Value-Based Health Care: Long-Term Care Insurance for Out-of-Pocket Medical Expenses and Self-Rated Health.

Long-term care insurance (LTCI) is a significant approach in the effort to actively manage aging and the currently unmet need for aged care in China. Based on data from the 2011, 2013, 2015, and 2018 phases of the China Health and Retirement Longitudinal Study, we used the propensity score matching-difference in difference (PSM-DID) approach to explore the impact of LTCI on out-of-pocket medical expenses and self-rated health. Results showed that LTCI can significantly reduce out-of-pocket medical expenses by 37.16% (p < 0.01) per year and improve self-rated health by 5.73% (p < 0.01), which conforms to the spirit of "value-based health care". The results were found to be stable in the robustness tests conducted. Currently, China is at the intersection of "low-value-based health care" and "value-based health care". Improving the health level of aged individuals while keeping medical costs under reasonable control is crucial for formulating and implementing a new round of healthcare reform in China.

"The biggest reform to China's health system": did the zero-markup drug policy achieve its goal at traditional Chinese medicines county hospitals?

The zero-markup drug policy (ZMDP) was heralded as the biggest reform to China's modern health system. However, there have been a very limited number of investigations of the ZMDP at county hospital level, and those limited county hospital studies have several limitations in terms of sample representativeness and study design. We investigated the overall and dynamic effects of ZMDP at traditional Chinese medicine (TCM) county hospitals. We obtained longitudinal data from all TCM county hospitals in 2004-16 and the implementation year of ZMDP for each hospital. We used differences-in-difference methods to identify the overall and dynamic effects of ZMDP. On average, the ZMDP reform was associated with the reduction in the share of revenue from drug sales (3.1%), revenue from western medicines sales (12.7%), revenue from medical care services (3.6%) and gross hospital revenue (3.4%), as well as increased government subsidies (24.4%). The ZMDP reform was not significantly associated with the number of annual outpatient and inpatient visits. In terms of dynamic effects, the share of revenue from drug sales decreased by 2.5% in the implementation year and by about 5% in the subsequent years. Revenue from western medicine sales fell substantially in the short term and continued to drop in the long term. Government subsidies went up strikingly in the short term and long term, and revenue from medical care services and gross revenue decreased only in the implementation year. The ZMDP achieved its stated goal through reducing the share of revenue from drug sales without disrupting the availability of healthcare services at TCM county hospitals. The success of ZMDP was mainly due to the huge growth in the government's financial investment in TCM hospitals.

Not-in-My-Backyard: Legislation Requirements and Economic Analysis for Developing Underground Wastewater Treatment Plant in China.

Underground wastewater treatment plants (WWTPs) have achieved fast development in China in recent years. Due to the remarkable differences between underground and conventional aboveground construction mode, legislation including technical specifications and regulations for underground WWTPs, which was revealed in vacancy, should be issued in time to promote its development. It is also expected to avoid not-in-my-backyard sentiment by decreasing negative effects of WWTPs via construction in sealed underground space. This research took Beijing city as case study to investigate the impacts of WWTPs on nearby community from the perspective of housing price quantitatively. Differences-in-Difference (DID) model result indicates that WWTPs inhibited nearby housing price increases, leading to huge financial losses. The closer are the houses and WWTPs, the severer were the inhibition effects, indicating the relationship between environmental quality and property price. During 2016⁻2017, the deteriorated estate value surrounding the investigated WWTPs in Beijing was estimated as high as 32.53 billion RMB, much higher than their construction cost of about 4.38 billion RMB. Transformation from grey to green by underground construction was expected to avoid these huge value distortions, while providing alternative to enhance WWTPs with various social functions for public services. This research demonstrates the high social requirements in highly developed cities to promote fast development of underground WWTPs in China.