The Economic Burden of Hospital Costs on Families With Type 1 Diabetes Mellitus Children: The Role of Medical Insurance in Shandong Province, China.

Objective: This study estimates the economic burden imposed on families by comparing the hospitalization costs of T1DM children with and without medical insurance in Shandong province. Methods: Our data comprised 1,348 T1DM inpatient records of patients aged 18 years or younger from the hospitalization information system of 297 general hospitals in 6 urban districts of Shandong Province. Descriptive statistics are presented and regression analyses were conducted to explore the factors associated with hospitalization costs. Results: Children with medical insurance had on average total hospitalization expenditures of RMB5,833.48 (US$824.02) and a hospitalization stay of 7.49 days, compared with the children without medical insurance who had lower hospitalization expenditures of RMB4,021.45 (US$568.06) and an average stay of 6.05 days. Out-of-pocket expenses for insured children were RMB3,036.22 (US$428.89), which is significantly lower than that of the uninsured children (P < 0.01). Out-of-pocket (OOP) expenditures accounted for 6% of the annual household income of insured middle-income families, but rose to a significant 25% of the annual income for low-income families. These OOP expenditures imposed a heavy economic burden on families, with some families experiencing long-term financial distress. Both insured and uninsured families, especially low-income families, could be tipped into poverty by hospitalization costs. Conclusion: Hospitalization costs imposed a significant economic burden on families with children with T1DM, especially low-income insured and uninsured families. The significantly higher hospitalization expenses of insured T1DM children, such as longer hospitalization stays, more expensive treatments and more drugs, may reflect both excess treatment demands by parents and over-servicing by hospitals; lower OOP expenses for uninsured children may reflect uninsured children from low-income families forgoing appropriate medical treatment. Hospital insurance reform is recommended.

CO2 emissions, income inequality, and country risk: some international evidence.

This research explores the effects of income inequality and country risk on CO2 emissions and examines whether the effects change across countries with different development stages or income levels. A new panel quantile regression approach is used to conduct a comprehensive analysis of the impacts of affecting factors on CO2 emissions at various quantiles, while addressing econometric challenges such as endogeneity and heterogeneity. From a global perspective, we can conclude that the marginal impact of inequality on emissions drops constantly with decreasing country risk at 10th to 50th quantiles, which even performs negative, whereas at the other quantiles, the marginal impact of inequality always remains negative. When we focus on the different income groups, the nexus of inequality emissions is negative first and then positive with decrease of country risk in low-income countries but shows no significant in low-middle- and upper-middle-income countries. Additionally, we validate the detrimental impact of income inequality in upper-income countries. Besides, country risk adversely moderates the nexus of inequality and emissions in low- and upper-income countries. Empirical results confirm that the nexus of inequality emissions lies in country risk, income level, and existing emission degree. These findings provide some important recommendations for policy-makers.

Income inequality and CO2 emissions in belt and road initiative countries: the role of democracy.

This paper investigates the interaction effects of income inequality and democracy on CO2 emissions. The spatial panel model, which accounts for the spatial spillover effects across countries, is used. Using the panel data covering 41 Belt and Road initiative countries, the results indicate significant positive spatial spillovers effect to country-level CO2 emission activity. The Kuznets Curve hypothesis, which assumes that reverse U relation presents between income and CO2 emissions, is identified. Empirical results provide evidence that democracy levels promote the nonlinear nexus between income inequality and CO2 emissions. High levels of inequality, ceteris paribus, in conjunction with poor democratic institutions are likely to result in higher pollution. The findings are robust to various robustness tests.

Hospitalization Costs and Financial Burden on Families with Children with Depression: A Cross-Section Study in Shandong Province, China.

BACKGROUND: Depression, one of the most frequent mental disorders, affects more than 350 million people of all ages worldwide, with China facing an increased prevalence of depression. Childhood depression is on the rise; globally, and in China. This study estimates the hospitalization costs and the financial burden on families with children suffering from depression and recommends strategies both to improve the health care of children with depression and to reduce their families' financial burden. METHODS: The data were obtained from the hospitalization information system of 297 general hospitals in six regions of Shandong Province, China. We identified 488 children with depression. The information on demographics, comorbidities, medical insurance, hospitalization costs and insurance reimbursements were extracted from the hospital's information systems. Descriptive statistics were presented, and regression analyses were conducted to explore the factors associated with hospitalization costs. STATA14 software was used for analysis. RESULTS: The mean age of children with depression was 13.46 ± 0.13 years old. The availability of medical insurance directly affected the hospitalization costs of children with depression. The children with medical insurance had average total hospitalization expenses of RMB14528.05RMB (US$2111.91) and length of stay in hospital of 38.87 days compared with the children without medical insurance of hospital with expenses of RMB10825.55 (US$1573.69) and hospital stays of 26.54 days. Insured children's mean out-of-pocket expenses (6517.38RMB) was lower than the those of uninsured children (RMB10825.55 or US$1573.69), significant at 0.01 level. Insured children incurred higher treatment costs, drug costs, bed fees, check-up fees, test costs and nursing fees than uninsured patients (p < 0.01). CONCLUSIONS: Children suffering from depression with medical insurance had higher hospitalization costs and longer hospitalization stays than children without medical insurance. While uninsured inpatients experienced larger out-of-pocket costs than insured patients, out-of-pocket hospital expenses strained all family budgets, pushing many, especially low-income, families into poverty-insured or uninsured. The different hospital cost structures for drugs, treatment, bed fees, nursing and other costs, between insured and uninsured children with depression, suggest the need for further investigations of treatment regimes, including over-demand by parents for treatment of their children, over-supply of treatment by medical staff and under-treatment of uninsured patients. We recommend more careful attention paid to diagnosing depression in girls and further reform to China's health insurance schemes-especially to allow migrant families to gain basic medical insurance.

The heterogeneous effects of urbanization and income inequality on CO2 emissions in BRICS economies: evidence from panel quantile regression.

This paper empirically examines the effects of urbanization and income inequality on CO2 emissions in the BRICS economies (i.e., Brazil, Russia, India, China, and South Africa) during the periods 1994-2013. The method we used is the panel quantile regression, which takes into account the unobserved individual heterogeneity and distributional heterogeneity. Our empirical results indicate that urbanization has a significant and negative impact on carbon emissions, except in the 80th, 90th, and 95th quantiles. We also quantitatively investigate the direct and indirect effect of urbanization on carbon emissions, and the results show that we may underestimate urbanization's effect on carbon emissions if we ignore its indirect effect. In addition, in middle- and high-emission countries, income inequality has a significant and positive impact on carbon emissions. The results of our study indicate that in the BRICS economies, there is an inverted U-shaped environmental Kuznets curve (EKC) between the GDP per capita and carbon emissions. The conclusions of this study have important policy implications for policymakers. Policymakers should try to narrow the income gap between the rich and the poor to improve environmental quality; the BRICS economies can speed up urbanization to reduce carbon emissions, but they must improve energy efficiency and use clean energy to the greatest extent in the process.