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.

What influences the public's willingness to report health insurance fraud in familiar or unfamiliar healthcare settings? a cross-sectional study of the young and middle-aged people in China.

INTRODUCTION: Young and middle-aged people are important participants in the fight against health insurance fraud. The study aims to investigate the differences in their willingness to report health insurance fraud and the factors influencing it when it occurs in familiar or unfamiliar healthcare settings. METHODS: Data were obtained from a validated questionnaire from 828 young and middle-aged people. McNemar's test was used to compare the public's willingness to report under the two scenarios. Chi-square tests and multiple logistic regression analysis were used to analyze the determinants of individuals' willingness to report health insurance fraud in different scenarios. RESULTS: Young and middle-aged people were more likely to report health insurance fraud in a familiar healthcare setting than in an unfamiliar one (McNemar's χ²=26.51, P < 0.05). Their sense of responsibility for maintaining the security of the health insurance fund, the government's openness about fraud cases, and the perception of their ability to report had significant positive effects on the public's willingness to report in both settings (P < 0.05). In a familiar healthcare setting, the more satisfied the public is with government measures to protect whistleblowers, the more likely they are to report (OR = 1.44, P = 0.025). Those who perceive the consequences of health insurance fraud to be serious are more likely to report than those who perceive the consequences to be less serious (OR = 1.61, P = 0.042). CONCLUSION: Individuals are more likely to report health insurance fraud in familiar healthcare settings than in unfamiliar ones, in which their awareness of the severity of the consequences of health insurance fraud and their perceived risk after reporting it play an important role. The government's publicizing of fraud cases and enhancing the public's sense of responsibility and ability to maintain the safety of the health insurance fund may be a way to increase their willingness to report, regardless of whether they are familiar with the healthcare setting or not.

The Public's Self-Avoidance and Other-Reliance in the Reporting of Medical Insurance Fraud: A Cross-Sectional Survey in China.

Purpose: To understand the public's self-willingness to report medical insurance fraud and their expectations on others, to provide a reference for the government to do a good job in medical insurance anti-fraud. Methods: Data were obtained from a questionnaire survey of 846 respondents in China. Descriptive statistical analyses and multinomial logistic regression were used to analyze the different subjective attitudes of the public toward different subjects when faced with medical insurance fraud and the influencing factors. Results: 511 (60.40%) respondents were willing to report medical insurance fraud, while 739 (87.35%) respondents expected others to report it. 485 (57.33%) respondents were willing and expected others to report medical insurance fraud, followed by those who were not willing but expected others to report it (254, 30.02%). Compared to those who were unwilling to report themselves and did not want others to report, those who believe their reporting is useless (OR=3.13, 95% CI=1.15-8.33) and those who fear for their safety after reporting (OR=2.96, 95% CI=1.66-5.26) were more likely to expect others to report. Self-reporting willingness was stronger among the public who were satisfied with the government's protective measures for the safety of whistleblowers (OR=4.43, 95% CI=1.38-14.17). The public who believe that both themselves and others have responsibilities to report medical insurance fraud were willing to report and expect others to do the same. Conclusion: The public had a "self-avoidance" and "other-reliance" mentality in medical insurance anti-fraud. The free-rider mentality, lack of empathy, concerns about own risk after reporting, and the interference of decentralized responsibility were important factors contributing to this public mentality. At this stage, the government should prevent the public's "collective indifference" in medical insurance anti-fraud efforts. Improving the safety and protection of whistleblowers and making everyone feel more responsible and valued may be effective incentives to enhance the public's willingness to report.

Horizontal inequity trends of health care utilization in rural China after the medicine and healthcare system reform: based on longitudinal data from 2010 to 2018.

BACKGROUND: To assess the effectiveness of China's medicine and health care reform in promoting equity in health care utilization among rural residents, it is necessary to analyze temporal trends in equity in health care utilization among rural residents in China. This study is the first to assess horizontal inequity trends in health care utilization among rural Chinese residents from 2010 to 2018 and provides evidence for improving government health policies. METHODS: Longitudinal data obtained from China Family Panel Studies from 2010 to 2018 were used to determine trends in outpatient and inpatient utilization. Concentration index, concentration curve, and horizontal inequity index were calculated to measure inequalities. Decomposition analysis was applied to measure the contribution of need and non-need factors to the unfairness. RESULTS: From 2010 to 2018, outpatient utilization among rural residents increased by 35.10%, while inpatient utilization increased by 80.68%. Concentration indices for health care utilization were negative in all years. In 2012, there was an increase in the concentration index for outpatient utilization (CI = -0.0219). The concentration index for inpatient utilization decreased from -0.0478 in 2010 to -0.0888 in 2018. Except for outpatient utilization in 2012 (HI = 0.0214), horizontal inequity indices for outpatient utilization were negative in all years. The horizontal inequity index for inpatient utilization was highest in 2010 (HI = -0.0068) and lowest in 2018 (HI = -0.0303). The contribution of need factors to the inequity exceeded 50% in all years. CONCLUSIONS: Between 2010 and 2018, low-income groups in rural China used more health services. This seemingly pro-poor income-related inequality was due in large part to the greater health care need among low-income groups. Government policies aimed at increasing access to health services, particularly primary health care had helped to make health care utilization in rural China more equitable. It is necessary to design better health policies for disadvantaged groups to reduce future inequities in the use of health services by rural populations.

What has affected the governance effect of the whole population coverage of medical insurance in China in the past decade? Lessons for other countries.

Objective: This study aimed to explore the current state of governance of full population coverage of health insurance in China and its influencing factors to provide empirical references for countries with similar social backgrounds as China. Methods: A cross-sectional quantitative study was conducted nationwide between 22 January 2020 and 26 January 2020, with descriptive statistics, analysis of variance, and logistic regression models via SPSS 25.0 to analyze the effectiveness and influencing factors of the governance of full population coverage of health insurance in China. Results: The effectiveness of the governance relating to the total population coverage of health insurance was rated as good by 59% of the survey respondents. According to the statistical results, the governance of the public's ability to participate in insurance (OR = 1.516), the degree of information construction in the medical insurance sector (OR = 2.345), the government's governance capacity (OR = 4.284), and completeness of the government's governance tools (OR = 1.370) were all positively correlated (p < 0.05) on the governance effect of the whole population coverage of health insurance. Conclusions: The governance of Chinese health insurance relating to the total population coverage is effective. To effectively improve the effectiveness of the governance relating to the total population coverage of health insurance, health insurance information construction, governance capacity, and governance tools should be the focus of governance to further improve the accurate expansion of and increase the coverage of health insurance.

Workplace loneliness mediates the relationship between perceived organizational support and job performance: Differing by extraversion.

This study investigated the mediating role of workplace loneliness relating perceived organizational support to job performance, as well as the moderating role of extraversion in such relationship. 332 full-time Chinese employees from various enterprises voluntarily participated in the two-wave surveys via either paper-and-pencil or online survey conducted at Credamo and Tencent Questionnaire website. Hierarchical regression and bootstrapping analyses were employed to examine the hypotheses. Results indicated that workplace loneliness partially mediates the linkage between perceived organizational support and job performance; extraversion serves as a moderator in the relationship between workplace loneliness and job performance, as well as the mediating role of workplace loneliness linking perceived organizational support to job performance, such that the relationship is stronger when extraversion is high. Supplementary analyses revealed that social companionship, but not emotional deprivation, serves as a mediator in the relationship between perceived organizational support and job performance; extraversion enhanced the direct influence of social companionship on job performance, as well as the indirect influence of perceived organizational support on job performance via social companionship. Theoretical and practical implications are discussed.

Rural residents' willingness to participate in basic medical insurance and influential factors: A survey of three provinces in China.

Background: Rural residents' participation in medical insurance has a significant relationship to the affordability of their medical care. This study aims to investigate the willingness of rural residents to participate in basic medical insurance for urban and rural residents and its determinants so as to enhance their willingness to participate in medical insurance. Methods: Data were obtained from 1,077 validated questionnaires from rural residents. Chi-square test and multiple logistic regression analysis were adopted to analyze determinants of rural residents' willingness to participate in basic medical insurance for urban and rural residents. Results: 94.3% of respondents were willing to participate in basic medical insurance for urban and rural residents and this was associated with the familiarity with the medical insurance policies [OR = 2.136, 95% CI (1.143, 3.989)], the reasonability of medical insurance premiums [OR = 2.326, 95% CI (0.998, 5.418)], the normality of doctors' treatment behavior [OR = 3.245, 95% CI (1.339, 7.867)] and the medical insurance's effectiveness in reducing the economic burden of disease [OR = 5.630, 95% CI (2.861, 11.079)]. Conclusion: Even though most respondents were willing to participate in basic medical insurance for urban and rural residents, some aspects need to be improved. The focus should be on promoting and regulating the behavior of medical staff. Financing policies and reimbursement of treatment costs need to be more scientifically developed. A comprehensive basic healthcare system needs to be optimized around the core function of "hedging financial risks".

Who is More Likely to Report Medical Insurance Fraud in the Two Scenarios of Whether It Results in a Direct Loss of Individual Benefit? A Cross-Sectional Survey in China.

Purpose: An individual's willingness to report is largely related to whether he or she is a direct victim. This study takes two scenarios of whether medical insurance fraud results in a direct loss of personal benefit and explores the differences in individuals' willingness to report and influencing factors in the two scenarios. Methods: In this study, questionnaires were used and participants were selected from 571 individuals in eastern, central, and western China. Analysis was performed using descriptive statistics and logistic regression models. Results: 51.0% of individuals were willing to report when no direct loss of personal benefit was caused, and conversely, 78.3% of individuals were willing to report when direct loss of personal benefit was caused. The factors influencing the attitude dimension of individuals toward whistleblowing behavior were consistent in the two scenarios. In contrast, there were significant differences among the influences in the perceived behavioral control, consequence perception, and subjective norm dimensions. Conclusion: There were significant differences in the willingness of individuals to report medical insurance fraud and the factors influencing it in both scenarios. The most significantly influencing factor difference was perceived behavioral control, a dimension that had an effect only when it did not result in a direct loss of personal benefit. When an individual's direct interests are at stake, the individual's fear for his or her safety is not a deterrent to his or her willingness to report. And when there is no loss of direct personal benefit, individuals care more about government measures to protect whistleblowers. There are differences in the subjects that influence individuals' willingness to report in the two scenarios. The factors influencing the attitude dimension are the same in both scenarios, and the more supportive the attitude toward the whistleblower, the stronger the individual's willingness to report will be.

The "jolly fat" for the middle-aged and older adults in China, was education level considered?

BACKGROUND: Several studies have found a negative association between obesity and depression in Chinese middle-aged and elderly, suggesting the existence of "jolly fat". This study aims to investigate whether "jolly fat" is applicable among middle-aged and elderly with different education levels, and to provide a new perspective for depression screening and obesity interventions in middle-aged and older adults. METHODS: 10,018 individuals aged 45 years and over in China Family Panel Study (2018) were selected for analysis. A short version of Center for Epidemiological Research Depression Scale was used to assess depression. Body mass index was applied to define obesity status. Subgroup analysis of multiple logistic regression was performed to explore whether the relationship between obesity and depression was influenced by education levels. RESULTS: The prevalence of obesity and depression was 9.02 % and 22.96 % among participants. Obesity reduced the probability of depression in middle-aged and elderly with primary school education or below (OR = 0.71, 95 % CI = 0.56-0.91) while not affecting those with junior high school education or above (OR = 0.80, 95 % CI = 0.57-1.13). LIMITATIONS: The results cannot be interpreted as causality due to the cross-sectional design. Besides, we cannot directly measure the body composition of the participants. CONCLUSIONS: "Jolly fat" existed among middle-aged and elderly with low education, but not in those with junior high school education or above. Health care providers need to monitor the psychological status of low-educated middle-aged and older adults who are seen as needing to lose weight, while the underweight group should be the key target of depression screening.

Assessing the income-related inequality in obesity among the elderly in China: A decomposition analysis.

Background: Obesity among the elderly imposes a significant health and economic burden. The purpose of this study was to measure the obesity prevalence and income-related inequality among older adults in China and to explore the determinants of the inequity. Methods: Data were obtained from 4,541 older adults (60 years and older) participating in the China Family Panel Study, 2018. Obesity was defined as body mass index (BMI) ≥28 kg/m2. Normalized concentration index and concentration curve were calculated to measure the income-related inequality. Decomposition analysis was used to measure the contribution of each factor to the overall unfairness. Results: The prevalence of obesity among the respondents was 7.99%. The 95% confidence interval for the overall prevalence was 7.20-8.78%. The normalized concentration index of obesity in the elderly was 0.075 (95% confidence interval: 0.047-0.103), indicating that obesity was more concentrated among the rich (p < 0.05). Socioeconomic factors contributed the most to the overall inequality (68.73%). Health behavior factors explained 16.38% of the observed income-related inequality in obesity among the elderly in China. Conclusions: In 2018, obesity was more concentrated among the elderly with higher incomes in China. The pro-poor income-related inequality was mainly due to the higher socioeconomic status of higher-income older adults. Health behaviors and psychosocial factors could also exacerbate the inequality. To prevent the heavy burden of obesity on the health and finances of older adults, more attention should be paid to those who are financially better off, especially those who smoke and are physically inactive, while extroverted older adults also need to be focused on. For developing countries, concern needs to be given to the obesity of the wealthy elderly as a result of economic development.

The influence of cross-regional medical treatment on total medical expenses, medical insurance payments, and out-of-pocket expenses of patients with malignant tumors in Chinese low-income areas.

BACKGROUND: In recent years, due to the increasing number of cross-regional medical patients, countries around the world have issued a series of policies or regulations to reduce their out-of-pocket burden. In this context, this study intended to explore the impact of the Spatio-temporal characteristics of cross-regional medical treatment on total medical expenses, medical insurance payments, and out-of-pocket expenses of patients with malignant tumors in low-income areas. METHODS: This study included 54,904 data of cross-provincial medical treatment of malignant tumor patients insured in Heilongjiang Province, China in 2020. Firstly, Microsoft Excel 2019 and ArcGIS 10.2 were applied to conduct a descriptive analysis of the Spatio-temporal characteristics of their cross-provincial medical treatment. Then, binary and multivariate logistic regression models were used to explore the specific impact of economic level and geographical distance of medical regions on total medical expenses, medical insurance payments, and out-of-pocket expenses. RESULTS: The number of cross-regional medical patients showed a gradual upward trend from February to December, and fell back in January. They were concentrated in regions with high economic level and short distance from the insured region, where were more likely to form the group with high out-of-pocket expenses (AOR = 3.620, P < 0.001; AOR = 1.882, P < 0.001). While this possibility in middle-distance medical regions were less (AOR = 0.545, P < 0.001). Afterwards, two sensitivity analysis methods showed that the results were robust. CONCLUSION: The number of cross-regional medical patients with malignant tumors in low-income areas is affected by seasonal factors, meanwhile, their total medical expenses, actual medical insurance payment levels, and out-of-pocket expenses are all affected by the economic level and geographical distance of medical regions. And the middle-distance medical regions may be the best choice for patients with planned cross-regional medical treatment. These provide some evidence for policymakers to improve the fairness and sustainability of medical security for cross-regional medical patients and reduce their direct economic burden of disease.

Perceived effect of financial risk protection by the Urban-Rural Resident Basic Medical Insurance Scheme: a mixed-methods study of rural residents in China.

OBJECTIVES: It is to explore the perceived financial risk protection effect of the Urban-Rural Resident Basic Medical Insurance Scheme (URRBMI) and its influencing factors to provide evidence to further improve the URRBMI. DESIGN: It is a cross-sectional survey. PARTICIPANTS: This mixed-methods study is conducted in five provinces in rural China. Through stratified cluster random sampling, 1681 rural residents participate in a cross-sectional questionnaire survey (1657 valid questionnaires are retrieved). Thirty rural residents participate in in-depth interviews. PRIMARY AND SECONDARY OUTCOME MEASURES: A multivariate logistic regression analysis is adopted to identify factors influencing respondents' perceptions. Semistructured interviews are used to identify the reasons why some respondents believed the URRBMI to be ineffective. RESULTS: Overall, 77.5% of respondents believe that the URRBMI is effective. Respondents, who are older, have a higher household income, prefer primary health facilities and provide a higher rating for critical illness compensation and maximum compensatory payouts. They are more likely to give the URRBMI a higher effectiveness rating than their counterparts. Qualitatively, participants who believe the URRBMI to be ineffective list the following reasons: low outpatient service coverage, insufficient or undersupplied drugs and services in the insurance list, problems in the arrangement of deductibles and maximum compensatory payouts, provider-induced behaviour and increased healthcare service price. CONCLUSIONS: This exploration focuses on the reasons why rural residents think the scheme is invalid, which are vital for policy reform. Policies should focus on benefits design and coverage, the assumption of a supervisory role, avoiding financial risk stemming from critical illness and cross-sectoral actions to strengthen the primary healthcare system and comprehensive social security wealth.

Gender Differences in the Effect of Workplace Loneliness on Organizational Citizenship Behaviors Mediated by Work Engagement.

PURPOSE: Drawing on the self-determination theory and the social role theory, the purpose of this study was to test the moderating role of gender and the mediating role of work engagement in the relationship between workplace loneliness and organizational citizenship behaviors (OCBs), and more importantly, the integrated moderated mediation model. METHODS: A total of 290 employees from various Chinese enterprises voluntarily participated in the two-wave surveys. Hierarchical regression and bootstrapping analyses based on Hayes' Process Model were conducted to test the hypotheses. RESULTS: Results indicated that work engagement significantly mediates the association of workplace loneliness with OCBs. Gender serves as an important moderator in the relationship among workplace loneliness, work engagement, and OCBs that for female participants the indirect effect of work engagement linking workplace loneliness to OCBs was significant, but for male participants it was not. CONCLUSION: This study advances the current understandings of the moderated mediation mechanism among workplace loneliness, gender, work engagement, and OCBs. It is suggested that work engagement serves as a mediator linking workplace loneliness to OCBs, especially for the female employees.

Molecular imaging of MDM2 messenger RNA with 99mTc-labeled antisense oligonucleotides in experimental human breast cancer xenografts.

UNLABELLED: The mouse double-minute 2 (MDM2) oncogene, amplified or overexpressed in many human cancers, has been suggested to be a novel target for cancer therapy. Visualization of MDM2 expression using radionuclide targeting can provide important diagnostic information in malignant tumors. The overall aim of this study was to evaluate whether liposome-coated (99m)Tc-radiolabeled antisense oligonucleotides (ASONs) targeting MDM2 messenger RNA (mRNA) could be used for imaging of MDM2 expression in vivo. METHODS: ASON and mismatch oligonucleotide (ASONM) targeted to MDM2 mRNA were synthesized and radiolabeled with (99m)Tc using the bifunctional chelator hydrazinonicotinamide (HYNIC). Then the radiolabeled probe was characterized in vitro. Reverse-transcriptase polymerase chain reaction and Western blotting were performed to assay the MDM2 mRNA and protein level after MCF-7 (human breast adenocarcinoma cell line) cells were incubated with liposome-coated (99m)Tc-HYNIC-ASON/ASONM at various concentrations for 24 h. Following established MCF-7-bearing nude mice models, the biodistribution of liposome-coated (99m)Tc-HYNIC-ASON/ASONM was investigated, and in vivo tumor scintigraphic images were acquired for these animal models. All data were analyzed by statistical software. RESULTS: The labeling efficiencies of (99m)Tc-HYNIC-ASON and (99m)Tc-HYNIC-ASONM were 57.2% ± 2.98% and 56.3% ± 3.01%, respectively; the specific activities were 1,450 ± 60.2 and 1,370 ± 55.4 kBq/µg, respectively; and the radiochemical purity for both was above 95%. The radiolabeled ASON still had the ability to hybridize to the sense oligonucleotide. In comparison with the mismatch probe, the antisense probe had an obvious effect on the levels of MDM2 mRNA and protein. The levels of mRNA and protein were significantly different for different concentration antisense probe groups (P < 0.01). The excretion of the antisense and mismatch probe was mainly through the liver and kidneys. The tumor radioactivity uptake of the antisense probe was significantly higher than that of the mismatch probe (P < 0.01). At 1-10 h after injection of the antisense probe, the tumor could be clearly visualized, whereas the tumors were not imaged at any time after injection of the mismatch probe. CONCLUSION: The accumulation of liposome-coated (99m)Tc-labeled ASONs in breast cancer tissue is specific. The antisense imaging with liposome-coated (99m)Tc-HYNIC-ASON may be a promising method for visualization of MDM2 expression in human breast cancer.