Financial protection effects of private health insurance: experimental evidence from Chinese households with resident basic medical insurance.

BACKGROUND: After achieving universal basic medical insurance coverage, Chinese government put the development of private health insurance (PHI) on its agenda to further strengthen financial risk protection. This paper aims to assess the level of financial protection that PHI provides for its insured households on the basis of resident basic medical insurance (RBMI). METHODS: We employed balanced panel data collected between 2015 and 2017 from the China Household Finance Survey (CHFS). Catastrophic health expenditure (CHE) and impoverishment due to health spending were applied to measure the financial protection effects. Random effects panel logistic regression model was performed to identify the factors associated with CHE and impoverishment among households covered by RBMI. In the robustness test, the method of propensity score matching (PSM) was employed to solve the problem of endogeneity. RESULTS: From 2015 to 2017, the CHE incidence increased from 12.96 to 14.68 % for all sampled households, while the impoverishment rate decreased slightly from 5.43 to 5.32 % for all sampled households. In 2015, the CHE incidence and impoverishment rate under RBMI + PHI were 4.53 and 0.72 %, respectively, which were lower than those under RBMI alone. A similar phenomenon was observed in 2017. Regression analysis also showed that the households with RBMI + PHI were significantly less likely to experience CHE (marginal effect: -0.054, 95 %CI: -0.075 to -0.034) and impoverishment (marginal effect: -0.049, 95 %CI: -0.069 to -0.028) compared to those with RBMI alone. The results were still robust after using PSM method to eliminate the effects of self-selection on the estimation results. CONCLUSIONS: In the context of universal basic medical insurance coverage, the CHE incidence and impoverishment rate of Chinese households with RBMI were still considerably high in 2015 and 2017. PHI played a positive role in decreasing household financial risk on the basis of RBMI.

Urban-rural differences in catastrophic health expenditure among households with chronic non-communicable disease patients: evidence from China family panel studies.

BACKGROUND: The prevalence of chronic non-communicable diseases (NCDs) challenges the Chinese health system reform. Little is known for the differences in catastrophic health expenditure (CHE) between urban and rural households with NCD patients. This study aims to measure the differences above and quantify the contribution of each variable in explaining the urban-rural differences. METHODS: Unbalanced panel data were obtained from the China Family Panel Studies (CFPS) conducted between 2012 and 2018. The techniques of Fairlie nonlinear decomposition and Blinder-Oaxaca decomposition were employed to measure the contribution of each independent variable to the urban-rural differences. RESULTS: The CHE incidence and intensity of households with NCD patients were significantly higher in rural areas than in urban areas. The urban-rural differences in CHE incidence increased from 8.07% in 2012 to 8.18% in 2018, while the urban-rural differences in CHE intensity decreased from 2.15% in 2012 to 2.05% in 2018. From 2012 to 2018, the disparity explained by household income and self-assessed health status of household head increased to some extent. During the same period, the contribution of education attainment to the urban-rural differences in CHE incidence decreased, while the contribution of education attainment to the urban-rural differences in CHE intensity increased slightly. CONCLUSIONS: Compared with urban households with NCD patients, rural households with NCD patients had higher risk of incurring CHE and heavier economic burden of diseases. There was no substantial change in urban-rural inequality in the incidence and intensity of CHE in 2018 compared to 2012. Policy interventions should give priority to improving the household income, education attainment and health awareness of rural patients with NCDs.

Inequity in inpatient services utilization: a longitudinal comparative analysis of middle-aged and elderly patients with the chronic non-communicable diseases in China.

BACKGROUND: Aging and the chronic non-communicable diseases (NCDs) challenge the Chinese government in the process of providing hospitalization services fairly and reasonably. The Chinese government has developed the basic medical insurance system to solve the problem of "expensive medical cost and difficult medical services" for vulnerable groups and alleviate the unfair phenomenon. However, few studies have confirmed its effect through longitudinal comparison. This study aimed to explore the trend in the inequity of inpatient use among middle-aged and elderly individuals with NCDs in China. METHODS: This longitudinal comparative study was based on CHARLS data in 2011, 2013 and 2015. Concentration index (CI) was used to measure the variation trend of inequity of inpatient services utilization, while the decomposition method of the CI was applied to measure the factors contributing to inequity in inpatient services utilization. The effect of each factor on the change of inequity in inpatient services utilization was divided into the change of the elasticity and the change of inequality using the Oaxaca-type decomposition method. RESULTS: The affluent middle-aged and elderly patients with NCDs used more inpatient services than poor groups. The per capita household consumption expenditure (PCE) and Urban Employee Basic Medical Insurance (UEBMI) contributed to the decline in pro-rich inequality of inpatient use, while the New Rural Cooperative Medical Scheme (NRCMS) contributed to the decline in pro-poor inequality of inpatient use. CONCLUSIONS: There was a certain degree of pro-rich unfairness in the probability and frequency of inpatient services utilization for middle-aged and elderly individuals with NCDs in China. The decrease of pro-wealth contribution of PCE and UEBMI offset the decrease of pro-poor contribution of NRCMS, and improved the equity of inpatient services utilization, favoring poor people.

[Spatial and Temporal Distribution Characteristics of Heavy Metals in Main Rivers Sediments and Ecological Risk Assessment in Kaifeng City].

Heavy metal pollution in urban river sediments is an important threat to river ecosystem health. To explore the temporal and spatial distribution characteristics of heavy metals in river sediments of Kaifeng City, the surface sediments of rivers were sampled in 2015 and 2021, respectively, and the contents of Cd, Cr, Cu, Ni, Pb, and Zn in sediments at different periods were compared. The heavy metal pollution in the two periods was evaluated using the indices of geo-accumulation, bio-toxicity risk assessment, and potential ecological risk. The results showed that the content of heavy metals in river sediments of Kaifeng City in 2021 were decreased significantly compared with that in 2015. Cd, Cr, Cu, Ni, Pb, and Zn decreased by 94.42%, 18.4%, 85.7%, 45.19%, 75.61%, and 92.28%, respectively. The heavy metal content in the Huafei River and Huiji River was higher than that in other rivers in both periods. Correlation and principal component analyses showed that the heavy metal pollution sources of river sediments in Kaifeng City were highly similar, and human activities such as industrial layout, road traffic, and land use were the main pollution sources. However, the results showed that the main pollutants were different between the two sampling times. In 2015, Cd, Cr, Pb, and Zn were the main pollutants, and in 2021, Cd, Cu, Pb, and Zn were the main pollutants. The results of the geo-accumulation, bio-toxicity risk assessment, and potential ecological risk indices showed that the temporal and spatial differences in heavy metal pollution in river sediments in Kaifeng City were large. However, the heavy metal pollution of the Huiji River and Huafei River was still serious, with contents in the medium and high pollution levels, especially to Cd. The heavy metal treatment of rivers in Kaifeng City has a long way to go, and it is particularly necessary to strengthen the engineering treatment for key river sections and effectively monitor key pollution elements.

The comparison of catastrophic health expenditure and its inequality between urban and rural households in China.

BACKGROUND: In recent years, the goal of universal coverage of the basic medical insurance schemes has been basically achieved in China, but the heavy economic burden of diseases is still the main cause of poverty in many households. Exploring catastrophic health expenditure (CHE) and its inequality are highly important for forward-looking policymaking. This study aims to compare the incidence, intensity and inequality of CHE between urban and rural households in China. METHODS: This study was based on a national representative household survey-the China Family Panel Studies (CFPS)-that was conducted from 2012 to 2018. Concentration index (CI) was employed to measure the inequality of CHE incidence and overshoot, while the decomposition method of the CI was used to estimate the main influencing factors affecting inequality of CHE incidence. RESULTS: From 2012 to 2018, the CHE incidence of urban households increased from 11.01 to 11.88%, while the CHE incidence of rural households decreased from 18.42 to 18.31%. During the same period, the CI of CHE incidence for urban households decreased from - 0.1480 to - 0.1693, while that for rural households declined from - 0.1062 to - 0.1501. The major contribution to the pro-poor inequality in CHE incidence was associated with socioeconomic status, lagged CHE, receiving inpatient services, having elderly members, education of household head, and self-assessed health status of household head. CONCLUSIONS: Rural households had higher risk of incurring CHE than urban households. The strong pro-poor inequality for CHE incidence and overshoot could be found in both two groups. The problem of poverty due to illness was more severe among low-income groups in rural areas than in urban areas. The relevant policy interventions should further focus on encouraging the development of supplementary medical insurance and increasing the reimbursement rate for hospitalization expenses in the medical assistance system.

[Grafting reaction of tetrabutyltin on the MCM-41 surface and characterization of the grafted product].

MCM-41 modified with tetrabutyltin and Sn-O-MCM-41 obtained from calcination of the modified MCM-41 in pure oxygen were characterized by XRD, FTIR, UV-Vis DRS, and TG analysis. It was found that the hydrothermal stability, surface acidity, and coordinative states of tin atoms on both samples were evidently different. After calcination, the surface tin atoms of sample remained in the tetrahedronal structure, and the hydrothermal stability and surface acidity were improved. According to the results, the reason for the enhancement of catalytic activity of Sn-O-MCM-41 was discussed.

[Study of photocatalytic performance of TiO2 membrane for oleic acid by FTIR-ATR technique].

The TiO2 membranes were prepared on glass, ceramic tile and aluminum pieces by Sol-Gel and PVD methods. A fast and exact evaluation on the photocatalytic self-cleaning performance of the membrane materials was achieved by FTIR-ATR technique using oleic acid which was laid on the surface of the membrane. The hydrophilic property of the samples was also determined by the contact angle with water. The results showed that both the TiO2 membrane prepared on glass by the Sol-Gel and PVD methods displayed good photo-induced hydrophilic property and degradation activity of oleic acid, and no difference in hydrophilic property, but the former was a little superior to the latter in photocatalytic activity. The photocatalytic conversion of oleic acid on the TiO2/glass, TiO2/ceramic tile and TiO2 aluminum piece were 92%, 85% and 46%, respectively after illumination 3.5 h, showing a distinct effect of support material property on TiO2 photocatalytic performance. The results suggested that the photocatalytic activity of TiO2 membrane coated on insulator support was higher than that coated on conductor support.

[Investigation of TiO2 photocatalytic degradation of bovine serum albumin].

The present paper reports photocatalytic degradation of bovine serum albumin (BSA) by TiO2 under near UV (365 nm) irradiation. Ultraviolet-Visible spectrometry, FTIR spectrometry and HPLC were used to study the degradation and characterize the final degradation products. It was found that under near UV irradiation, BSA (0.1 g x L(-1)) can be totally degraded to small fragments by TiQ2 in 5 h. Total mineralization of BSA (93.5%) is reached after reacting for 40 h. C, N and S in BSA are mineralized to give CO2, NO3- and SO4(2-). It is suggested that the degradation of BSA happens in two steps: first to small fragments, then further mineralized to small inorganic molecule. The absence of UV irradiation or TiQ2 can only lead to partial degradation of BSA (30%) in 5 h and no CO2 is observed even in longer reaction time.

[An experimental study of immune function effect of rats irradiated with the complex field cure instrument].

The complex field cure instrument is a new medical instrument with which an experiment was carried out. Rats were continuously irradiated by the complex field for 90 days, with a day's total dose of 285.9 M.T.G. while other rats weren't irradiated for control group. The animals were respectively killed at 7d, 14d, 30d, 60d and 90d, and their blood samples were taken for cell and humoral immune analysis. The results show that values of lymphocyte transform rate, soluble receptor (SIL-2R), total hemolytic complement levels (CH50) and immunoglobulin (A.G.) after irradiation are more than those of the control group having proved that the instrument may improve immune function of rats.

[Photocatalytic removing of a mustard gas analogue 2-CEES vapor over SO4(2-)/TiO2].

Disinfection with photocatalysis, compared to with the conventional cleanout, is both high efficient and non contaminative, but the simple TiO2 photocatalyst is showing to be of low activity and low active stability so to be hardly practical application. In the paper, SO4(2-)/TiO2 were papered by surface modification of TiO2 with dilute H2SO4, and the photocatalytic degradation of 2-chloroethyl ethyl sulfide (2-CEES) on the samples was examined in a fixed-bed microreactor. The examination show that the acidic modification enhanced both the activity and the active stability of TiO2, and the sample ST200 prepared by calcination at 200 degrees C was better than ST400 by calcination at 400 degrees C. The effect of water vapor content and reaction temperature on the photocatalytic degradation of 2-CEES was also tested, showing that the sample ST200 had high activity and stability at 90 degrees C, and kept a constant activity when adding 30.5 mL/L water vapor into the reactive system in which 2-CEES initial concentration was low to < 61 microL x L(-1). In addition, it was found that supporting SO4(2-)/TiO2 on gamma-Al2O3, SiO2 and active carbon could improve on the activity and stability of SO4(2-)/TiO2, and on supports SiO2 is the best one.

[Photocatalytic functional ceramic and its speciality of photodecomposition].

Photocatalytic ceramic was prepared by coating photocatalytic membrane on ceramic matrix. The photocatalytic behavior of the TiO2 coated ceramic for degradation of oleic acid, ethylene, SO2, NOx and sterilization was studied by using XRD, chromatogram, in-situ IR and spectrophotometer. The results showed that the photocatalytic ceramic prepared by special conditions have the function of environmental conservation such as the photodegradating organic contaminants, removing inorganic baleful gas and killing bacteria. Degradation ratio of ethylene, oleic acid, SO2 and NOx reached 95%-100% respectively for the photocatalytic functional ceramic.