Determinants of Differences in Health Service Utilization between Older Rural-to-Urban Migrant Workers and Older Rural Residents: Evidence from a Decomposition Approach.

BACKGROUND: The widening gap in health service utilization between different groups in mainland China has become an important issue that cannot be avoided. Our study explored the existence of differences and the causes of the differences in the health service utilization of older rural-to-urban migrant workers in comparison to older rural dwellers. Further, our study explored socioeconomic differences in health service utilization. METHODS: The data from the China Labor-Force Dynamic Survey in 2016, the data from the Urban Statistical Yearbook in 2016, and the Statistical Bulletin were used. Our study applied the latest Andersen Model according to China's current situation. Before we studied health service utilization, we used Coarsened Exact Matching to control the confounding factors. After matching, 2314 respondents were successfully matched (859 older rural-to-urban migrant workers and 1455 older rural dwellers). The Fairlie decomposition method was used to analyze the differences and the sources of health service utilization between older rural-to-urban migrant workers and their rural counterparts. RESULTS: After matching, the probability two-weeks outpatient for older rural-to-urban migrant workers (5.59%) was significantly lower than older rural dwellers (7.57%). The probability of inpatient for older rural-to-urban migrant workers (5.59%) was significantly lower than older rural dwellers (9.07%). Overall, 17.98% of the total difference for two-week outpatient utilization was due to the observed influence factors. Moreover, 71.88% of total difference in inpatient utilization was due to the observed influence factors. Income quantiles (49.57%), health self-assessments (80.91%), and the sex ratio in the community (-102.29%) were significant in the differences in inpatient utilization. CONCLUSIONS: The findings provide important insights into the socioeconomic differences in health service utilization among older rural-to-urban migrant workers and older rural residents in China. These insights urge the government to take full account of the heterogeneity in designing health security system reform and public health interventions targeting vulnerable groups.

Assessing Income-Related Inequality on Health Service Utilization among Chinese Rural Migrant Workers with New Co-Operative Medical Scheme: A Multilevel Approach.

Background: Eliminating inequality in health service utilization is an explicit goal of China's health system. Rural migrant workers with New Rural Cooperative Medical Insurance (NCMS) still face the dilemma of limited health service; however, there is a lack of analysis or measurement on the income-related inequality of health service utilization. Method: The nationally representative data of the China Labor-Force Dynamic Survey in 2016 were used for analysis. Multilevel regressions were used to obtain robust estimates and to account for various covariates associated with health service utilization of rural migrant workers with NCMS. The concentration index and its decomposition method were applied to quantify the income-related inequality of health service utilization of rural migrant workers. Result: The multilevel model analysis indicated that influencing factors of health service utilization were diversified, including gender, city service quality index, type of industry, the per capita annual income, marital status, health self-assessment, the community health index and the number of friends. The concentration indices of the total cost of inpatient and OOP cost of inpatient were 0.102 (95%CI: 0.031, 0.149), and the CI of OOP cost of inpatient was 0.094 (95%CI: 0.007, 0.119), respectively. The horizontal inequality indices of the total cost of inpatient and OOP cost of inpatient were 0.051 and 0.009, respectively. Conclusion: Our study presented a unique opportunity to examine the potential influence factors of health service utilization of rural migrant workers with NCMS, and highlighted that unequal health service utilization is evident among rural migrant workers with NCMS. This study provides important corroborative evidence to take full account of the contribution of each determinant to the inequality and health service needs among rural migrant workers with NCMS, in order to improve the basic medical insurance and social security systems-particularly for some marginal groups in China.

The Influence of China's COVID-19 Treatment Policy on the Sustainability of Its Social Health Insurance System.

BACKGROUND: While past experiences show that a health system financing mechanism can support resilience to shocks, the impact on the sustainability of the financing system is exceptionally important considering the magnitude of the COVID-19 pandemic. The role of Social Health Insurance (SHI) in responding to the pandemic brings about an influence on insurance system sustainability. This study investigates the impact of China's COVID-19 treatment policy on the sustainability of its SHI system, explores influences of the policy on Wuhan's system, and discusses the effects of an assumed equivalent emergency on SHI funds for five other provincial capital cities in China. METHODS: The study was conducted using pay-as-you-go actuarial models of Urban Employee Basic Medical Insurance (UEBMI) and Urban and Rural Residents Basic Medical Insurance (URRBMI) funds, which constitute China's basic health insurance system. Current and accumulated balances of the funds in 2020 are predicted and utilized to measure the sustainability of health insurance funds during emergencies. RESULTS: The findings suggest a disparity in the capacities of insurance schemes and localities. If the surplus before 2018 is not considered, it is likely that the URRBMI fund of Wuhan would suffer a deficit, whereas the UEBMI would retain a considerable surplus. To maintain the current actuarial balance of the URRBMI fund, coverage for ordinary inpatient and outpatient expenses would have to be significantly reduced in Wuhan, potentially affecting enrollees' wellbeing. A similar situation may occur in three other cities, some with underdeveloped economies and lower per capita income are likely to be encountered with worse situation than Wuhan. CONCLUSION: Concerning fragmentation of China's SHI system, to strengthen longer-term preparedness to manage future emergencies, this study suggests the integration of insurance schemes and provincial pooling, fund balance adjusting and an emergency safety net are also advised. All options call for more public health investments.

The impact of health insurance on poverty among rural older adults: an evidence from nine counties of western China.

BACKGROUND: Older adults are more prone to various diseases. Health insurance becomes effective mechanism to relieve financial burden when the insured is sick. In China, most older adults live in the countryside, and New Rural Cooperative Medical Scheme is a kind of health insurance system in rural areas. The relationship between New Rural Cooperative Medical Scheme and financial burden due to health expenditure of older adults in China was investigated. This paper aims at the impact of New Rural Cooperative Medical Scheme on the poverty among rural older adults. METHODS: This study employs Probit model and Tobit model to assess the impact of New Rural Cooperative Medical Scheme on alleviating poverty among rural older adults based on a survey in nine representative counties in western China. RESULTS: The findings show that diseases have significantly negative impact on rural elderly poverty. New Rural Cooperative Medical Scheme has impact on alleviating of the health-payment poverty due to catastrophic health expenditure, but the impact is limited. The impact of health insurance on poverty alleviation is greater for men, older adults aged between 60 to 69 and households in in economically poorer area than their counterparts. CONCLUSIONS: This study show the relationship between New Rural Cooperative Medical Scheme and catastrophic health expenditure of older adults in China. The results draw policy attention to introduce different reimbursement expense ratios for different groups to alleviate them from poverty based on more comprehensive insurance packages.

Study on the relationship between social support and mental health of the elderly in China: a case study of Xi'an city, Shaanxi province.

BACKGROUND: The elderly's mental health is becoming more and more severe under the aging society in China (one third of the elderly had the symptom of depression according to the statistics). It is urgent to explore how the social support system of the elderly can influence their mental health and how to enhance their mental care from the perspective of social support. AIMS: This article analyzes the relationship between social support and mental health of the elderly using quantitative and qualitative data. Methods results: This study relies on a survey did in 2016 in Xi'an among elderly over the age of 60, mainly using structural questionnaires and assisted with interviews for some specific people. The study finds that the status of mental health of the elderly in Xi'an maintains a medium-to-high level (the minimum value is 8, the maximum is 32, the average is 24.06 and the standard deviation is 4.278). CONCLUSIONS: The children's support plays a decisive role in the elderly's mental health, which is a hygiene factor; friends, neighbors and social participation for the elderly also contribute to the mental health, which is a motivator factor. Besides, some special cases, such as those elderly who lost their only child, those migrating to other cities and those empty nesters, have become the vulnerable groups in mental health.

Research on the Accumulation Effect of Pension Income and Payments Caused by Progressive Retirement Age Postponement Policy in China.

A retirement age postponement policy will not only increase pension income but also reduce pension payments, which will cause an accumulation effect on the size of the pension fund and relieve the intensifying pressure on pension payments. Based on the analysis of historical data in order to predict the population and pension scale in China, this research shows that the working-age population will gradually decrease, the supply of labor will decrease, and the demographic dividend will gradually disappear between 2018 and 2055 if the current retirement policy remains unrevised. According to three different retirement age postponement policy options, we establish that there are significant accumulation effects that can alleviate the pressure on pension funds. Among these policies, the postpone retirement policy option, which is based on the working period, is more conducive to a smoother policy implementation effect in the long term.

A study on satisfaction with publicly financed health services in China.

BACKGROUND: With implementation of Chinese universal healthcare, the performance of urban and rural residents' healthcare and the degree of satisfaction with publicly financed health services have become a hot issue in assessing health reforms in China. An evaluation model of health services in community and evaluation indexes of health-system performance have been put forward in related researches. This study examines variation in satisfaction with publicly financed health services among urban and rural residents in five Chinese cities and assesses their determinants. METHODS: The data are derived from a survey of 1198 urban and rural residents from five nationally representative regions concerning their perceptions of satisfaction with China's publicly financed health services. The respondents assessed their degree of satisfaction with publicly financed health services on a 5-point Likert scale. It is a kind of questionaire scale that features the answers for 1-5 points labeled very unsatisfied, unsatisfied, neither unsatisfied nor satisfied, satisfied and very satisfied linking to each factor or variable, where a score of 1 reflects the lowest degree of satisfaction and a score of 5 represents the highest degree. The logistic regression methods are used to identify the variables into its determining components. RESULTS: The overall satisfaction degree representing satisfaction of all factors (variables) is 3.02, which is at the middle level of a 1-5 Likert scale, inferring respondents' neutral attitude to publicly financed health services. According to the correlation test, the factors with characteristic root greater than 0.5 are chosen to take the factor analysis and 12 extracted factors can explain 77.97% of original 18 variables' total variance. Regression analysis based on the survey data finds that health records, vaccinations, pediatric care, elder care, and mental health management are the main factors accounting for degree of satisfaction with publicly financed health services for both urban and rural residents. CONCLUSIONS: What can be done to increase the degree of satisfaction with health services needs to be considered based on our findings. Regression analysis based on the survey data finds that health records, vaccinations, pediatric care, elder care, and mental health management are the main factors accounting for degree of satisfaction with publicly financed health services for both urban and rural residents. Therefore, with improvements in health records, timely vaccination, elder care for women or elder, pediatric care and major psychosis management, degree of satisfaction with publicly financed health services are likely to grow.

A study on the equality and benefit of China's national health care system.

BACKGROUND: This study is designed to evaluate whether the benefit which the residents received from the national health care system is equal in China. The perceived equality and benefit are used to measure the personal status of health care system, health status. This study examines variations in perceived equality and benefit of the national health care system between urban and rural residents from five cities of China and assessed their determinants. METHODS: One thousand one hundred ninty eight residents were selected from a random survey among five nationally representative cities. The research characterizes perceptions into four population groupings based on a binary assessment of survey scores: high equality & high benefit; low equality & low benefit; high equality & low benefit; and low equality & high benefit. RESULTS: The distribution of the four groups above is 30.4%, 43.0%, 4.6% and 22.0%, respectively. Meanwhile, the type of health insurance, educational background, occupation, geographic regions, changes in health status and other factors have significant impacts on perceived equality and benefit derived from the health care system. CONCLUSION: The findings demonstrate wide variations in perceptions of equality and benefit between urban and rural residents and across population characteristics, leading to a perceived lack of fairness in benefits and accessibility. Opportunities exist for policy interventions that are targeted to eliminate perceived differences and promote greater equality in access to health care.

The Study of Living Conditions and Perceived Needs for Social Security among Clergy in China: A Case Study of Guanzhong Qinling Area.

This study used quantitative and qualitative data collected in the Guanzhong Qinling area of China to examine living conditions and perceived needs for social security among men and women of the clergy. The survey finds that most respondent clergy are Buddhists. When the clergy have economic difficulties, their main types of support include self-support (28.8%), help from other believers (25.6%), and assistance from other community residents (18.4%). When the clergy are old, they tend to live alone (25%), receive institutional care from religious organizations (19%), and receive support from other believers (18%). When the clergy are ill, they will often select self-treatment (primarily the use of traditional Chinese medicine [25%], and spiritual healing [25%], including meditation, prayers, and psychotherapy) and receive treatment at hospitals (20%). The study found that the clergy perceived their needs for social security as either great (19.7%) or modest (36.5%). Very few clergy (10%) indicate the absence of social security needs. Most clergy believe that the key social security priorities should be medical care (34%), elderly care (29%), and charitable assistance (21%).