCLUSION

Self-medication behaviors with OTC drugs were prevalent in China, and consideration factors of medical insurance reimbursement or drug prices were related to socio-demographic characteristics and health literacy. There is a need to take measures to reduce the economic burden of self-medication, improve the health literacy of residents and strengthen public health education.

Research on the Efficiency of Green Agricultural Science and Technology Innovation Resource Allocation Based on a Three-Stage DEA Model-A Case Study of Anhui Province, China

In order to achieve sustainable development of agriculture, people have gradually begun to attach importance to the development of low-carbon agriculture and to regard green agricultural technology innovation and promotion as increasingly more important. Taking the Anhui Province of China as an example, this study analyzed the impact of green agricultural science and technology innovation resource allocation on rural revitalization by constructing an econometric model. We found that the overall efficiency of the overall allocation of agricultural science and technology innovation resources in Anhui Province increased in the sample period, but the scale efficiency level was relatively low. The key path to improving the overall efficiency of allocation was to improve the scale efficiency level. The allocation of agricultural science and technology innovation resources in 16 cities and prefectures performed well in terms of pure technical efficiency, but there were significant differences in scale efficiency, which further affected the overall allocation efficiency of different regions. Among them, the allocation efficiencies of agricultural science and technology innovation resources in Hefei and Fuyang were at the leading level in Anhui Province. Similar to the overall situation of the province, the improvement path of areas with low comprehensive efficiency lay in the improvement of scale efficiency. In view of this, from the policy level, we need to optimize the relationship between the government and the market, speed up the construction of platforms and carriers, attach importance to the construction of the agricultural science and technology talent training system, and improve the open sharing mechanism.

Longitudinal Relationship between Cognitive Function and Health-Related Quality of Life among Middle-Aged and Older Patients with Diabetes in China: Digital Usage Behavior Differences

BACKGROUND

Cognitive function and health-related quality of life (HRQoL) are important issues in diabetes care. According to the China Association for Aging, it is estimated that by 2030, the number of elderly people with dementia in China will reach 22 million. The World Health Organization reports that by 2044, the number of people with diabetes in China is expected to reach 175 million.

METHODS

Cohort analyses were conducted based on 854 diabetic patients aged ≥45 years from the third (2015) and fourth (2018) survey of the China Health and Retirement Longitudinal Study (CHARLS). Correlation analysis, repeated-measures variance analysis, and cross-lagged panel models were used to measure the difference in digital usage behavior in the established relationship.

RESULTS

The results show that the cognitive function of middle-aged and older diabetic patients is positively correlated with HRQoL. HRQoL at T1 could significantly predict cognitive function at T2 (PCS: B = 0.12, p < 0.01; MCS: B = 0.14, p < 0.01). This relationship is more associated with individual performance than digital usage behavior.

CONCLUSIONS

Unidirectional associations may exist between cognitive function and HRQoL among middle-aged and older Chinese diabetes patients. In the future, doctors and nurses can recognize the lowering of self-perceived HRQoL of middle-aged and older diabetic patients, and thus draw more attention to their cognitive function, in turn strengthening the evaluation, detection, and intervention of their cognitive function.

Does Elderly Chronic Disease Hinder the Sustainability of Borderline Poor Families’ Wellbeing: An Investigation From Catastrophic Health Expenditure in China

Objectives: Health and health expenditure caused by elderly chronic diseases are a global problem. As China has just lifted itself out of poverty in 2020, the sustainable development of Borderline Poor Families’ Wellbeing faces severe challenges. Therefore, it is of great practical significance to explore the impact of elderly chronic diseases on the catastrophic health expenditure of Borderline Poor Families.

Methods: Based on screening 8086 effective samples from China Health and Retirement Longitudinal Study (CHARLS) database and calculating catastrophic health expenditure, this paper uses two-part model and logit regression to discuss the impact of elderly chronic diseases on the sustainable development of Borderline Poor Families’ Wellbeing.

Results: The results showed that stroke, cancer, and liver disease caused the most catastrophic health expenditures and had the greatest impact on the Borderline Poor Families’ Wellbeing.

Conclusion: Therefore, in order to ensure the sustainable development of Borderline Poor Families’ Wellbeing, the government should strengthen the publicity of pre-prevention and post-healthcare of chronic diseases such as stroke, and combine pre-prevention policy with post-guarantee policy.

Analysis of Major Factors Affecting the Quality of Life of the Elderly in Korea in Preparation for a Super-Aged Society

In preparation for the expected super-aged society in 2025, this study attempted to prepare basic data that can help design development measures for the welfare of the elderly so that everyone can prepare for a healthy and happy retirement. Accordingly, the major factors affecting the quality of life of the elderly in Korea were verified. To this end, the questionnaire consisted of 22 questions in total, and a mobile survey was conducted between September and October 2021; in total, 250 copies were used for the final analysis, and the following conclusions are derived. The major factors that were found to determine the quality of life of the elderly were age, subjective health status, monthly household income, leisure activities, and health inequality fairness. It was found that the higher the age, the lower the quality of life. Further, the higher the subjective health status, monthly household income, participation in leisure activities, and perceptions of health inequality as fair, the more the quality of life of the elderly was affected. Therefore, policy support such as leisure activity, health programs, and medical welfare services for the elderly and sufficient attention from our society are all required.

Multi-dimensional vulnerability analysis on catastrophic health expenditure among middle-aged and older adults with chronic diseases in China

OBJECTIVE

Middle-aged and older adults are more likely to suffer from chronic diseases because of their particular health characteristics, which lead to a high incidence of catastrophic health expenditure (CHE). This study plans to analyse the different factors affecting CHE in middle-aged and older adults with chronic diseases, target the vulnerable characteristics, and suggest groups that medical insurance policies should pay more attention to.

METHODS

The data used in this study came from the 2018 China Health and Retirement Longitudinal Study (CHARLS) database. The method of calculating the CHE was adopted from the World Health Organization (WHO). The logistic regression was used to determine the family characteristics of chronic disease in middle-aged and older adults with a high probability of incurring CHE.

RESULTS

The incidence of CHE in middle-aged and older adults with chronic disease was highest in sub-poverty level families (26.20%) was lowest in wealthier level families (20.07%). Households with malignant tumours had the highest CHE incidence under any circumstances, especially if the householder had been using inpatient service in the past year. Among the comparison of CHE incidence in different types of medical insurance, the Urban and Rural Residents' Basic Medical Insurance (URRBMI) was the highest (27.46%). The incidence of CHE was 2.73 times (95% CI 2.30-3.24) and 2.16 times (95% CI 1.81-2.57) higher among people who had used inpatient services in the past year or outpatient services in the past month than those who had not used them.

CONCLUSIONS

Relatively wealthy economic conditions cannot significantly reduce the financial burden of chronic diseases in middle-aged and older adults. For this particular group with multiple vulnerabilities, such as physical and social vulnerability, the high demand and utilization of health services are the main reasons for the high incidence of CHE. After achieving the goal of lowering the threshold of universal access to health services, the medical insurance system in the next stage should focus on multiple vulnerable groups and strengthen the financial protection for middle-aged and older adults with chronic diseases, especially for patients with malignant tumours.

The Path of Housing Prices in Promoting the Upgrading of Industrial Structure: Bank Credit Funds, Land Finance, and Consumer Demand

The impact path of housing prices on the upgrading of the industrial structure is an important part of realizing the high-quality operation of the national economy in China. In order to discuss the mechanism of different influencing paths to upgrading industrial structure, this paper introduces three different intermediary variables from the levels of supply, demand, and government, and further subdivides and compares them to empirically test the specific impact path of housing prices on industrial structure upgrading by constructing multi-dimensional industrial structure upgrading indicators. It obtains some meaningful results. Firstly, there is a significant U-shaped relationship between housing prices and industrial structure upgrading; secondly, rising house prices will exacerbate the real estate industry’s occupation of bank credit funds, hindering the upgrading of the whole industrial structure; thirdly, the negative impact of the land’s financial dependence on the upgrading of the industrial structure was underestimated; and, finally, the rise in housing prices can improve the consumption level and promote the upgrading of regional industrial structures. By studying the impact path of house prices on the upgrading of different industrial structures, it will help local governments regulate house prices and give full play to the role of house prices in promoting the upgrading of industrial structure through multiple channels.