Yingying Meng

Background: The fragmentation of the medical insurance system is a major challenge to achieving health equity. In response to this problem, the Chinese government is pushing to establish the unified Urban and Rural Resident Basic Medical Insurance (URRBMI) system by integrating the New Rural Cooperative Medical Scheme and the Urban Resident Basic Medical Insurance. By the end of 2020, URRBMI had been implemented almost entirely across China. Has URRBMI integration promoted health equity for urban and rural residents? Objective: This study aims to examine the effect of URRBMI integration on the health level of residents and whether the integration can contribute to reducing health disparities and promoting health equity. Methods: We used the staggered difference-in-differences method based on the China Family Panel Studies survey from 2014 to 2018. Our study had a nationally representative sample of 27,408 individuals from 98 cities. We chose self-rated health as the measurement of health status. In order to more accurately discern whether the sample was covered by URRBMI, we obtained the exact integration time of URRBMI according to the official documents issued by local governments. Finally, we grouped the sample by urban and rural areas, regions, and household income to examine the impact of the integration on health equity. Results: We found that overall, the URRBMI integration has improved the health level of Chinese residents (B=0.066, 95% CI 0.014-0.123; P=.01). In terms of health equity, the results showed that first, the integration has improved the health level of rural residents (B=0.070, 95% CI 0.012-0.128; P=.02), residents in western China (B=0.159, 95% CI 0.064-0.255; P<.001), and lower-middle-income groups (B=0.113, 95% CI 0.004-0.222, P=.04), so the integration has played a certain role in narrowing the health gap between urban and rural areas, different regions, and different income levels. Through further mechanism analysis, we found that the URRBMI integration reduced health inequity in China by facilitating access to higher-rated hospitals and increasing reimbursement rates for medical expenses. However, the integration did not improve the health of the central region and low-income groups, and the lack of access to health care for low-income groups was not effectively reduced. Conclusions: The role of URRBMI integration in promoting health equity among urban and rural residents was significant (P=.02), but in different regions and income groups, it was limited. Focusing on the rational allocation of medical resources between regions and increasing the policy tilt toward low-income groups could help improve the equity of health insurance integration.

BACKGROUND The fragmentation of the medical insurance system is a major challenge to achieving health equity. In response to this problem, the Chinese government is pushing to establish the unified Urban and Rural Resident Basic Medical Insurance (URRBMI) system by integrating the New Rural Cooperative Medical Scheme and the Urban Resident Basic Medical Insurance. By the end of 2020, URRBMI had been implemented almost entirely across China. Has URRBMI integration promoted health equity for urban and rural residents? OBJECTIVE This study aims to examine the effect of URRBMI integration on the health level of residents and whether the integration can contribute to reducing health disparities and promoting health equity. METHODS We used the staggered difference-in-differences method based on the China Family Panel Studies survey from 2014 to 2018. Our study had a nationally representative sample of 27,408 individuals from 98 cities. We chose self-rated health as the measurement of health status. In order to more accurately discern whether the sample was covered by URRBMI, we obtained the exact integration time of URRBMI according to the official documents issued by local governments. Finally, we grouped the sample by urban and rural areas, regions, and household income to examine the impact of the integration on health equity. RESULTS We found that overall, the URRBMI integration has improved the health level of Chinese residents (B=0.066, 95% CI 0.014-0.123; P=.01). In terms of health equity, the results showed that first, the integration has improved the health level of rural residents (B=0.070, 95% CI 0.012-0.128; P=.02), residents in western China (B=0.159, 95% CI 0.064-0.255; P<.001), and lower-middle-income groups (B=0.113, 95% CI 0.004-0.222, P=.04), so the integration has played a certain role in narrowing the health gap between urban and rural areas, different regions, and different income levels. Through further mechanism analysis, we found that the URRBMI integration reduced health inequity in China by facilitating access to higher-rated hospitals and increasing reimbursement rates for medical expenses. However, the integration did not improve the health of the central region and low-income groups, and the lack of access to health care for low-income groups was not effectively reduced. CONCLUSIONS The role of URRBMI integration in promoting health equity among urban and rural residents was significant (P=.02), but in different regions and income groups, it was limited. Focusing on the rational allocation of medical resources between regions and increasing the policy tilt toward low-income groups could help improve the equity of health insurance integration.

As an important source of income for elderly people, pensions have a great impact on their wellbeing. There are three different pension systems in China (the Old-age Insurance System for Government Agencies and Institutions (OISGAI), the Basic Old-age Insurance System for Urban Employees (BOISUE) and the Social Insurance of the Old-age Pension for Urban and Rural Residents (SIOPURR)). This study empirically analyses the impact of various pension types on the happiness of elderly people in China and further explores the potential impact mechanism using the 2014 China Family Panel Studies data. The study suggests that first, receiving pensions from OISGAI, BOISUE and SIOPURR is positively correlated with the happiness level of elderly people. Second, the sense of happiness of elderly people who receive BOISUE is higher than that of those receiving SIOPURR, which is mainly caused by the difference in the level of pension benefits. When the level of benefits is controlled for, there is no significant difference between these two groups. Third, when they have the same level of pension benefits, the happiness of elderly people who receive OISGAI is significantly higher than that of those who receive pensions from the other two systems, which is possibly related to the hidden ‘special’ government guarantee and the difference of the growth rate of the benefit level.

This paper explores and tests the impact of health and security on the participation of Chinese older people using data from the China Longitudinal Ageing Social Survey (CLASS) in 2014. Based on the framework of Active Ageing, the exogenous latent variables “health” and “security” are assumed to directly affect the endogenous latent variable “participation”, and indirectly affect it via mediating the function of “willingness”. The estimation results of the structural equation model show that health has a significant positive impact, while security has a significant negative impact on participation. In addition, health and security can significantly enhance the willingness of older people to participate. After the opposite effects of health and security are offset, their net effect on participation is generally negative. According to these empirical results, this paper concludes that the optimization of health coupled with the moderation of security level is more beneficial for promoting the participation of older people.

Purpose: Medical insurance is a disease risk-sharing mechanism that can improve residents’ financial access to medical treatment and thus increase their utilization of health services. This paper aims to identify the impact of different kinds of medical insurances on the use of healthcare for Chinese mid-aged and older urban residents from four aspects: outpatient behaviour, outpatient costs, inpatient behaviour and inpatient costs. Materials and Methods: The data used in this study were from 2015 China Health and Retirement Longitudinal Study (CHARLS) conducted by Peking University. Binary logit model and multiple linear regression model were used to analyse the impact of health insurance on the use of healthcare, and the PSM method was used to test the robustness of the results. Results: Participating in either BMIUSE or BMISURR can significantly improve all kinds of healthcare utilization for mid-aged and older urban groups. However, there are huge differences on the healthcare utilization between BMISUE and BMISURR. Specifically, the probability of using inpatient care and inpatient costs of urban residents enrolled in the BMISUE are 4.2% and 45% higher, respectively, than those covered by the BMISURR, but there are no differences in outpatient care utilization and outpatient costs between these two health insurance programs. Conclusion: This paper suggests that the large gaps between BMISUE and BMISURR only reflect on inpatient care and inpatient costs, there is no difference in outpatient services between these two health insurance programs. “Excessive demand”, “induced demand” and other moral hazard phenomena in BMISUE should be avoided when receiving hospitalization services.

Health is the key to the aging problem, and “healthy aging” depicts the overall changing trends in the health of all elderly individuals in a society. Based on the Chinese Longitudinal Healthy Longevity Survey (CLHLS) data from the years 2002, 2005, 2008, 2011 and 2014, this article investigates whether there is a trend of “healthy aging” in China. A second-order factor model including four dimensions of physical health, functional status, mental health and social health was constructed to measure a latent variable, “Health_elders”. The further multigroup comparison results by structural equation modeling showed that, with the exception of 2008, the Health_elders in 2002, 2005, 2011 and 2014 displayed an upward trend, and the mean differences in Health_elders across five periods were significant. These findings indicate that on the whole, compared with older people in the past, older people in more recent periods are healthier, which supports the trend of “healthy aging” in China. In terms of cohorts, the average health levels of male, town-residing elderly populations are higher, while the healthy aging trends among female, rural and urban elderly populations are stronger. Moreover, the physical health levels of the 60–74 years-old cohort are decreasing, and the participation of elderly individuals in social activities is low, which are the weaknesses in the healthy aging process in China.

Background: The rapid rise of medical expenditure is a common problem in the field of public health around the world, but the challenges for the Chinese government are even greater. How to control the rapid rise in medical expenditure and reduce individuals’ economic burden when receiving medical treatment has become one of the core issues that the Chinese government urgently needs to solve. The aim of this study was to evaluate the impact of Internet use on individuals’ medical expenditure and further discuss the potential impact mechanism. Methods: The data used in this study were from the 2018 China Family Panel Studies (CFPS) conducted by Peking University. The Heckman sample selection model was used to analyse the impact of Internet use on individuals’ medical expenditure. Results: Internet use reduced the medical expenditure of individuals by 6.19%; high frequency Internet use reduced the medical expenditure of individuals by 15.1%, while low frequency Internet use had no impact. In addition, Internet use had different impacts on individuals’ medical expenditure at different levels of hospitals. Specifically, Internet use reduced the medical expenditure of individuals who received medical treatment at general hospitals by 9.63%, and high frequency Internet use reduced the medical expenditure of individuals by 22.2%. However, Internet use had no impact on the medical expenditure of individuals who received medical treatment at primary hospitals. Conclusions: Findings from this study underscore the importance of Internet use as an important role in reducing individuals’ medical expenditure. The use of the Internet can significantly reduce the level of individuals’ medical expenditure, and high frequency Internet use has a greater effect. However, Internet use has different impacts on individuals’ medical expenditure among different levels of hospitals. The reduction effect of Internet use on individuals’ medical expenditure is mainly concentrated in general hospitals but has no effect in primary hospitals.

The basic pension plan for urban enterprise workers (PPUEW) is the primary form of public pension system in China and is managed by provincial governments. Although the federal government requires that employers contribute 20% and individuals 8%, provincial governments have the right to adjust the rate. As different rates apply in different provinces, this study assesses the effect of rates on enterprises’ incentive to participate in the PPUEW, using data from the 2011 China Annual Survey of Industrial Firms. As rates increase, employers and employees pay more; however, once the contribution ratio reaches a tipping point, they try to reduce deductibles. The findings suggest that a lower contribution rate motivates enterprises to participate in the PPUEW and boosts the fund’s revenue.

Summary: This study conducted empirical research on Chinese residents to explore the relationship between religious beliefs and health based on the China General Social Survey (CGSS) data for 2015. Considering the reciprocal correlations between religion and health, this paper uses an instrumental variable to recognize religion's influence on health. The instrumental variable was the number of religious sites per 10 000 residents in every province (including autonomous regions and municipalities) in 2004. The results indicate that religion had different impacts on the health of different groups in China. It was found that religion significantly improved the health of those aged 60 or older; however, for those younger than 60 years old, their health was not affected by following a religion. Second, after classifying the samples according to urban and rural areas, it was found that religion significantly improved the health of urban residents, while rural residents were not affected by this factor.