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.

Poverty Reduction Effects of Medical Insurance on Middle-Aged and Elderly Families under the Goal of Common Prosperity in China.

Eliminating poverty due to illness is an important way for China to pursue common prosperity. The high medical expenditure caused by the aging population has brought severe challenges to governments and families of all countries, especially in China, where the entire population has just been lifted out of poverty in 2020 and then hit by COVID-19. How to prevent the possible return of poor boundary families to poverty in China has become a difficult research topic. Based on the latest data from the China Health and Retirement Longitudinal Survey, this paper discusses the poverty reduction effect of medical insurance on middle-aged and elderly families from the absolute index and relative index. Medical insurance had a poverty reduction effect on middle-aged and elderly families, especially the poor boundary families. For example, people who participated in medical insurance reduced their financial burden by 2.36% for middle-aged and older families compared to people who did not participate in medical insurance. Furthermore, the poverty reduction effect had heterogeneity in gender and age. This research brings some policy implications. For example, the government should give more protection to vulnerable groups such as the elderly and low-income families and improve the fairness and effectiveness of the medical insurance system.

Halloysite Nanotube-Based Pesticide Formulations with Enhanced Rain Erosion Resistance, Foliar Adhesion, and Insecticidal Effect.

The incorporation of green and sustainable nanomaterials in pesticide formation is an effective method to lower the use of conventional pesticides without adverse effects on productivity. Here pesticide Pickering emulsions stabilized by halloysite nanotubes (HNTs) were developed for low cost, less environmental pollution, low toxic effects, and better emulsion stability. HNTs were added to chlorantraniliprole (CAP) emulsions, and good stability was exhibited due to the adsorption and aggregation of HNTs at the interface of CAP oil droplets, forming a three-dimensional network structure that prevented the emulsion from aggregation. In addition, Spodoptera frugiperda was used as a pest model and corn was used as a plant model to explore the washout resistance, insecticidal effect, and biological safety of HNTs-CAP emulsion. After spraying emulsion on corn leaves and washing for 10 min, the HNTs-CAP emulsion (5 wt % HNTs) pesticide residue rate was 2.7 times that of pristine CAP emulsion. When the HNT dispersion concentration was 2 wt %, the larva mortality was 83%, which was 1.5 times that of the CAP emulsion group. These results demonstrated that HNTs-CAP emulsion showed good foliar adhesion, rainfall resistance, and insecticidal effect. The tubular clay-based nanopesticide formulations show potential applications in the control of crop pests with modern agriculture technology.

Review of evolution of the public long-term care insurance (LTCI) system in different countries: influence and challenge.

BACKGROUND: The growing demand for LTC (Long-term care) services for disabled elderly has become a daunting task for countries worldwide, especially China, where population aging is particularly severe. According to CSY (China Statistical Yearbook,2019), the elderly aged 65 or above has reached 167 million in 2018, and the number of disabled elderly is as high as 54%. Germany and other countries have alleviated the crisis by promoting the public LTCI (Long-Term Care Insurance) system since the 1990s, while China's public LTCI system formal pilot only started in 2016. Therefore, the development of the public LTCI system has gradually become a hot topic for scholars in various countries, including China. METHODS: This review has been systematically sorted the existing related literature to discuss the development of public LTCI (Long-Term Care Insurance)system form four aspects, namely, the comparison of public LTCI systems in different countries, the influence of public LTCI, challenge of public LTCI, and the relationship between public LTCI and private LTCI. We searched some databases including Web of Science Core Collection, Medline, SCOPUS, EBSCO, EMBASE, ProQuest and PubMed from January 2008 to September 2020. The quality of 38 quantitative and 21 qualitative articles was evaluated using the CASP(Critical Appraisal Skills Programme) critical evaluation checklist. RESULTS: The review systematically examines the development of public LTCI system from four aspects, namely, the comparison of public LTCI systems in different countries, the influence of public LTCI, the challenge of public LTCI, and the relationship between public LTCI and private LTCI. For example, LTCI has a positive effect on the health and life quality of the disabled elderly. However, the role of LTCI in alleviating the financial burden on families with the disabled elderly may be limited. CONCLUSION: Some policy implications on the future development of China's LTCI system can be obtained. For example, the government should fully consider the constraints such as price rise, the elderly disability rate, and the substantial economic burden. It also can strengthen the effective combination of public LTCI and private LTCI. It does not only help to expand the space for its theoretical research but also to learn the experiences in the practice of the LTCI system in various countries around the world. It will significantly help the smooth development and further promote the in-depth reform of the LTCI system in China.

Effect Evaluation of the Long-Term Care Insurance (LTCI) System on the Health Care of the Elderly: A Review.

BACKGROUND: How to cope with the rapid growth of LTC (long-term care) needs for the old people without activities of daily living (ADL), which is also a serious hazard caused by public health emergencies such as COVID-2019 and SARS (2003), has become an urgent task in China, Germany, Japan, and other aging countries. As a response, the LTCI (long-term care insurance) system has been executed among European countries and piloted in 15 cities of China in 2016. Subsequently, the influence and dilemma of LTCI system have become a hot academic topic in the past 20 years. METHODS: The review was carried out to reveal the effects of the LTCI system on different economic entities by reviewing relevant literature published from January 2008 to September 2019. The quality of 25 quantitative and 24 qualitative articles was evaluated using the JBI and CASP critical evaluation checklist, respectively. RESULTS: The review systematically examines the effects of the LTCI system on different microeconomic entities such as caretakers or their families and macroeconomic entities such as government spending. The results show that the LTCI system has a great impact on social welfare. For example, LTCI has a positive effect on the health and life quality of the disabled elderly. However, the role of LTCI in alleviating the financial burden on families with the disabled elderly may be limited. CONCLUSION: Implementation of LTCI system not only in reducing the physical and mental health problems of health care recipients and providers, and the economic burden of their families, but also promote the development of health care service industry and further improvement of the health care system. However, the dilemma and sustainable development of the LTCI system is the government needs to focus on in the future due to the sustainability of its funding sources.

Does COVID-2019 have an Impact on the Purchase Intention of Commercial Long-Term Care Insurance among the Elderly in China?

PURPOSE: As an important measure to alleviate long-term care (LTC) costs for the disabled due to the aging of the population, long-term care insurance (LTCI) system has been paid more attention in China. In addition to the government-led public LTCI system that has been piloted in cities such as Qingdao, Chongqing and Shanghai, health insurers such as the China Life Insurance Company are also experimenting with various types of commercial LTCI in the private market. However, the commercial LTCI market is developing very slowly due to public awareness and other reasons. On the other hand, COVID-2019 has had an impact on the cognition of the importance of long-term care for the elderly due to the fact that the death cases of COVID-2019 have been mainly concentrated in the elderly population with chronic diseases such as hypertension. Therefore, the purpose of this study is to explore the differences in the purchase intention of commercial LTCI among the elderly in two different periods: before and after the outbreak of COVID-2019. METHODS: By using the Andersen behavioral model and two investigations in two different periods before and after the outbreak of COVID-2019, this study explores the impacts of COVID-2019 on the purchase intention of commercial LTCI. RESULTS: Some significant discoveries were found. For example, 25.8% of interviewees showed purchase intention in LTCI in the time before the COVID-2019 outbreak, while this proportion increased to 37.6% after the COVID-2019 outbreak. People who were younger (OR = 2.128, before COVID-2019; OR = 1.875, after COVID-2019) or who had more education (OR = 1.502, before COVID-2019; OR = 2.218, after COVID-2019) were more interested in commercial LTCI. CONCLUSION: This study shows that COVID-2019 has had an obvious impact on the purchase intention of commercial LTCI, which provides some enlightenment for China to improve the LTCI system in the future, especially to accelerate the development of commercial LTCI. For example, it is essential to promote the importance of long-term care among the elderly in a focused and targeted way. In terms of the key target audience, it can be developed gradually from the groups with higher education levels and the middle elderly aged 45-64 years old.

Health Insurance and Long-Term Care Services for the Disabled Elderly in China: Based on CHARLS Data.

PURPOSE: This paper aimed to explore the relationship between the different factors, especially health insurance, and the availability of long-term care (LTC) services, among the disabled elderly. METHODS: Based on the data of China Health and Retirement Longitudinal Study (CHARLS), the logistic regression model was utilized to evaluate the influence of the different factors, especially health insurance, on the availability of long-term care services. RESULTS: Our findings show some interesting results. Firstly, the findings suggest that informal long-term care (LTC) services for elderly persons with disabilities heavily depend on a family member from different health insurance groups. About 80.733% of the disabled elderly depend on a family member as their primary caregivers. Secondly, other influence factors such as income and area of residence were also significantly related to the availability of long-term rental services. Thirdly, Health insurance is a very important factor influencing the availability of Long-term care services both in urban and rural areas (p<0.001) but Income is the most interesting variable. CONCLUSION: Based on our results, the growth and integration of formal long-term care (LTC) services should be facilitated. Firstly, policymakers can encourage formal long-term care (LTC) services from a variety of sources to work together to increase overall supply capability. Secondly, the long-term living security needs of people who do not have health insurance should be regulated through subsidies according to the economic status.

An assessment of the economic burden of senile chronic diseases in China based on China Health and Retirement Longitudinal Survey.

OBJECTIVE: This study assessed the economic burden of senile chronic diseases (SCD) in China. METHODS: Based on China Health and Retirement Longitudinal Survey data, we used propensity score matching to compare the economic burden of SCD for families with and without members with SCD. RESULTS: We examined three aspects of economic burden: health service utilization, including health care utilization and expenditure, family daily consumption spending, and workforce participation of family members in labor markets. SCD-families showed a higher hospitalization rate and number of outpatient visits than the control group. SCD-families also consumed less per capita. Additionally, the negative influence of SCD on total family income may be partially offset by increasing the labor force participation rate of healthy family members. Finally, we also discussed the burden of SCD  in different educational status. CONCLUSIONS: Relevant results may provide insight into formulating health and labor policies by the Chinese government. The study significance consists of the selection of matching variables and robustness, whereas study limitations include the omission of other important variables.

Factors Influencing Long-Term Care Service Needs among the Elderly Based on the Latest Anderson Model: A Case Study from the Middle and Upper Reaches of the Yangtze River.

The rapid growth of population aging makes providing adequate long-term care (LTC) services for the elderly a serious social dilemma in China. Thus, it is necessary to carry out a theoretical discussion on the LTC service needs of the elderly and find out their influencing factors. With four regions of the middle and upper reaches of the Yangtze River as the sample case, this study aims to explore the factors that affect LTC service needs of the elderly in the frame of the latest Anderson Model, which added psychosocial factors to predisposing characteristics, enabling factors, and need factors in the old version. Some interesting results have been found, for example, self-image evaluation is composed of several factors such as general physical health, attitude towards life, or psychosocial states. Finally, sub-analyses-namely, by age, by gender, and by educational level-were carried out since the choice of different long-term care service patterns is related to different age/gender/education groups.

Is Carbon Dioxide (CO2) Emission an Important Factor Affecting Healthcare Expenditure? Evidence from China, 2005-2016.

As a result of China's economic growth, air pollution, including carbon dioxide (CO2) emission, has caused serious health problems and accompanying heavy economic burdens on healthcare. Therefore, the effect of carbon dioxide emission on healthcare expenditure (HCE) has attracted the interest of many researchers, most of which have adopted traditional empirical methods, such as ordinary least squares (OLS) or quantile regression (QR), to analyze the issue. This paper, however, attempts to introduce Bayesian quantile regression (BQR) to discuss the relationship between carbon dioxide emission and HCE, based on the longitudinal data of 30 provinces in China (2005-2016). It was found that carbon dioxide emission is, indeed, an important factor affecting healthcare expenditure in China, although its influence is not as great as the income variable. It was also revealed that the effect of carbon dioxide emission on HCE at a higher quantile was much smaller, which indicates that most people are not paying sufficient attention to the correlation between air pollution and healthcare. This study also proves the applicability of Bayesian quantile regression and its ability to offer more valuable information, as compared to traditional empirical tools, thus expanding and deepening research capabilities on the topic.

Spatial-Temporal Characteristics of Agriculture Green Total Factor Productivity in China, 1998-2016: Based on More Sophisticated Calculations of Carbon Emissions.

Environmental costs should be taken into account when measuring the achievements of China's agricultural development, since the long-term extensive development of agriculture has caused huge environmental pollution. This study took agricultural carbon emissions as an undesired output to estimate the agricultural development efficiency in 31 provinces of China from 1998 to 2016, based on the green total factor productivity, as assessed by the slacks-based measure directional distance function and constructing the global Malmquist-Luenberger index. We measured agricultural carbon emissions in terms of five aspects: agricultural materials, rice planting, soil, livestock and poultry farming, and straw burning, and then compared the green total factor productivity index and the total factor productivity index. The study came to the following conclusions: (1) the green technology efficiency change was smaller than the technology efficiency change at first, but the gap between them is narrowing with time, such that the former is now larger than the latter; (2) the green technology efficiency was in a declining state and the green technology progress was increasing, promoting the green total factor productivity growth, from 1998 to 2016; and (3) China's agricultural green total factor productivity increased by 4.2% annually in the east, 3.4% annually in the central region, and 2.5% annually in the west.

Family Economic Burden of Elderly Chronic Diseases: Evidence from China.

Chronic diseases among the elderly and their huge economic burden on family have caught much attention from economists and sociologists over the past decade in China. This study measured the economic burden of elderly chronic disease (ECD) in families using the China Health and Retirement Longitudinal Study (CHARLS) data set from Peking University (China). We studied some aspects of this burden, including health-service utilization, out-of-pocket expenditure on inpatient and outpatient, total family expenditures on items, and labor force participation rates of family members, etc. Some interesting things were found, for example, the additional annual expenditure on inpatient care (per member) in ECD-families was 37 to 45 percent of the annual expenditure in the control group; the labor-force participation rate in ECD-families was 2.4 to 3.3 percent of points lower than in the control group.

How Does Industrial Waste Gas Emission Affect Health Care Expenditure in Different Regions of China: An Application of Bayesian Quantile Regression.

Industrial development has brought about not only rapid economic growth, but also serious environmental pollution in China, which has led to serious health problems and heavy economic burdens on healthcare. Therefore, the relationship between the industrial air pollution and health care expenditure (HCE) has attracted the attention of researchers, most of which used the traditional empirical methods, such as ordinary least squares (OLS), logistic and so on. By collecting the panel data of 30 provinces of China during 2005-2016, this paper attempts to use the Bayesian quantile regression (BQR) to reveal the impact of industrial air pollution represented by industrial waste gas emission (IWGE) on HCE in high-, middle-, low-income regions. It was found that double heterogeneity in the influence of IWGE on HCE was obvious, which revealed that people in high-, middle-, low-income regions have significantly different understandings of environmental pollution and health problems. In addition, the BQR method provided more information than the traditional empirical methods, which verified that the BQR method, as a new empirical method for previous studies, was applicable in this topic and expanded the discussion space of this research field.

Assessment of Agricultural Carbon Emissions and Their Spatiotemporal Changes in China, 1997-2016.

Despite achieving remarkable development, China's agricultural economy has been under severe environmental pressure. Based on previous studies, the present study further considers the sources of agricultural carbon emissions in depth, estimates China's agricultural carbon emissions from 1997 to 2016, and analyzes the agricultural pollution faced by China and its provinces. The study estimates the amount and intensity of agricultural carbon emissions in China from five carbon sources-agricultural materials, rice planting, soil N2O, livestock and poultry farming, and straw burning-and analyzes their spatial and temporal characteristics. The following results were obtained: (1) between 1997 and 2016, the amount of agricultural carbon emissions in China generally increased, while the intensity of agricultural carbon emissions decreased; (2) in the same period, the amount of carbon emissions from each category of carbon source generally increased, with the exception of rice planting; however, the amount of emissions fluctuated; (3) the amount and intensity of carbon emissions varied greatly among provinces; (4) the emissions from different categories of carbon source showed different concentration trends and agglomeration forms; (5) China's agricultural carbon emissions showed obvious spatial correlation, which overall was high-high agglomeration; however, its carbon emissions gradually weakened, and the spatial agglomeration of agricultural carbon emissions in each province changed between 1997 and 2016.

Influencing factors of disability among the elderly in China, 2003-2016: application of Bayesian quantile regression.

Background: More and more disabled elderly need long-term care as China becomes an aging society. In 2016, there were 220 million people over the age of 60, and nearly 10 million completely disabled elderly people who cannot complete Activities of Daily Living (ADLs). Therefore, the topic of influencing factors for disability among the elderly in China has attracted close attention from researchers, most of which use the traditional empirical methods, such as Ordinary Least Squares (OLS) and logistic. Objective: The purpose of this paper was to introduce the Bayesian Quantile Regression (BQR) method to the topic of the disabled elderly, which was achieved by using BQR to study the influencing factors of disability among the elderly in China during 2003-2016. Methods: This paper was the first attempt to use the BQR for the influencing factors of disability among the elderly in China. Furthermore, a comparison was made between the regression results of BQR, OLS, Quantile Regression (QR), and Bayesian Linear Regression (BLR). Results: It was found that there was a relatively stable relationship between chronic diseases and disability, although there was a little difference in different quantiles. In addition, the BQR can obtain results similar to the traditional method. For instance, the coefficient of chronic diseases (to total disability) obtained by OLS, QR, and BLR were basically consistent (around 0.778), which was similar to BQR. The BQR not only provided estimates for all the quantiles, but also provided upper and lower values of a certain confidence interval. Conclusions: By applying the BQR to the influencing factors of disability among the elderly in China, we reached the conclusion that BQR methods are adaptable for this research topic because of their characteristics and advantages over the traditional methods, such as less strict constraints, the estimates for all quantiles, and the combination of historical information with prior information. Moreover, the BQR method appropriately obtained the lower and upper values in a confidence interval, which can provide prediction space for the future.