Clinical and Economic Insights into Parkinson's Disease Hospitalization: A Comprehensive Study of 19,719 Inpatient Cases in Hubei Province, China.

OBJECTIVE: Parkinson's disease (PD) is a profoundly incapacitating neurodegenerative disorder, which presents a substantial challenge to the economic sustainability of the global healthcare system. The present study seeks to clarify the factors that contribute to the costs associated with PD hospitalization and analyze the economic burden it imposes. METHODS: We examined data of 19,719 patients with a primary diagnosis of PD who were admitted to hospitals in Hubei Province, China, during the study period. Healthcare data were obtained from the database of electronic medical records. The study presents a comprehensive analysis of the demographic characteristics and investigates the factors that affect their healthcare expenditure. RESULTS: The cohort consisted of 10,442 (53.0%) males and 9,277 (47.0%) females. The age-group of 66-70 years experienced the highest incidence of hospitalization among PD patients, with a mortality rate of 0.76‰. The average length of stay for patients was 9.9 ± 8.6 days and the average cost per patient was USD 1,759.9 ± 4,787.7. Surgical interventions were conducted on a mere 2.0% of the total inpatient population. The primary cost component for these interventions was material expenses, accounting for 70.1% of the total. Non-surgical patients primarily incurred expenses related to diagnosis and medication. Notably, surgical patients faced a substantial out-of-pocket rate, reaching up to 90.6%. Surgery was identified as the most influential factor that negatively affected both length of stay and hospitalization costs. Inpatients exhibited significant associations with prolonged length of stay and increased medical expenditure as age increased. Male patients had significantly longer hospital stays and higher medical costs than did females. Additionally, patient's occupation and type of medical insurance exerted significant effects on both length of stay and medical expense. CONCLUSION: Age significantly affects PD hospitalization costs. Given the prevailing demographic shift toward an aging population, the government's medical insurance burden related to PD will continue to escalate. Meanwhile, high treatment expenses and out-of-pocket rates impose substantial financial burdens on patients, limiting surgical intervention access to a small fraction of patients. Addressing these issues is of utmost importance in order to ensure comprehensive disease management for the majority of individuals affected by PD.

The impact of an innovative payment method on medical expenditure, efficiency, and quality for inpatients with different types of medical insurance: evidence from a pilot city, China.

BACKGROUND: Since 2020, China has implemented an innovative payment method called Diagnosis-Intervention Packet (DIP) in 71 cities nationwide. This study aims to assess the impact of DIP on medical expenditure, efficiency, and quality for inpatients covered by the Urban Employee Basic Medical Insurance (UEBMI) and Urban and Rural Residents Basic Medical Insurance (URRBMI). It seeks to explore whether there are differences in these effects among inpatients of the two insurance types, thereby further understanding its implications for health equity. MATERIALS AND METHODS: We conducted interrupted time series analyses on outcome variables reflecting medical expenditure, efficiency, and quality for both UEBMI and URRBMI inpatients, based on a dataset comprising 621,125 inpatient reimbursement records spanning from June 2019 to June 2023 in City A. This dataset included 110,656 records for UEBMI inpatients and 510,469 records for URRBMI inpatients. RESULTS: After the reform, the average expenditure per hospital admission for UEBMI inpatients did not significantly differ but continued to follow an upward pattern. In contrast, for URRBMI inpatients, the trend shifted from increasing before the reform to decreasing after the reform, with a decline of 0.5%. The average length of stay for UEBMI showed no significant changes after the reform, whereas there was a noticeable downward trend in the average length of stay for URRBMI. The out-of-pocket expenditure (OOP) per hospital admission, 7-day all-cause readmission rate and 30-day all-cause readmission rate for both UEBMI and URRBMI inpatients showed a downward trend after the reform. CONCLUSION: The DIP reform implemented different upper limits on budgets based on the type of medical insurance, leading to varying post-treatment prices for UEBMI and URRBMI inpatients within the same DIP group. After the DIP reform, the average expenditure per hospital admission and the average length of stay remained unchanged for UEBMI inpatients, whereas URRBMI inpatients experienced a decrease. This trend has sparked concerns about hospitals potentially favoring UEBMI inpatients. Encouragingly, both UEBMI and URRBMI inpatients have seen positive outcomes in terms of alleviating patient financial burdens and enhancing the quality of care.

Multilevel medical insurance mitigate health cost inequality due to air pollution: Evidence from China.

BACKGROUND: Air pollution affects residents' health to varying extents according to differences in socioeconomic status. However, there has been a lack of research on whether air pollution contributes to unfair health costs. METHODS: In this research, data from the China Labour Force Dynamics Survey are matched with data on PM2.5 average concentration and precipitation, and the influence of air pollution on the health expenditures of residents is analysed with econometric methods involving a two-part model, instrument variables and moderating effects. RESULTS: The findings reveal that air pollution significantly impacts Chinese residents' health costs and leads to low-income people face health inequality. Specifcally, the empirical evidence shows that air pollution has no significant influence on the probability of residents' health costs (ß = 0.021, p = 0.770) but that it increases the amount of residents' total outpatient costs (ß = 0.379, p < 0.006), reimbursed outpatient cost (ß = 0.453, p < 0.044) and out-of-pocket outpatient cost (ß = 0.362, p < 0.048). The heterogeneity analysis of income indicates that low-income people face inequality due to health cost inflation caused by air pollution, their total and out-of-pocket outpatient cost significantly increase with PM2.5 (ß = 0.417, p = 0.013; ß = 0.491, p = 0.020). Further analysis reveals that social basic medical insurance does not have a remarkable positive moderating effect on the influence of air pollution on individual health inflation (ß = 0.021, p = 0.292), but supplementary medical insurance for employees could reduce the effect of air pollution on low-income residents' reimbursed and out-of-pocket outpatient cost (ß=-1.331, p = 0.096; ß=-2.211, p = 0.014). CONCLUSION: The study concludes that air pollution increases the amount of Chinese residents' outpatient cost and has no significant effect on the incidence of outpatient cost. However, air pollution has more significant impact on the low-income residents than the high-income residents, which indicates that air pollution leads to the inequity of medical cost. Additionally, the supplementary medical insurance reduces the inequity of medical cost caused by air pollution for the low-income employees.

The development of day surgery in China and the effectiveness and reflection of day surgery in ophthalmology-specialized hospitals.

This survey investigates the development of day surgery in China, and analyzes the national policy support, medical service management model, disease types of day surgery, medical insurance payment methods, and the medical service capacity, efficiency, quality and safety, health economics indicators, and patient satisfaction after the implementation of day surgery in a tertiary eye hospital. After more than 20 years of development, China's day surgery has shown a good development trend. The implementation of day surgery in eye hospitals accounts for more than 70% of elective surgery, and patients, medical institutions, and medical insurance institutions have all achieved good social benefits.

Relationship between nurses' perceptions and financial toxicity management in the public health insurance system.

Aims: To describe nursing practices for financial toxicity management based on nurses' perceptions. Materials & methods: A survey was conducted with 615 oncology nurses in Japan, focusing on nurses' perspectives on the importance of financial toxicity, nursing practices to manage financial toxicity and factors inhibiting its management. Results: A total of 521 participated, of whom 266 respondents (51.1%) considered nurses' role important, and they engaged in a significantly higher proportion of nursing practices. Participants with greater perceptions of their role included certified or specialized nurses and nurses responsible for outpatient care. Conclusion: Interventions leveraging the expertise of certified or specialized nurses and nurses involved in outpatient care could help to spread proactive nurse practices addressing financial toxicity.

What are people's attitudes toward medical insurance fraud whistleblowers? a study from China.

PURPOSE: Medical insurance fraud has caused huge losses to countries around the world, and public reporting has become an important means to combat medical insurance fraud. The attitude of medical insurance fraud whistleblowers affects people's reporting behavior, and understanding people's attitude toward medical insurance fraud whistleblowers provides a basis for further improving the system and policy of public participation in medical insurance fund supervision. METHODS: We adopted the questionnaire method to conduct a national cross-sectional survey of the Chinese public and analyzed the data using Chi-square tests, Fisher's exact tests, and binary logistic regression models. RESULTS: A total of 837 respondents were included, and 81.8% of the population had a supportive attitude toward medical insurance fraud whistleblowers, with gender, whether they had used medical insurance reimbursement, and present life satisfaction being statistically significant (P < 0.05). CONCLUSION: The public is generally supportive of medical insurance fraud whistleblowers, and women, those who have used medical insurance for reimbursement, and those who are satisfied with their lives are more likely to be supportive of medical insurance fraud whistleblowers.

Enhancing pooling levels strengthens the risk resilience of healthcare insurance: a case study of basic medical insurance fund operations data in Gansu, China.

BACKGROUND: In China, enhancing the pooling levels of basic health insurance has consistently been regarded as a pivotal measure to promote the refinement of the healthcare insurance system. From 2020 to 2022, the widespread outbreak of COVID-19 posed new challenges to China's basic health insurance. METHODS: The research utilizes Data Envelopment Analysis (DEA), Malmquist index assessment, and fixed-effects panel Tobit models to analyze panel data from 2020 to 2022, assessing the efficiency of basic health insurance in Gansu Province. RESULTS: From 2020 to 2022, the average overall efficiency of the municipal pooling of Basic Medical Insurance for Urban and Rural Residents was 0.941, demonstrating a stable trend with a modest increase. The efficiency frontier regions have expanded from 5 (35.71%) to 7 (50%). Operational efficiency exhibited a negative correlation with per capita hospitalization expenses and per capita fund balance but a positive correlation with per capita accumulated fund balance and reimbursement rates for hospitalized patients. In 2021, compared to 2020, the county-pooling Basic Medical Insurance for Urban Employees saw a decline of 0.126 in overall efficiency, reducing the efficiency frontier regions from 8 to 3. However, from 2021 to 2022, the municipal-coordinated Basic Medical Insurance for Urban Employees experienced a 0.069 increase in overall efficiency, with the efficiency frontier regions expanding from 3 to 5. Throughout 2020 to 2022, the operational efficiency of the Urban Employee Basic Medical Insurance showed a consistent negative correlation with per capita fund balance. CONCLUSION: From 2020 to 2022, the overall operational performance of basic health insurance in Gansu Province was satisfactory, and enhancing the pooling level is beneficial in addressing the impact of unforeseen events on the health insurance system.

Impact of medical insurance access negotiation on the utilization of innovative anticancer drugs in China: an interrupted time series analysis.

BACKGROUND: The high costs of innovative anticancer drugs hinder a number of cancer patients' access to these drugs in China. To address this problem, in 2018, the medical insurance access negotiation (MIAN) policy was implemented, when the prices of 17 innovative anticancer drugs were successfully negotiated and they were therefore included in the reimbursement list. This study aimed to explore the impact of the MIAN policy on the utilization of innovative anticancer drugs. METHODS: With monthly data on drug expenditures and defined daily doses (DDDs) of each innovative anticancer drug from January 2017 to December 2019, interrupted time series analysis was employed to estimate both the instant (change in the level of outcome) and long-term (change in trends of outcomes) impacts of the MIAN policy on drug utilization in terms of drug expenditures and DDDs. Our sample consists of 12 innovative anticancer drugs. RESULTS: From January 2017 to December 2019, the monthly drug expenditures and DDDs of 12 innovative anticancer drugs increased by about 573% (from US$8,931,809.30 to US$51,138,331.09) and 1400% (from 47,785 to 668,754), respectively. Overall, the implementation of the MIAN policy led to instant substantial increases of US$8,734,414 in drug expenditures and 158,192.5 in DDDs. Moreover, a sharper upward trend over time was reported, with increases of US$2,889,078 and 38,715.3 in the monthly growth rates of drug expenditures and DDDs, respectively. Regarding individual innovative anticancer drugs, the most prominent instant change and trend change in drug utilization were found for osimertinib, crizotinib, and ibrutinib. In contrast, the utilization of pegaspargase was barely affected by the MIAN policy. CONCLUSIONS: The MIAN policy has effectively promoted the utilization of innovative anticancer drugs. To ensure the continuity of the effects and eliminate differentiation, supplementary measures should be carried out, such as careful selection of drugs for medical insurance negotiations, a health technology assessment system and a multichannel financing mechanism.

The impact of medical insurance and old-age security on the utilization of medical services by the older population with disabilities.

OBJECTIVE: In this study, the impact of medical insurance and old-age security on the use of medical services by the older population with disabilities is analyzed. A reference for decision makers is provided to improve medical and old-age security policies and enhance the use of medical services by the older population. METHODS: Data were drawn from 3,737 older people with disabilities aged 65 years or above from the 2018 China Longitudinal Healthy Longevity Survey. A two-part model based on social ecological theory was used for both analysis and group prediction. RESULTS: In terms of the use of outpatient medical services, old-age pension significantly increased the probability of outpatient visits for this population group (P < 0.05). Urban employee/resident medical insurance, the new rural cooperative medical insurance, and retirement pension significantly affected medical expenses. In terms of the use of inpatient medical services, the new rural cooperative medical insurance and retirement pension significantly influenced the choice of inpatient medical services; retirement pension increased inpatient medical expenditure (p < 0.01). The expected average probability of hospitalization, unconditional expected cost, and conditional expected cost for the older population with disabilities were 49.5%, RMB 6629.31, and RMB 3281.51, respectively. Both conditional and unconditional expected costs were significantly higher for older people with disabilities with the following attributes: male, married, no less than three chronic conditions, and unassisted daily care; costs were lower for older people with disabilities who are female, not married, had less than three chronic conditions, and had a spouse, child, or other caregiver. CONCLUSION: Medical insurance and old-age security can significantly promote the utilization of medical services by the older population with disabilities. It is therefore recommended to focus on strengthening the support and health management of these people who are unattended to improve the effective use of health services and better meet their needs.

An open repository of real-time COVID-19 indicators.

The COVID-19 pandemic presented enormous data challenges in the United States. Policy makers, epidemiological modelers, and health researchers all require up-to-date data on the pandemic and relevant public behavior, ideally at fine spatial and temporal resolution. The COVIDcast API is our attempt to fill this need: Operational since April 2020, it provides open access to both traditional public health surveillance signals (cases, deaths, and hospitalizations) and many auxiliary indicators of COVID-19 activity, such as signals extracted from deidentified medical claims data, massive online surveys, cell phone mobility data, and internet search trends. These are available at a fine geographic resolution (mostly at the county level) and are updated daily. The COVIDcast API also tracks all revisions to historical data, allowing modelers to account for the frequent revisions and backfill that are common for many public health data sources. All of the data are available in a common format through the API and accompanying R and Python software packages. This paper describes the data sources and signals, and provides examples demonstrating that the auxiliary signals in the COVIDcast API present information relevant to tracking COVID activity, augmenting traditional public health reporting and empowering research and decision-making.

The promotion of pooling level of basic medical insurance and participants' health: impact effects and mediating mechanisms.

BACKGROUND: Enhancing the pooling of basic medical insurance plays a vital role in strengthening the resilience to risk and co-payment capacity of medical insurance funds. In China, there is a concerted effort to shift from municipal to provincial pooling of medical insurance. While existing research suggests that provincial pooling of basic health insurance affects the health of participants, the findings are not yet consistent, and there is limited research on the specific pathways of impact between the two. Therefore, this study aims to explore the influence of provincial pooling of basic medical insurance on participants' health and analyze the mediating role of medical cost burden and medical service utilization. METHODS: Using data from the 2012-2018 China Labor Dynamics Survey (CLDS), this study focuses on a sample of urban workers enrolled in basic medical insurance. After excluding samples with missing information, a total of 5,684 participants were included in the analysis. The effects of the provincial pooling policy of basic medical insurance on participants' medical cost burden, medical service utilization, and health were analyzed using double difference modeling. Furthermore, structural equation modeling was employed to explore the mediating paths between provincial pooling and health. RESULTS: The findings reveal that provincial pooling of basic medical insurance significantly impacts participants' medical cost burden, medical service utilization, and health. Specifically, provincial pooling helps reduce the participants' medical cost burden (ß = -0.1205; P < 0.001), improves the level of medical institutions visited (ß = 1.7962; P < 0.001), and promotes health improvement (ß = 1.8370; P < 0.001). The mediating effect analysis demonstrates that the direct effect of provincial pooling on health is 1.073 (P < 0.001), with a mediating effect of medical cost burden between provincial pooling and health measuring 0.129 (P < 0.001). Heterogeneity analysis indicates that provincial pooling is more effective in reducing the burden of medical costs for low-income (ß = -0.2273; P < 0.001) and high-age participants (ß = -0.2710; P < 0.001), and it also helps increase the burden of medical costs for low-income (ß = 4.0875; P < 0.001) and high-age participants (ß = 1.9010; P < 0.001) based on provider ranking. Moreover, it is found that provincial pooling is more beneficial in improving the health of high-income (ß = 1.7984; P < 0.001) and middle- and high-age enrollees (ß = 1.9220; P < 0.001; ß = 0.5900; P < 0.001). Further analysis reveals that the provincial unified income and expenditure mode has a more positive effect than the provincial risk adjustment fund mode in reducing the medical expense burden of the insured (-0.2053 < -0.0775), improving the grade of medical institutions (1.8552 > 0.8878), and enhancing the health level (2.8406 > 0.6812). CONCLUSION: The study concludes that provincial pooling of basic medical insurance has a direct positive impact on participants' health and indirectly promotes health improvement by reducing the burden of medical costs. The effects of provincial pooling on participants' medical cost burden, medical service utilization, and health vary based on income and age. Additionally, the provincial-level unified collection and payment model proves to be more advantageous in optimizing the functioning of health insurance funds through the "law of large numbers" principle.

The impact of urban-rural medical insurance integration on medical impoverishment: evidence from China.

BACKGROUND: Financial protection is a key dimension of Universal Health Coverage (UHC), and social medical insurance is an effective measure to provide financial protection. The aim of this study is to examine the impact of urban-rural medical insurance integration on medical impoverishment in China. METHODS: We collected the time of integration policy in 337 prefecture-level cities across China, combined with the longitudinal database of China Labor-force Dynamics Survey (CLDS) from 2012-2016, and used a difference-in-differences (DID) method with multiple time periods at the city level to study the effect of urban-rural medical insurance integration on the medical impoverishment. Besides, to explore the heterogeneity of policy effects across populations, we conducted subgroup analyses based on respondents' age, household registration, and whether they were rural-urban migrants. FINDINGS: A total of 8,397 samples were included in the study. The integration policy has significantly reduced the incidence of medical impoverishment (average treatment effect on the treated (ATT) = - 0.055, p < 0.05). Subgroup analysis showed that the impacts on medical impoverishment varied by age group, and the integration policy has more effect on older people than on younger people (ATT for age 15-34 = - 0.018, p > 0.05; ATT for age 35-54 = - 0.042, p < 0.05; ATT for age 55-64 = - 0.163, p < 0.01). Moreover, the impacts also varied by household registration. The integration policy has a more significant impact on rural residents (ATT for rural = - 0.067, p < 0.05) compared to urban residents (ATT for urban = - 0.007, p > 0.05). Additionally, the policy has a bigger influence on rural-urban migrants (ATT for rural-urban migrated = - 0.086, p < 0.05) than on those who have not migrated (ATT for rural-urban unmigrated = - 0.071, p < 0.05). CONCLUSION: China's policy of integrating urban-rural medical insurance has been successful in reducing medical impoverishment, especially for older age, rural, and rural-urban migrated people. It can be speculated that the integrating policy may be adapted to other similar settings in developing countries to reduce medical impoverishment.

Does the immediate reimbursement of medical insurance reduce the socioeconomic inequality in health among the floating population? Evidence from China.

BACKGROUND: Enhancing health intervention for floating populations has become an essential aspect of public health around the world. China launched a policy reform aimed at implementing immediate reimbursement for trans-provincial inpatient treatments. The objective of this study was to investigate the effects of this policy change on socioeconomic inequality in health among the floating population. METHODS: This study used two waves of individual-level data from the China Migrants Dynamic Survey (CMDS) collected in 2017 and 2018 as well as administrative hospital data at the city level. The sample included 122061 individuals and 262 cities. Under a quasi-experimental research design, we built up the framework to employ the generalized and multi-period difference-in-differences estimation strategy. We used the number of qualified hospitals that could provide immediate reimbursement to represent the degree and intensity of the implementation of this policy change. We also calculated the Wagstaff Index (WI) to measure socioeconomic inequality in health. RESULTS: This policy change and income level had a negative joint impact on the health status of floating population (odds ratio = 0.955, P < 0.01), that is, the lower the income, the better the number of qualified hospitals' effect on health improvement. Furthermore, as the number of qualified tertiary hospitals increased, the health inequality would decrease significantly on average at the city level (P < 0.05). In addition, inpatient utilization as well as total expenditure and reimbursement significantly improved after the policy change, and the magnitude of increase was greater in the relatively lower-income group (P < 0.01). Finally, only inpatient spending could obtain immediate reimbursement in the early stage, thus, compared with primary care, these impacts were greater in tertiary care. CONCLUSIONS: Our study revealed that after the implementation of immediate reimbursement, the floating population could obtain greater and more timely reimbursement, which significantly increased its inpatient utilization, promoted health, and reduced the health inequality caused by socioeconomic factors. These results suggest that a more accessible and friendly medical insurance scheme should be promoted for this group.

A Novel Multi-view Bi-clustering method for identifying abnormal Co-occurrence medical visit behaviors.

Abnormal co-occurrence medical visit behavior is a form of medical insurance fraud. Specifically, an organized gang of fraudsters hold multiple medical insurance cards and purchase similar drugs frequently at the same time and the same location in order to siphon off medical insurance funds. Conventional identification methods to identify such behaviors rely mainly on manual auditing, making it difficult to satisfy the needs of identifying the small number of fraudulent behaviors in the large-scale medical data. On the other hand, the existing single-view bi-clustering algorithms only consider the features of the time-location dimension while neglecting the similarities in prescriptions and neglecting the fact that fraudsters may belong to multiple gangs. Therefore, in this paper, we present a multi-view bi-clustering method for identifying abnormal co-occurrence medical visit behavioral patterns, which performs cluster analysis simultaneously on the large-scale, complex and diverse visiting record dimension and prescription dimension to identify bi-clusters with similar time-location features. The proposed method constructs a matrix view of patients and visit records as well as a matrix view of patients and prescriptions, while decomposing multiple data matrices into sparse row and column vectors to obtain a consistent patient population across views. Subsequently the proposed method identifies the corresponding abnormal co-occurrence medical visit behavior and may greatly facilitate the safe operations and the sustainability of medical insurance funds. The experimental results show that our proposed method leads to more efficient and more accurate identifications of abnormal co-occurrence medical visit behavior, demonstrating its high efficiency and effectiveness.

Population ageing and sustainability of healthcare financing in China.

BACKGROUND: In China, the healthcare financing structure involves multiple parties, including the government, society and individuals. Medicare Fund is an important way for the Government and society to reduce the burden of individual medical costs. However, with the aging of the population, the demand of Medicare Fund is increasing. Therefore, it is necessary to explore the sustainability of the healthcare financing structure in the context of population ageing. OBJECTIVE: The purpose of this paper is to organize the characteristics of population ageing as well as healthcare financing in China. On this basis, it analyzes the impact mechanism of population ageing on healthcare financing and the sustainability of existing healthcare financing. METHODS: This paper mainly adopts the method of literature research and inductive summarization. Extracting data from Health Statistics Yearbook of China and Labor and Social Security Statistics Yearbook of China. Collected about 60 pieces of relevant literature at home and abroad. RESULTS: China has already entered a deeply ageing society. Unlike developed countries in the world, China's population ageing has distinctive feature of ageing before being rich. A healthcare financing scheme established by China, composing of the government, society, and individuals, is reasonable. However, under the pressure of population ageing, China's current healthcare financing scheme will face enormous challenges. Scholars are generally pessimistic about the sustainability of China's healthcare financing scheme. CONCLUSIONS: Population ageing will increase the expenditure and reduce the income of the Medicare Fund. This will further affect the sustainability of the healthcare financing structure. As a consequence, the state should pay particular attention to this issue and take action to ensure that the Fund continues to operate steadily.

Ex-ante moral hazard and health insurance: Evidence from China's urban residence basic medical insurance scheme.

This study examines whether implementing Urban Residents Medical Insurance Scheme decreased an individual's risky lifestyle behavior before illness, termed ex-ante moral hazard. Ex-ante moral hazard is predicted by the classical economic theory suggesting that health insurance coverage reduces an individual's incentive to take preventive efforts to remain healthy. Studies have provided mixed evidence for this prediction. China's 2006 nationwide social experiment of implementing the Urban Residents Basic Medical Insurance Scheme offers an excellent opportunity for examining the effect of the transition from uninsured to insured on an individual's health behaviors. We exploit the longitudinal dimension of a representative survey data for 2007-2010 and employ the instrumental variable technique, thereby addressing the issue of self-selection into voluntary health insurance schemes. The results do not provide evidence for and contrast the prediction of the ex-ante moral hazard. Significant differences exist between insured and uninsured groups with respect to smoking, drinking habits, and being overweight. People with insurance care more about their health than people without insurance do. The main results still hold if we use alternative estimation methods and other robustness tests.

Higher Prevalence of Generalized Pustular Psoriasis in Asia? A Population-Based Study Using Claim Data in China and a Systematic Review.

BACKGROUND: Few studies have reported the burden of generalized pustular psoriasis (GPP), a severe and potentially life-threatening skin disease, especially at a national level. OBJECTIVES: The aim of this study is to estimate the nationwide burden of GPP in China and make a systemic review of the published data. METHODS: We conducted a population-based study using Urban Basic Medical Insurance in China from 2012 to 2016. GPP cases were identified by primary diagnoses including the international classification of Diseases codes (ICD-10: L40.1 and ICD-9: 694.3). A systematic review was conducted using relevant databases up to January 2022. RESULTS: The crude prevalence and incidence of GPP in 2016 were 1.403 (95% confidence interval [CI]: 1.115-1.691) and 0.629 (95% CI: 0.483-0.775) per 100,000 person-years, respectively. The rates were higher in males than in females for both prevalence (1.429 vs. 1.135) and incidence (0.635 vs. 0.520). The prevalence and incidence showed a bimodal age distribution, with the first peak occurring in the 0- to 3-year age-group and the second peak occurring in the 30- to 39-year age-group. The per capita total cost per year for 1 patient with GPP was 609.26 (± 45.77) US dollars. Seven studies were identified in a systematic review, according to which the prevalence (per 100,000) of GPP tended to be higher in Asian countries (0.746-8.178 in Japan and 12.230 in Korea) than in France (0.176), Sweden (6.25), and Brazil (0.7). CONCLUSIONS: This is the largest study concerning the disease burden of GPP, and in this study, the prevalence seemed to be higher in Asia. Although the direct economic burden of GPP did not seem high during the study period, the future usage of biologics and the humanistic burden should also be considered for policy-related decision-making.

Association between the location of social medical insurance and social integration among China's elderly rural migrants: a nationwide cross-sectional study.

BACKGROUND: Universal social medical insurance coverage is viewed as a major factor in promoting social integration, but insufficient evidence exists on the integration of elderly rural migrants (ERM), generally aged 60 years and above, in low- and middle-income countries. To address this problem, we explore the relationship between the location of social medical insurance (SMI), such as a host city, and social integration in the context of Chinese ERM. METHODS: This study is based on data from the 2017 National Internal Migrant Dynamic Monitoring Survey in China. The study participants were Chinese ERM. An integration index was constructed to measure the degree of social integration in a multi-dimensional manner using a factor analysis method. This study used descriptive statistics and one-way analysis of variance to explore the differences in social integration between ERM with SMI from host cities and hometowns. Stepwise multiple linear regression analysis was used to test the correlation between SMI location and social integration level in the overall sample. Finally, the results were verified by propensity score matching. RESULTS: It was found that 606 (18.2%) of the insured ERM chose host city SMI, while 2727 (81.8%) chose hometown SMI. The level of social integration was lower among ERM with hometown SMI (-1.438 ± 32.795, F = 28.311, p ≤ 0.01) than those with host city SMI (6.649 ± 34.383). Among the dimensions of social integration, social participation contributed more than other factors, with a contribution rate of 45.42%. Host city SMI increased the probability of the social integration index by 647% among ERM (k-nearest neighbor caliper matched (n = 4, caliper = 0.02), with a full sample ATT value of 6.47 (T = 5.32, SE = 1.48, p < 0.05)). CONCLUSIONS: ERM with host city SMI have a higher social integration level than those with hometowns SMI. That is, host city SMI positively affects social integration. Policymakers should focus on the access of host city SMI for ERM. Removing the threshold of host city SMI coverage for ERM can promote social integration.

Factors and key problems influencing insured's poor perceptions of convenience of basic medical insurance: a mixed methods research of a northern city in China.

BACKGROUND: This study aimed to explore the factors that affect insured's perceptions of convenience of the basic medical insurance (PCBMI) in Harbin, China and to diagnose the key problems to further propose corresponding measures. The findings provide evidence-based support for the reform of convenience of the basic medical insurance system (BMIS) and the cultivation of public literacy. METHODS: We adopted a mixed methods design composing a multivariate regression model using the data from a cross-sectional questionnaire survey (n = 1045) of residents who were enrolled for BMIS in Harbin to identify the factors influencing the PCBMI. A quota sampling method was further adopted. Semi-structured interviews were then conducted with 30 important information providers selected by convenience sampling. Interpretative phenomenological analysis was employed to summarize and analyze the key problems. RESULTS: Overall, approximately 51% of respondents reported poor PCBMI. The logistic regression model showed that insured without outpatient experience within two weeks (OR = 2.522, 95% CI = 1.267-5.024), had poorer levels of understanding of basic medical insurance information (OR = 2.336, 95% CI = 1.612-3.386), lived in rural areas (OR = 1.819, 95% CI = 1.036-3.195), had low levels of annual out-of-pocket medical expenses (OR = 1.488, 95% CI = 1.129-1.961), and were more likely to give the PCBMI a worse evaluation than their counterparts. The results of the qualitative analysis showed that the key problem areas of the PCBMI were the design of the BMIS, the cognitive biases of the insured, publicity information about the BMIS, and the health system environment. CONCLUSIONS: This study found that in addition to the design of BMIS, the cognition of the insured, the BMIS information publicity and the health system environment are also the key problems hindering PCBMI. While optimizing system design and implementation, Chinese policymakers need to focus on the insured with low PCBMI characteristics. Moreover, it is necessary to focus on exploring effective BMIS information publicity methods, supporting public policy literacy and improving the health system environment.

The impacts of urban-rural integrated medical insurance on the quality of labor supply for migrant workers in China.

BACKGROUND: The transformation from the quantity of labor supply to the quality of labor supply is an important measure to improve the self-development of migrant workers. METHOD: Based on the 2018 China Floating Population Dynamic Monitoring Survey data, this paper uses the 2SLS model based on instrumental variable estimation to analyze the impact of urban and rural integrated medical insurance on the quality of migrant workers' labor supply. RESULTS: The study found that: First, urban and rural integrated medical insurance can significantly improve the quality of labor supply for migrant workers. Even with different instrumental variables and the use of propensity score matching for counterfactual inferences, the findings remain robust. Second, the impact of urban-rural integrated medical insurance on the quality of labor supply for migrant workers has nonlinear characteristics. At the low quantile, the impact of urban-rural integrated medical insurance on the quality of labor supply for migrant workers showed a downward trend, but with the increase of the quantile, the impact of urban and rural integrated medical insurance continued to increase, showing a U-shaped trend. CONCLUSION: Urban-rural integrated medical insurance can not only directly reduce the labor time of migrant workers and ease the labor burden of migrant workers, but also indirectly improve the quality of labor supply for migrant workers through the intermediary role of promoting the availability of public services such as family contracted doctor services and health education.