Environmental regulatory intensity, green finance and corporate green sustainable development performance.

In the "14th Five-Year Plan" period, the emphasis is made on green and low-carbon initiatives, which has become a defining feature of China's development, and it is of great significance to help enterprises realize green and sustainable development under the guidance of environmental regulation to achieve the goal of "dual-carbon". At first, this research analyzes the decision-making process between the government and enterprises under environmental regulation using the evolutionary game model. Moreover, using the TOPSIS method, this paper constructs the indicators of corporate green sustainable development performance, and empirically examines the impact of the intensity of environmental regulation on the green sustainable development performance of enterprises based on the data of Chinese A-share listed enterprises from 2010 to 2022. A noteworthy positive correlation between the intensity of environmental regulation and the sustainable green development performance of enterprises is unveiled by the results. Mechanism tests suggest that the intensity of environmental regulation has a positive impact on the green sustainable development performance of enterprises through enhancing green finance and green technological innovation. Moreover, this effect tends to be more pronounced for enterprises that are in the mature life cycle, with green executive team, and high media attention. The research presented in this study contributes to establishing a novel theoretical foundation for corporate sustainable development.

Disparities in awareness and utilisation of National Essential Public Health Services between the floating population and the registered residents: a cross-sectional study in China.

OBJECTIVE: There are differences between the floating population and the registered population in the awareness and use of the National Essential Public Health Services (NEPHS) due to the influence of China's household registration system. The Equalization of Basic Public Health and Family Planning Services (EBPHFPS) policy aims to reduce disparities among populations by enhancing the migrant population's access to basic public health services. The aim of this study is to examine the relationship between the EBPHFPS targeted at the floating population and the disparities in access to and utilisation of NEPHS between registered residents and the floating population. DESIGN: A cross-sectional study. SETTING: 8 cities (regions, autonomous prefectures) in China. PARTICIPANTS: 13 998 floating population and 14 000 registered residents in eight cities (regions, autonomous prefectures) were included in the analysis. OUTCOME MEASURES: Three binomial variables, including awareness of NEPHS, acceptance of health education and establishment of health records, were used as outcome indicators to examine the relationship between the EBPHFPS and the disparities between the floating and registered populations. METHODS: A linear regression model, fairness gap calculation and propensity score matching were used to explore the associations. RESULTS: The areas that implemented EBPHFPS exhibited an 8.3% increase in awareness of the NEPHS (p<0.01) and a 4.0% increase (p<0.05) in the likelihood of individuals having received health education within the previous year compared with the areas without the policy implementation. In contrast to registered residents, however, the floating population still faces significant disparities in NEPHS awareness and utilisation. Compared with areas without the equalisation policy, the inequality of opportunity in health education of the floating population in implementation areas is significantly lower (p<0.01), whereas no significant difference is observed in the inequality of opportunity regarding NEPHS awareness among the floating population (p>0.1). The floating population in the pilot areas of the policy encountered greater disparities in the establishment of health records (p<0.01). CONCLUSIONS: Positive associations between the EBPHFPS policy and NEPHS awareness and utilisation among the floating population were demonstrated to some extent; however, the floating population was still confronted with a degree of inequality of opportunity. The government needs to develop target-oriented policies and a guaranteed mechanism to ensure access to NEPHS among the floating population.

Individual-Level Health Care Costs Attributable to Noncommunicable Diseases: A Longitudinal Study Based on the Older Adults in China.

Noncommunicable chronic diseases among the elderly population represent a significant economic burden in China. However, previous disease-related health cost studies lacked representation of older adults and comparability of the burden of multiple chronic diseases. The objective of this study was to determine the fraction of health care costs attributable to the 6 most prevalent chronic diseases and comorbidities in the sample of older adults. This study employed data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), with 3 waves in 2011, 2014, and 2018, and included 18 349 observations in total. Outpatient costs, inpatient costs, and total health care costs were included in this study. Based on a 2-part random effects model, the effect of chronic disease on health service utilization was first explored by constructing a dummy variable for whether or not to utilize health care, followed by estimation of attributable costs in the population with health care utilization. Among the older adults in the sample, hypertension, heart disease, cataracts, arthritis, stroke or Cerebrovascular disease (CVD) and chronic lung disease are the 6 most prevalent chronic conditions. The costs attributable to the 6 chronic diseases mentioned above were 36.00% of outpatient costs, 55.92% of inpatient costs, and 45.05% of total health care costs for older adults. Of these, heart disease, stroke or CVD, and chronic lung disease accounted for 22.11%, 13.24%, and 10.56% of total health care costs, respectively. Moreover, the proportion of health care costs attributable to chronic diseases was higher for older adults who were male, lived in urban areas, and had a lower level of education. The proportion of health care costs attributable to chronic diseases is substantial among older adults in China. Health care costs associated with chronic diseases can be decreased with well-targeted interventions and comprehensive access to health services.

Cost savings in male circumcision post-operative care using two-way text-based follow-up in rural and urban South Africa.

INTRODUCTION: Voluntary medical male circumcision (VMMC) clients are required to attend multiple post-operative follow-up visits in South Africa. However, with demonstrated VMMC safety, stretched clinic staff in SA may conduct more than 400,000 unnecessary reviews for males without complications, annually. Embedded into a randomized controlled trial (RCT) to test safety of two-way, text-based (2wT) follow-up as compared to routine in-person visits among adult clients, the objective of this study was to compare 2wT and routine post-VMMC care costs in rural and urban South African settings. METHODS: Activity-based costing (ABC) estimated the costs of post-VMMC care, including counselling, follow-ups, and tracing in $US dollars. Transportation for VMMC and follow-up was provided for rural clients in outreach settings but not for urban clients in static sites. Data were collected from National Department of Health VMMC forms, RCT databases, and time-and-motion surveys. Sensitivity analysis presents different follow-up scenarios. We hypothesized that 2wT would save per-client costs overall, with higher savings in rural settings. RESULTS: VMMC program costs were estimated from 1,084 RCT clients: 537 in routine care and 547 in 2wT. On average, 2wT saved $3.56 per client as compared to routine care. By location, 2wT saved $7.73 per rural client and increased urban costs by $0.59 per client. 2wT would save $2.16 and $7.02 in follow-up program costs if men attended one or two post-VMMC visits, respectively. CONCLUSION: Quality 2wT follow-up care reduces overall post-VMMC care costs by supporting most men to heal at home while triaging clients with potential complications to timely, in-person care. 2wT saves more in rural areas where 2wT offsets transportation costs. Minimal additional 2wT costs in urban areas reflect high care quality and client engagement, a worthy investment for improved VMMC service delivery. 2wT scale-up in South Africa could significantly reduce overall VMMC costs while maintaining service quality.

Healthcare costs attributable to abnormal weight in China: evidence based on a longitudinal study.

BACKGROUND: The prevalence of abnormal weight is on the rise, presenting serious health risks and socioeconomic problems. Nonetheless, there is a lack of studies on the medical cost savings that can be attained through the mitigation of abnormal weight. The aim of this study was to estimate the impact of abnormal weight on healthcare costs in China. METHODS: The study employed a 4-wave panel data from China Family Panel Studies (CFPS) between 2012 and 2018 (11,209 participants in each wave). Inpatient, non-inpatient and total healthcare costs were outcome variables. Abnormal weight is categorized based on body mass index (BMI). Initially, the two-part model was employed to investigate the impact of overweight/obesity and underweight on healthcare utilisation and costs, respectively. Subsequently, the estimated results were utilised to calculate the overweight/obesity attributable fraction (OAF) and the underweight attributable fraction (UAF). RESULTS: In 2018, healthcare costs per person for overweight and obese population were estimated to be $607.51 and $639.28, respectively, and the underweight population was $755.55. In comparison to people of normal weight, individuals who were overweight/obese (OR = 1.067, p < 0.05) was more likely to utilise healthcare services. Overweight/obesity attributable fraction (OAF) was 3.90% of total healthcare costs and 4.31% of non-inpatient costs. Overweight/obesity does not result in additional healthcare expenditures for young people but increases healthcare costs for middle-aged adults (OAF = 7.28%) and older adults (OAF = 6.48%). The non-inpatient cost of underweight population was significantly higher than that of normal weight population (ß = 0.060,p < 0.1), but the non-inpatient health service utilisation was not significantly affected. CONCLUSIONS: Abnormal weight imposes a huge economic burden on individuals, households and the society. Abnormal weight in Chinese adults significantly increased healthcare utilisation and costs, particular in non-inpatient care. It is recommended that government and relevant social agencies provide a better social environment to enhance individual self-perception and promote healthy weight.

Social causation, social selection, and economic selection in the health outcomes of Chinese older adults and their gender disparities.

Background: The economic selection hypothesis, which argues that the initial economic situation determines both subsequent health and economic conditions, has been drawn into the debate on causation-selection issues. This study aims to construct a path model with self-rated health and depression score of older adults as health outcomes to measure and compare the social causation forces of wealth accumulation, social selection forces of adulthood health, and economic selection forces of childhood economics, and to examine their gender disparities. Methods: Data was obtained from a sample of 19613 older adults aged 45 years or above from the 2014 life history survey and the 2015 routine follow-up survey of the China Health and Retirement Longitudinal Study. Structural equation modeling analysis was conducted employing the full information maximum likelihood estimation method. Results: The presence of social causation, social selection, and economic selection were all statistically supported. In self-rated health, social selection forces held the dominant position, while social causation forces were comparable to economic selection forces. In depression score, social selection still exhibited stronger forces than economic selection, but social causation had forces close to social selection and greater than economic selection. The forces of the three hypotheses in self-rated health did not significantly change with gender, but social causation exerted mightier forces than economic selection within the male group, unlike the female group. The forces of economic selection in depression score were greater in females than males and no significant differences were observed among the forces of the three hypotheses in the female group. Conclusions: Social causation, social selection, and economic selection operate simultaneously on the self-rated health and depression score of older adults. However, the force magnitudes of the three hypotheses and/or their rankings differ by health outcomes and gender.

Inequality of opportunity in outpatient expenditure among the elderly with multimorbidity: evidence from China.

BACKGROUND: Inequality of opportunity (IOp) stemming from social circumstances exists in outpatient service utilization for the multimorbid elderly in China. However, little is known regarding the magnitude of the IOp and its composition. Therefore, this study aims to measure the IOp in outpatient expenditure and provide potential pathways for policy reform by assessing the contribution of each circumstance. METHODS: This study included 3527 elderly aged ≥ 65 years with multimorbidity from the Chinese Longitudinal Healthy Longevity Study conducted in 2017-2018. An ordinary least squares regression model was used to analyze the circumstance-influencing factors of outpatient expenditure. The parametric approach was performed to quantify the IOp in outpatient expenditure and the Shapley value decomposition method was employed to determine the contribution of each circumstance. By extracting heterogeneity in the residual of the circumstance-dependent equation of outpatient expenditure across circumstance groups divided based on cluster analysis, we captured the effect of unobserved circumstances. RESULTS: Except for pension and distance to health facilities, all the associations between circumstance and outpatient expenditure were statistically significant. The inequality caused by circumstances accounted for 25.18% of the total inequality. The decomposition results revealed that the reimbursement rate contributed 82.92% of the IOp, followed by education duration (4.55%), household registration (3.21%), household income (3.18%), pension (1.49%), medical insurance (1.26%), physical labor (0.99%), unobserved circumstances (0.86%), distance to health facilities (0.83%) and region (0.71%). CONCLUSIONS: The priority of policy enhancement is to effectively improve the outpatient reimbursement benefit for treating chronic diseases. Additional crucial actions include enhancing the health literacy of the multimorbid elderly to promote the shift from medical needs to demands and accelerating the construction of rural capacity for providing high-quality healthcare to the elderly with multimorbidity.

Cost savings in male circumcision post-operative care using two-way text-based follow-up in rural and urban South Africa.

Introduction: Voluntary medical male circumcision (VMMC) clients are required to attend multiple post-operative follow-up visits in South Africa. However, with demonstrated VMMC safety, stretched clinic staff in SA may conduct more than 400,000 unnecessary reviews for males without complications, annually. Embedded into a randomized controlled trial (RCT) to test safety of two-way, text-based (2wT) follow-up as compared to routine in-person visits among adult clients, the objective of this study was to compare 2wT and routine post-VMMC care costs in rural and urban South African settings. Methods: Activity-based costing (ABC) estimated the costs of post-VMMC care, including counselling, follow-ups, and tracing in $US dollars. Transportation for VMMC and follow-up was provided for rural clients in outreach settings but not for urban clients in static sites. Data were collected from National Department of Health VMMC forms, RCT databases, and time-and-motion surveys. Sensitivity analysis presents different follow-up scenarios. We hypothesized that 2wT would save per-client costs overall, with higher savings in rural settings. Results: VMMC program costs were estimated from 1,084 RCT clients: 537 in routine care and 547 in 2wT. On average, 2wT saved $3.56 per client as compared to routine care. By location, 2wT saved $7.73 per rural client and increased urban costs by $0.59 per client. 2wT would save $2.16 and $7.02 in follow-up program costs if men attended one or two post-VMMC visits, respectively. Conclusion: Quality 2wT follow-up care reduces overall post-VMMC care costs by supporting most men to heal at home while triaging clients with potential complications to timely, in-person care. 2wT saves more in rural areas where 2wT offsets transportation costs. Minimal additional 2wT costs in urban areas reflect high care quality and client engagement, a worthy investment for improved VMMC service delivery. 2wT scale-up in South Africa could significantly reduce overall VMMC costs while maintaining service quality.

Comparative assessment of environmental impacts, mitigation potentials, and economic benefits of rain-fed and irrigated apple production systems on China's Loess Plateau.

Although the repaid development of China's apple industry heavily depends on excessive fertilizer-water-pesticide (FWP) inputs, little information is available that systematically evaluates environmental impacts, mitigation potential, and economical benefits of apple production systems in China. In this study, life cycle assessment (LCA) was conducted to elucidate environmental risks and mitigation potentials of rain-fed and irrigated apple production systems on China's Loess Plateau based on survey data from 847 farmers, and economic benefits were analyzed simultaneously. Results showed that irrigated orchards caused more severe environmental risks associated with energy depletion (ED), global warming potential (GWP) and acidification potential (AP) than those in rain-fed orchards, whereas an opposite was true for eutrophication potential (EP), human toxicity potential (HTP), aquatic toxicity potential (ATP) and soil toxicity potential (STP). ED and GWP occurred primarily in the agricultural material stage, while AP, EP, HTP, ATP, and STP occurred mostly in the orchard management stage. Optimized FWP management can markedly mitigate environmental impacts in both irrigated and rain-fed orchard systems. Synthetic fertilizer, because of production and field-associated emissions, was the greatest contributor to environmental impacts of an apple production system. An environmental pollution index (EPI) that integrated environmental categories was highest in conventional irrigated orchards (0.946), followed by conventional rainfed orchards (0.857), and optimized irrigated orchards (0.459), and the lowest EPI was in optimized rainfed orchards (0.389). Economic analysis revealed that the benefits of rainfed orchards were higher than those of irrigated orchards because of higher apple prices and lower labor costs. Optimized FWP management sharply decreased input costs, thereby substantially increasing net income in irrigated and rain-fed apple orchards. Overall, severe environmental risk and large mitigation potential co-exist in rain-fed and irrigated apple orchards on China's Loess Plateau. Integrated soil-crop-market management potentially exhibited considerable environmental and economic advantages, thereby efficiently developing high-quality apple production.

Healthcare Expenditures among the Elderly in China: The Role of Catastrophic Medical Insurance.

China has been piloting the catastrophic medical insurance (CMI) program since 2012 and rolled it out nationally in 2016 to reduce the incidence of catastrophic health expenditure among Chinese residents. Few studies have been conducted to determine its effect on healthcare expenditures, particularly among the elderly. The purpose of this study is to examine the effect of CMI on healthcare expenditures among China's elderly population. The data for this study were derived from 4 waves of the Chinese Longitudinal Healthy Longevity Survey, which included 344 and 1199 individuals in the treatment and control groups, respectively. To examine the effect of CMI on healthcare expenditures among the elderly, we used difference-in-differences and fixed-effects models. Additionally, a heterogeneity analysis was used to examine the differences in the impact of CMI on different groups. Finally, we confirmed the robustness of the results using robustness and placebo tests. CMI increased total health and out-of-pocket expenditures significantly, as well as inpatient and corresponding out-of-pocket expenditures. The reassults of the heterogeneity analysis indicated that CMI had a greater impact on elderly residents of rural areas. Economic burden protection has been enhanced for low-income groups and patients with serious diseases over the last two years. Our research indicated that CMI can promote the use of inpatient medical services for the elderly to a certain extent. Targeted measures such as expanding the CMI compensation list, establishing a more precise compensation scheme, and specific diseases associated with high healthcare expenditures can be considered in the practice of CMI implementation.

Inequalities in health-related quality of life and the contribution from socioeconomic status: evidence from Tibet, China.

BACKGROUND: This study aimed to understand the association between socioeconomic status (SES) and Health Related Quality of Life (HRQoL) and the contribution of SES to health inequality among Tibetans of agricultural and pastoral areas (APA) in Tibet, China. METHODS: The data were from Health Survey of Tibetans in APA conducted in 2014. A total of 816 respondents were enrolled for the analysis Multiple linear regression was employed to examine the relationship between SES and HRQoL. Concentration index (CI) was used to measure the degree of health inequality and a Wagstaff-type CI decomposition method was applied to measure the contribution of SES to inequality. RESULTS: SES had significant association with HRQoL among the Tibetans in APA. The high SES group was more likely to have a higher Eq-5d index (0.77 vs. 0.67, P < 0.001) and VAS (72.94 vs. 62.41, P < 0.001) than the low SES group. The Concentration index of the Eq-5d index and VAS for total sample was 0.022 and 0.026 respectively, indicating a slight pro-rich inequality among this population. The decomposition analyses showed the SES is the main contributor to health inequality and contributed 45.50 and 41.39% to inequality for the Eq-5d index and VAS, respectively. CONCLUSION: The results showed SES is positively associated with HRQoL among Tibetans in APA. There was a slight pro-rich inequality in the health of the participants and most health inequality was attributable to SES. This study is helpful in gaining an insight into the HRQoL, health inequality and the relationship between SES and health inequality among Tibetans of APA in China.

Are People Enrolled in NCMS and CURBMI Susceptible in Catastrophic Health Expenditure? Evidence From China.

This study investigated associations between different types of medical insurance and the incidence of catastrophic health expenditure among middle-aged and the aged in China. The data came from the China Health and Retirement Longitudinal Survey implemented in 2013, with 9782 individuals analyzed. Probit regression models and multiple linear regressions were employed to explore the relationship mentioned above and potential mechanisms behind it. It was found that compared with participants in Urban Resident Basic Medical Insurance, individuals participating in New Cooperative Medical Scheme and Coordinating Urban and Rural Basic Medical Insurance was less likely to undergo catastrophic health expenditure (P < .001, P = .008), especially for low-income and middle-income group. Participants in New Cooperative Medical Scheme and Coordinating Urban and Rural Basic Medical Insurance were more likely to utilize inpatient medical service (P < .001, P = .020) and choose low-level medical institutions for treatment (P = .003, P = .006). And individuals participating in New Cooperative Medical Scheme had lower out-of-pocket expenditure (P = .034). The study showed the significant difference in the incidence of catastrophic health expenditure among participants in different medical insurances. Efforts should be made to improve the service quality of grassroots medical institutions except for the increase of reimbursement ratio, so that rural residents can enjoy high-quality medical services.

Social determinants of delivery mode in Jiangsu, China.

BACKGROUND: Less evidence exists regarding the association of social determinants and delivery mode in Jiangsu, and if the trend is influenced by the type of residence. This study aims to identify the significant social determinants of delivery mode, and also to compare the main differences in delivery mode between urban and rural areas. METHODS: We used data from the cross-sectional National Health Service Surveys conducted in Jiangsu Province in 2013. For the purposes of this study, information from women (15-64 years old) who had experienced childbirth the last 5 years were examined, and a total of 1365 participants were selected as research subjects. RESULTS: Participants using vaginal delivery mode and cesarean delivery mode were found in 616 (45.1%) and 751(54.9%) participants, respectively. The proportion of women using cesarean delivery was 53.5% in rural area and 58.2% in urban area. Meanwhile, our results showed that women in middle Jiangsu were more likely to use cesarean delivery, and cesarean delivery is more prevalent among richer women. We also find that the more use of prenatal care visit, the more use of cesarean delivery. CONCLUSIONS: This study validated the relationship between social determinants and the mode of delivery in Jiangsu province. Social determinants are contextual factors, which may vary by region and additional work is needed to fully understand these relationships globally. Further studies are needed to elucidate mechanisms and pathways across various populations, and these social determinants should be incorporated into future multi-level interventions designed to decrease the cesarean delivery rate.

Factors Associated With Prescribed Antenatal Care Utilization: A Cross-Sectional Study in Eastern Rural China.

With relatively sufficient antenatal health service supplies in eastern rural China, the utilization still needs to be improved. The objective of this study was to identify factors that correlate with antenatal care (ANC) utilization from the demand-side in Jiangsu, China. In a cross-sectional survey, a sample of 896 rural women who had a childbearing history in the previous 5 years answered ANC questions and formed the final analysis. Questionnaire was designed based on Andersen's behavioral model. The outcome variables included receiving times and items of prescribed ANC utilization, and the explanatory variables were organized into 3 hierarchical levels: predisposing, enabling, and need factors. Univariate analysis and multivariate logistic regression analysis were conducted. In the results of multivariate logistic regression, factors significantly associated with ANC examination times included income, odds ratio (OR) (95% confidence interval [CI]) = 2.90 (1.92-4.39); the distance from the nearest hospital, OR (95% CI) = 0.67 (0.47-0.95); chronic disease, OR (95% CI) = 1.77 (1.15-2.72); and parity, OR (95% CI) = 0.66 (0.46-0.95), while factors significantly associated with ANC examination items included education, OR (95% CI) = 8.02 (1.08-59.67); income, OR (95% CI) = 3.90 (1.72-8.85); female medical staff in towns and villages, OR (95% CI) = 2.64 (1.39-5.02); and parity, OR (95% CI) = 0.41 (0.23-0.75). In reducing inadequate ANC utilization in rural area, efforts should be made not only to target the rural women with lower income, lower educational level, and multi-parity, but also to further improve the accessibility of the primary medical facilities and female staff at the grassroots level.

Measurement and decomposition of income-related inequality in self-rated health among the elderly in China.

BACKGROUND: Population ageing in China has brought increasing attention to the health inequalities of the elderly. The purpose of this paper is to measure income-related health inequality among the elderly in China and decompose its causes. METHODS: The data are from the China Health and Retirement Longitudinal Study (CHARLS) survey in 2013, which contains 6176 individuals aged 60 years and above. A multiple linear regression model was used to analyze the influencing factors of self-rated health (SRH) among the elder people. Furthermore, the corrected concentration index were used to measure income-related health inequality. Wagstaff-type decomposition analysis was employed to explore the cause of inequality. The measurement and decomposition of health inequality was also performed separately in the male and female subgroups. RESULTS: Most elderly declared their health status as "fair" (51.33%) or "poor" (21.88%). Income, gender, residence, region, health insurance and other factors had significant association with SRH (P < 0.05). The corrected concentration index (CCI) was 0.06, indicating pro-rich inequality in health among the elderly. Decomposition analyses revealed that the main contributors to health inequality included income, residence, region, health insurance, and employment. For female elderly, most of the inequality was due to residence (50.78%) and income (49.51%); for male elderly, most of the inequality was due to insurance (38.65%) and income (22.26%); for the total sample, employment had a negative contribution to health inequality (- 25.83%). CONCLUSION: The findings confirm a high proportion of elderly with poor SRH, and health inequality in the Chinese. Some socioeconomic strategies should be conducted to reduce this health inequality among the elderly, such as reducing income disparities, consolidating health insurance schemes, and narrowing urban-rural and regional gaps. Older females with low incomes in rural areas are a vulnerable subgroup and warrant targeted policy attention.