Policy interplay among social health insurance system, pension system, delayed retirement initiative and implications for the self-rated health status of older workers.

Delayed retirement initiative proposed in China attaches greater importance to the sustainability of pension systems and the labour shortage, but less to the health status of older people. The existing social health insurance and pension system are not well established to match this initiative. This study investigates the policy mix of delayed retirement, employment-based social health insurance, social pension participation for health status of older people. Results of the data from the China Health and Retirement Longitudinal Study (CHARLS-2018) show that late retirement could benefit health status among older adults. Moreover, such effect of late retirement appears more salient for those uninsured by employment-based social health insurance and those still in the pension contribution phase upon reaching the statutory retirement age. Hence, in countries with inadequate health insurance and pension systems, such as China, delayed retirement may serve as an important alternative to social security for the health of older people.

Longstanding health risk across the life course: The influence of early-life experience on health status throughout the life span.

This study tracked the longstanding effect of childhood adversities on health status over the course of a life. This study used the data from China Health and Retirement Longitudinal Study which was a nationally representative survey and documented the generation who had arrived in the middle- and old-age phase and experienced the difficult time in the early founding of PR China in their childhood. Results shown the significant associations between multiple forms of children adversities (economic distress, child neglect, child abuse, lack of friends, parental mental health problems) and health status in adolescence (from 0.068 to 0.102, p<0.01), and health status in mid and late adulthood, including self-rated general health problems (from 0.039 to 0.061, p<0.01), chronic conditions (from 0.014 to 0.120, p<0.01 except for lack of friends), body aches (from 0.016 to 0.062, p<0.01 except for child neglect), and depression (from 0.047 to 0.112, p<0.01). Meanwhile, results also shown an underlying pathway (i.e., health status in adolescence) linking childhood adversities and health status in mid and late adulthood. Results suggested that the experience of multiple forms of adversities in childhood represented a substantial source of health risk throughout life.

Understanding the health outcomes of the work pattern transformation in the age of gig economy: an investigation of the association between multiple-job holding and health status in the United States and China.

OBJECTIVE: The Slash (multiple-job holders) become increasingly prevalent in the labor force under the context of fast-developing gig economy and other emerging employment forms active on platforms. However, health outcomes of multiple-job holding have not received sufficient research treatment and is far from reaching consensus. This study provides an empirical investigation on the influence of multiple-job holding on individual health. METHOD: This study uses data from China Health and Retirement Longitudinal Study (CHARLS-2015 survey) which covers 28 provinces/municipalities in China and tracks work and health status of the population aged over 45 years using stratified random sampling (N = 12,659-16,526 for examinations of different types of health status (i.e., chronic conditions/body aches/depression, in study 1), and from the Survey of Household Economics and Decision-making (SHED-2019) which is conducted by the Federal Reserve Board of the United States and documents economic behavior and related risks of the population aged over 18 years (N = 6603 for baseline model and N = 10,718 for supplementary test, in study 2). To address the potential endogeneity of multiple-job holding, the instrumental variable (IV) regressions are conducted to ensure the validity of results. The implementation of Study 1 and 2 in different national context could help test the generalization of research results. RESULTS: Compared with non-multiple jobs holding, multiple-job holding with only one additional job is associated with better health status (i.e., less chronic conditions and body aches, a lower level of depression shown in study 1, and better self-assessed general health shown in study 2), however, multiple-job holding with at least two additional jobs turns to be associated with worse health status (shown in both study 1 and 2). These results show that the optimal level of multiple-job holding could be featured with one additional job besides the primary job. CONCLUSION: Multiple-job holding, with different structures, has both bright and dark side for health outcomes. To maintain an optimal level of multiple-job holding could benefit individual health.

The dilemma of dual adaptation to delayed retirement initiative and work model change of gig economy: the influence of late retirement and multiple-job holding on mental health among older workers.

PURPOSE: A growing number of older workers engage in multiple jobs in the context of delayed retirement initiative and the fast-growing gig economy in China. However, it remains unclear whether multiple jobs holding is beneficial to late retirees. METHODS: To preliminarily address this issue, this study applies the data of CHARLS-2015 to examine the effect of late retirement and multiple-job holding on mental health among older adults. Besides, instrumental variables (IVs) regression is conducted to clarify potential endogeneity problem. RESULTS: It is shown that both late retirement (coef. = - 2.726, p < 0.01) and multiple-job holding (coef. = - 1.523, p < 0.01) alleviate depression among older adults. However, multiple-job holding would weaken the relationship between late retirement and depression (coef. = 2.019, p < 0.01). CONCLUSION: The findings suggest that although the modest engagement in late careers and multiple-job holding could benefit mental health, respectively, the overlap of them could be overburdened for older adults. Policymakers should be aware of the occupational risk of multiple-job holding when incentivizing the delayed retirement to address the population aging.

Late career participation of late retirees in the age of the silver tsunami: understanding the influencing mechanism of health status and employment-based health insurance participation.

BACKGROUND: The delayed retirement initiative and population aging have led to a growing group of late retirees. However, it remains unclear whether the existing employment-based health insurance system can effectively match the recently proposed initiative and support late retirees, especially those with pre-existing function limitations. Thus, this study aims to investigate the influencing mechanism of China's Urban Employee Basic Medical Insurance (UEBMI), physical functioning limitation (PFL) and difficulty in instrumental activities of daily living (IADLs) on labour participation of late retirees in China. METHODS: This study uses data from the China Health and Retirement Longitudinal Study (CHARLS) survey, which tracks the quality of life among older adults in China (valid sample size = 5560). RESULTS: Empirical results show that China's employment-based health insurance (i.e. UEBMI) and health conditions (i.e. PFL and difficulty in IADLs) are positively associated with late retirees' withdrawal from late career participation. In addition, a higher level of difficulty in IADLs could strengthen the effect of PFL on late retirees' withdrawal from late career participation, which could be further buffered by UEBMI beneficiary status. CONCLUSION: In the formulation of delayed retirement policies, it is necessary to consider the influencing mechanism of the social health insurance system and health conditions on late career participation of older workers to ensure policy effectiveness.

Health policy response to mobility during the pandemic: Evaluating the effectiveness using location-based services big data.

As an emergent health policy response, the population mobility restriction policy was implemented to cope with the unprecedented pandemic that outbroke in early 2020, but its effectiveness showed vast disparities even within a single country. Using multisource data from Baidu mobility big data and the statistics of novel coronavirus disease in China, mobility restrictions (including restrictions on inflow-mobility, outflow-mobility, and intra-city mobility) were examined. It was found that the mobility restriction had contained the development of pandemic, but such effect would gradually recede over time. Moreover, there existed region-specific policy effectiveness. Specifically, outflow-mobility restrictions were ineffective in reducing death cases in population influx areas, and restrictions on inflow-mobility (or intra-city mobility) were ineffective in reducing confirmed cases (or death cases) in population outflow areas. It was concluded that the mobility restriction policy can be effective in epidemic prevention and control in spatial-temporal pattern. However, there was a remarkable disparity in policy effectiveness between different regions with different population mobility patterns.

The interaction of delayed retirement initiative and the multilevel social health insurance system on physical health of older people in China.

With many social challenges posed by an ageing population, the delayed retirement initiative has received wide attention from policymakers. However, China's current multi-level social health insurance system seems not perfect and not ready for the delayed retirement initiative. The public are generally concerned that the benefits of late retirees cannot be well guaranteed. Using data from China Health and Retirement Longitudinal Study (CHARLS) and the chorological design (CHARLS-2015 and -2018 waves), this study finds that (1) late retirement could be beneficial for physical health among older adults; (2) there have disparities between the effects of different social health insurances on physical health among older adults; (3) social health insurances could weaken the benefits of late retirement to physical health among older adults. Results imply that China's current multi-level social medical insurance system may lag behind the proposed delayed retirement initiative and have policy limitations for late retirees.

Socioeconomic disadvantages and vulnerability to the pandemic among children and youth: A macro-level investigation of American counties.

This study intends to reveal the underlying structural inequity in vulnerability to infection of the novel coronavirus disease pandemic among children and youth. Using multi-source data from New York Times novel coronavirus disease tracking project and County Health Rankings & Roadmap Program, this study shows that children and youth in socioeconomically disadvantaged status are faced with disproportionate risk of infection in this pandemic. On the county level, socioeconomic disadvantages (i.e., single parent family, low birthweight, severe housing problems) contribute to the confirmed cases and death cases of the novel coronavirus disease. Policymakers should pay more attention to this vulnerable group to implement more targeted and effective epidemic prevention and control.

The effectiveness of electronic health record promotion for healthcare providers in the United States since the Health Information Technology for Economic and Clinical Health Act: An empirical investigation.

The US Government has embarked on the largest initiative to date to encourage widespread use of electronic health records (EHRs). Up to now, it is not yet clear that what the actual effectiveness of EHR promotion is like since the Health Information Technology for Economic and Clinical Health (HITECH) Act. As a response, this study analyzes the EHR conversion at the primary stage (sign-up EHR→go-live EHR) and the advanced stage (go-live EHR→meaningful use of EHR) for different types of healthcare providers in the United States. With the data from the Office of National Coordinator for Health Information Technology-Regional Extension Centers Program, this study finds that healthcare providers have achieved progress in the EHR conversion at both the primary and advanced stage. However, the levels of progress made at different stages of EHR conversion vary for different providers. For rural and underserved healthcare settings, the progress made at the advanced stage is smaller than that at the primary stage, contrary to the case for other kinds of providers. Moreover, although the greater progress has been made at the advanced stage for some kinds of providers, the overall level of EHR conversion for various healthcare providers is far greater at the primary stage than at the advanced stage.

The Impact of Stigmatization on Social Avoidance and Fear of Disclosure among Older People: Implications for Social Policy Preparedness in a Public Health Crisis.

This study examined whether older people with epicenter travel experiences in the event of the novel coronavirus disease epidemic suffered from stigmatization, which in turn affected subsequent behavior, including fear of disclosure and social avoidance. A three-wave survey was conducted using a time-lagged design of older people who had travel experiences in Hubei, China on the eve of the outbreak. Results reveal positive associations between stigmatization and stress, social avoidance, and fear of disclosure, in addition to positive associations between stress and social avoidance and fear of disclosure. Findings thus suggest that the effects of stigmatization on social avoidance and fear of disclosure is mediated, in part, by stress. De-stigmatization and psychological supports should be prioritized for epidemic prevention and control among older people in quarantine.

Rural-urban disparity in risk exposure to involuntary social health insurance transition in China: An investigation of chronic disease patients' mental health problems.

Chronic disease patients have long suffered from mental health problems because of the long-lasting and costly treatments. Although the multilevel social health insurance system in China attempts to provide them with full-fledged health insurance coverage, the increasing prevalence of gig economy unexpectedly disrupts this situation. As the social health insurance system in China is closely associated with employment status, unemployed rural-to-urban migrant workers/regular urban workers have to accept the transition from urban employee basic medical insurance (UEBMI) to new cooperative medical scheme (NCMS)/urban resident basic medical insurance (URBMI). This study investigates the influence of this involuntary health insurance transition on the mental health of chronic disease patients. Empirical results show that the experience of transition from UEBMI to NCMS would significantly deteriorate the mental health of chronic disease patients, while the transition from UEBMI to URBMI would not. Accordingly, chronically ill rural-to-urban migrant workers are vulnerable to the involuntary health insurance transition that further deteriorates their mental health, and the multilevel social health insurance system in China cannot cope well with the emerging phenomenon of frequent employment change in labor market.

Understanding the effectiveness of government health expenditure in improving health equity: Preliminary evidence from global health expenditure and child mortality rate.

Governments around the world are committed to enhance health equity, but the effectiveness of government health expenditure in improving health equity is still full of controversy. To respond to it, this study investigates the influence of government health expenditure (including domestic government health expenditure and foreign-sourced health expenditure distributed by government) on child mortality rate across the world, in doing so evaluates its role in improving the social equity of health outcome. Using data of health expenditure and child mortality rate across the world (2000-2015), empirical results show that both domestic government and foreign-sourced health expenditure can greatly reduce the child mortality rate of families in rural areas with the lower level of maternal education and in the medium or low-income stratum. Further, even though domestic government health expenditure is found more effective to reduce the child mortality rate of males, foreign-sourced health expenditure can help cover such gender bias due to making a greater reduction in child mortality rate of females.

How the interplay of late retirement, health care, economic insecurity, and electronic social contact affects the mental health amongst older workers?

The delayed retirement initiative has become increasingly emphasised to cope with the population ageing. Based on the social-ecological model, this study explores the interplay of late retirement, health care, economic insecurity, and electronic social contact on mental health of older workers. Using data from the Survey of Health, Ageing and Retirement in Europe (wave 8), results show that the late retirement, health care quality, and electronic social contact are all negatively associated with the mental health problems among older workers. Besides, the influence of health care quality and electronic social contact on mental health problems are buffered by the economic insecurity respectively. It is concluded that more targeted policy response is in need to achieve better health outcomes among older workers.

How Work Pattern Transformation May Affect the Mental Health of Older Workers Faced With Unmet Health Care Needs During the Pandemic? A Comparative Investigation of Different Work Models.

PURPOSE: This study compares the relation between unmet health care needs and mental health of older people with different work patterns. METHODS: This study uses data of Survey of Health, Aging and Retirement in Europe Corona survey (n = 51,632 to 51,731). RESULTS: The unmet health care need results in depression/sadness during the pandemic (0.304, P < 0.01). Besides, such problem is more salient in workers than the nonemployed population (0.066, P < 0.01 for workers; 0.058, P < 0.01 for the nonemployed) and more outstanding in those working on site and with hybrid work model compared with the telecommuters (0.264, P < 0.01 for telecommuters; 0.378, P < 0.01 for on-site workers; 0.437, P < 0.01 for hybrid work model). CONCLUSIONS: Policymakers should focus on mental health of older people especially for those fully or partially involved in on-site work, when common health care need can be crowded out for limited health care resources during the pandemic.

Health Insurances and the Health-Related Work Capacity of Retirement-Aged Workers: A Comparative Investigation.

OBJECTIVE: This study is to investigate the health-related work capacity of retirement-aged workers under the beneficiary status of different health insurance schemes in China. METHOD: Using the data from CHARLS program, we investigate the health-related work capacity of retirement-aged workers in China (more than 60/55 years-old for men/women respectively). Multivariate regressions and robustness checks (Heckman two-stage procedures, chronological design, etc) are conducted. RESULTS: (1) Late-life career participation could reduce the risk of declining work capacity due to health problems; (2) different social health insurances affect health-related work capacity among retirement-aged workers differently; (3) social health insurances influence the role of late-life career participation in reducing the risk of health-related work capacity, with different schemes displaying different effects (mitigate or strengthen). CONCLUSIONS: Systematic inequity in benefit across health insurances may result in contrasting health outcomes of retirement-aged workers.

How Late-Life Working Affects Depression Among Retirement-Aged Workers? An Examination of the Influence Paths of Job-Related (Non-Job-Related) Physical Activity and Social Contact.

PURPOSE: This study investigates the influence paths that late career participation affects depression of older workers. METHOD: The data of China Health and Retirement Longitudinal Study (2018) are used. Those who have reached the statutory retirement age in China (>60 years for males/>55 years for females) are investigated. RESULTS: Late career participation may positively affect job-related physical activity and social contact (2.110 and 0.028, P < 0.01) and negatively affect non-job-related physical activity (-0.343, P < 0.01). Besides, job-related physical activity may exacerbate depression symptoms among older workers (0.017, P < 0.01), whereas non-job-related physical activity and social contact may alleviate it (-0.015 and -0.038, P < 0.01). CONCLUSIONS: Late career participation could be associated with depression through different pathways involving job-related (and non-job-related) physical activity and social contact. The overall impact of late career participation on depression would depend on which influence pathway is dominant.

Late-Life Working Participation and Mental Health Risk of Retirement-Aged Workers: How Much Impact Will There Be From Social Security System?

PURPOSE: Increasing retirement-aged workers are encouraged to stay in the labor market, as delayed retirement initiative is proposed. This study investigates the interplay of late-life working participation and social security on the mental health risk of retirement-aged workers. METHOD: We applied data from the China Health and Retirement Longitudinal Study (CHARLS-2018), and the instrumental variables regression was conducted. RESULTS: Late-life working could alleviate depression, as did the beneficiary status of employment-based social health insurance and the pensionable phase of social pension participation. Besides, the role of late-life working in alleviating depression became more salient when late retirees were not insured by the employment-based social health insurance and still in the pension contribution phase. CONCLUSIONS: It is suggested that the current social security system in China has not been sufficiently well designed to protect the mental health of retirement-aged workers.

Disparity in Occupational Health Risk During the Pandemic: Potential Misestimation and Its Implications for Health Policies.

OBJECTIVE: This study clarifies potential misestimation of occupational risk caused by the dichotomy of frontline essential and nonessential occupations in prior studies. METHODS: The linear regression is used to investigate the occupational risk in terms of incidence rate, hospitalization, and mortality on community level during the pandemic. RESULTS: Overall, frontline essential occupations were positively associated with incidence rate, hospitalization, and mortality (156.06, 18.47, and 3.49; P < 0.01). Among essential occupations, however, education, training, and library occupations were negatively associated with them, whereas transportation, protective service, food preparation, and serving occupations were insignificantly associated with them. Moreover, among nonessential occupations, building and grounds cleaning, construction, and extraction occupations were positively associated with them. CONCLUSION: The dichotomy of frontline essential and nonessential occupations can bring overestimation and underestimation of occupational risk during the COVID-19 pandemic.

Requested to do right things excessively: how citizenship pressure/future focus influence health-related work outcomes in health organizations during the pandemic.

PURPOSE: Public health practitioners face citizenship pressure when requested to engage in more extra-roles behaviors during the pandemic. The purpose of the study is to reveal the potential influence mechanism of citizenship pressure on the health and work outcomes of practitioners. DESIGN/METHODOLOGY/APPROACH: The authors completed a three-wave survey from a public healthcare organization during the coronavirus disease 2019 (COVID-19) delta-variant epidemic. FINDINGS: Results of polynomial regression and response surface showed that increased (versus decreased) and consistently high (versus low) level of citizenship pressure induced citizenship fatigue, which in turn increases negative affect/turnover intention. These negative effects of citizenship pressure are weaker among practitioners with a higher level of future focus. PRACTICAL IMPLICATIONS: Providing counseling service to health care practitioners in adopting a future time perspective of citizenship behaviors is important for public health organizations. ORIGINALITY/VALUE: This study is among the earliest attempts to reveal the potential dark side of excessive request of conducting organization citizenship behavior which is more commonly seen within public health organizations in the context of pandemic.

Travel experience and health service amongst older people from the perspective of social exclusion: Policy implications of alleviating transport deprivation.

The vulnerable population are often faced with the transport deprivation resulting in social exclusion (e.g. lack of access to healthcare service or suffering from lower health service quality). The disparity in travel experience can lead to different results of healthcare service seeking amongst the vulnerable population such as older adults with and without disabilities. This study applies Heckman's two-stage procedure and the data from China Health and Retirement Longitudinal Study. Based on having controlled the influence of individual financial situation and self-rated health, results show that longer travel time is observed in older adults who have paid the visit to the higher class healthcare facilities (HHCF). Besides, the visit to HHCF is negatively associated with disability and positively with travel mode with less discomfort. Further, the relationship between disability and the class of visited healthcare facilities is found to be conditioned on the travel time and travel mode, wherein such relationship could be intensified by longer travel time and be alleviated by travel mode with less discomfort. Therefore, social policies to alleviate transport deprivation are critical for accessing better healthcare services amongst older people with disabilities.