Long-term care insurance and the well-being of older adults and their families: Evidence from China.

This paper examines the impact of China's public long-term care insurance (LTCI) pilots on the well-being of older adults and their families. Using panel data from the Chinese Longitudinal Healthy Longevity Survey, we exploit the rollout of the LTCI pilots across different cities during 2015-2017 and identify the effect of LTCI using a difference-in-differences approach. We find that the implementation of LTCI has reduced the likelihood of older adults reporting unmet activity of daily living (ADL)-related need for care, the intensity of informal care, and the amounts of ADL-related care expenditures and out-of-pocket medical expenditures. LTCI coverage was also associated with an improvement in self-reported health and a reduction in one-year mortality risk of older adults with baseline need for care. From a policy perspective, these findings suggest that the introduction of LTCI may benefit all members of the household, both care recipient and caregivers, which has important implications for the development of LTCI in China and other middle-income and developing countries.

Combined Assessment of Elevated Plasma Lipoprotein-Associated Phospholipase A2 and Plaque Enhancement Improved Accuracy in the Risk of Acute Ischemic Stroke in Patients with Intracranial Artery Stenosis.

PURPOSE: We evaluated the relationship between plasma lipoprotein-associated phospholipase A2 (Lp-PLA2) concentration and plaque characteristics in patients with intracranial artery stenosis and their clinical relevance in acute ischemic stroke. METHODS: Eighty-seven patients with intracranial atherosclerotic stenosis (66 males, 21 females) were retrospectively enrolled. Plasma Lp-PLA2 concentration was measured, and vessel wall magnetic resonance imaging (VW-MRI) was used to determine intracranial vascular stenosis and plaque characteristics, including plaque enhancement, surface morphology, and T1 hyperintensity. Binary logistic regression was used to evaluate the relationship between Lp-PLA2 concentration and plaque characteristics of intracranial artery after adjusting for demographic and confounding factors and to assess their diagnostic efficacy for the risk of acute ischemic stroke. RESULTS: After adjustment for demographic, medication and related lipid factors, Lp-PLA2 elevation was associated with plaque enhancement (odds ratio [OR]=12.7, 95% confidence interval [CI] 2.51-64.82, P=0.002) and surface irregularity (OR=2.9, 95% CI 1.06-7.98, P=0.038). Both Lp-PLA2 elevation (OR=8.8, 95% CI 1.64-47.72, P=0.011) and plaque enhancement (OR=34.3, 95% CI 5.88-200.4, P=0.001) were associated with acute ischemic stroke. Receiver operating characteristic curve analysis showed that the area under the curve for Lp-PLA2 concentration and plaque enhancement combined in the diagnosis of acute ischemic stroke was 0.884, significantly higher than that for Lp-PLA2 concentration (0.724) and plaque enhancement (0.794) alone. CONCLUSION: Elevated Lp-PLA2 is associated with plaque enhancement and plaque surface irregularity. Combined assessment of Lp-PLA2 concentration and plaque enhancement is of greater diagnostic value for the risk of acute ischemic stroke in patients with intracranial artery stenosis.

Life Satisfaction in China and Consumption and Income Inequalities.

This research uses nationally representative data to study how economic resources and inequalities are associated with life satisfaction of Chinese residents. We construct economic resource and inequality measures from expenditure rather than from income, after confirming that expenditure inequality is a better measure in the Chinese context. We find that economic inequalities in general are negatively associated with life satisfaction, and that this association is larger for inequalities in the lower half of the distribution than those in the upper half of the distribution. We further explore the mechanisms under which inequality can be associated with life satisfaction, and find that aspiration is potentially one important channel.

Health Insurance and Health Care among the Mid-Aged and Older Chinese: Evidence from the National Baseline Survey of CHARLS.

We document the recent profile of health insurance and health care among mid-aged and older Chinese using data from the China Health and Retirement Longitudinal Study conducted in 2011. Overall health insurance coverage is about 93%. Multivariate regressions show that respondents with lower income as measured by per capita expenditure have a lower chance of being insured, as do the less-educated, older, and divorced/widowed women and rural-registered people. Premiums and reimbursement rates of health insurance vary significantly by schemes. Inpatient reimbursement rates for urban people increase with total cost to a plateau of 60%; rural people receive much less. Demographic characteristics such as age, education, marriage status, per capita expenditure, and self-reported health status are not significantly associated with share of out-of-pocket cost after controlling community effects. For health service use, we find large gaps that vary across health insurance plans, especially for inpatient service. People with access to urban health insurance plans are more likely to use health services. In general, Chinese people have easy access to median low-level medical facilities. It is also not difficult to access general hospitals or specialized hospitals, but there exists better access to healthcare facilities in urban areas. Copyright © 2016 John Wiley & Sons, Ltd.

Health Insurance and Health Status: Exploring the Causal Effect from a Policy Intervention.

Whether health insurance matters for health has long been a central issue for debate when assessing the full value of health insurance coverage in both developed and developing countries. In 2007, the government-led Urban Resident Basic Medical Insurance (URBMI) program was piloted in China, followed by a nationwide implementation in 2009. Different premium subsidies by government across cities and groups provide a unique opportunity to employ the instrumental variables estimation approach to identify the causal effects of health insurance on health. Using a national panel survey of the URBMI, we find that URBMI beneficiaries experience statistically better health than the uninsured. Furthermore, the insurance health benefit appears to be stronger for groups with disadvantaged education and income than for their counterparts. In addition, the insured receive more and better inpatient care, without paying more for services. Copyright © 2015 John Wiley & Sons, Ltd.

Gender Differences in Cognition in China and Reasons for Change over Time: Evidence from CHARLS.

In this paper, we model gender differences in cognitive ability in China using a new sample of middle-aged and older Chinese respondents. Modeled after the American Health and Retirement Survey (HRS), CHARLS respondents are 45 years and older and are nationally representative of the Chinese population in this age span. Our measures of cognition in CHARLS rely on two measures that proxy for different dimensions of adult cognition-episodic memory and intact mental status. We relate these cognitive measures to adult health and SES outcomes during the adult years. We find large cognitive differences to the detriment of women that were mitigated by large gender differences in education among these generations of Chinese people. These gender differences in cognition are especially concentrated in the older age groups and poorer communities within the sample. We also investigated historical, geographical, and cultural characteristics of communities to understand how they impact cognition. Economic development and environmental improvement such as having electricity, increases in wage per capita and green coverage ratio generally contribute to higher cognition ability. Women benefit more from the fruits of development -electricity and growth of green coverage ratio are conducive to lessening female disadvantage in cognition.

Depressive symptoms and SES among the mid-aged and elderly in China: evidence from the China Health and Retirement Longitudinal Study national baseline.

We examine the prevalence of depressive symptoms among the mid-aged and elderly in China and examine relationships between depression and current SES factors such as gender, age, education and income (per capita expenditures). In addition, we explore associations of depressive symptoms with measures of early childhood health, recent family deaths and current chronic health conditions. We use data from the China Health and Retirement Longitudinal Study (CHARLS) national baseline, fielded in 2011/12, which contains the ten question version of the Center for Epidemiologic Studies-Depression scale (CES-D) for 17,343 respondents aged 45 and older. We fill a major gap by using the CHARLS data to explore the general patterns of depression and risk factors among the Chinese elderly nationwide, which has never been possible before. We find that depressive symptoms are significantly associated with own education and per capita expenditure, and the associations are robust to the inclusion of highly disaggregated community fixed effects and to the addition of several other risk factors. Factors such as good general health during childhood are negatively associated with later depression. There exist strong gender differences, with females having higher depression scores. Being a recent widow or widower is associated with more depressive symptoms, as is having a series of chronic health problems, notably having moderate or severe pain, disability or problems with measures of physical functioning. Adding the chronic health problems to the specification greatly reduces the SES associations with depressive symptoms, suggesting that part of the pathways behind these associations are through these chronic health factors.

Health outcomes and socio-economic status among the mid-aged and elderly in China: Evidence from the CHARLS national baseline data.

Using a very rich set of health indicators that include both self-reported measures and biomarkers from the CHARLS national baseline data, we document health conditions of the Chinese mid-aged and elderly, examine correlations between these health outcomes and socio-economic status and compare these associations by gender, hukou status and region. As expected, we find that Chinese mid-aged and elderly are facing challenges from chronic diseases including hypertension. Overnutrition has become a bigger problem than undernutrition, particularly for women, reflected in a higher rate of overweight compared to underweight. Disability rates are also high, especially for female, rural and inland respondents, who also report suffering from more pain than male, urban and coastal ones. In general, education and PCE tend to be positively correlated with better health outcomes, as it is in other countries. For PCE the relationship is very nonlinear. At low levels of PCE, there exists a positive correlation with better health outcomes, while for higher levels of PCE the relationship flattens out. Unmeasured community influences turn out to be highly important, much more so than one usually finds in other countries. We also find a large degree of under-diagnosis of hypertension, a major health problems that afflicts the aged, although less large than in some other developing countries. This implies that the current health system is still not well prepared to address the rapid aging of the Chinese population.

The New Cooperative Medical Scheme in rural China: does more coverage mean more service and better health?

This paper explores the impact of the New Cooperative Medical Scheme (NCMS), a newly adopted public health insurance program in rural China. Using a longitudinal sample drawn from the China Health and Nutrition Survey (CHNS), we employed multiple estimation strategies (individual fixed-effect models, instrumental variable estimation, and difference-in-differences estimation with propensity score matching) to correct the potential selection bias. We find that participating in the NCMS significantly decreases the use of traditional Chinese folk doctors and increases the utilization of preventive care, particularly general physical examinations. However, we do not find that the NCMS decreases out-of-pocket expenditure nor do we find that it increases utilization of formal medical service or improves health status, as measured by self-reported health status and by sickness or injury in the past four weeks. Our study indicates that despite the wide expansion of coverage, the impact of the NCMS is still limited.