Health Insurance and Health Status: Exploring the Causal Effect from a Policy Intervention

2015 ◽  
Vol 25 (11) ◽  
pp. 1389-1402 ◽  
Author(s):  
Jay Pan ◽  
Xiaoyan Lei ◽  
Gordon G. Liu
Keyword(s):  
Health Insurance ◽  
Health Status ◽  
Causal Effect ◽  
Policy Intervention

scholarly journals Does the self-employment status affect the rural migrants’ health in China: the transmission channel of social health insurance?

2020 ◽  
Author(s):  
Zicheng Wang ◽  
Qiushi Wu ◽  
Juan Ming
Keyword(s):  
Health Insurance ◽  
Chronic Disease ◽  
Health Status ◽  
Causal Effect ◽  
Social Health Insurance ◽  
The Self ◽  
Social Health ◽  
Transmission Channel ◽  
Rural Migrants ◽  
Self Employment

Abstract Background There are growing attentions paid on rural migrants’ health. Previous studies found that rural migrants are more exposed to disease risks. The present study aims to explore the causal effect of self-employment behavior on the rural migrants’ health status, two issues are addressed to discuss: Does self-employment status affect the health of rural migrants? What is the potential mechanism linking the self-employment behavior and health status? Methods The dataset from the 2017 National Migrants Population Dynamic Monitoring Survey (NMPDMS-2017) is applied to explore the causal effect; the Logit regression is performed to make baseline estimation, while the IV-LPM estimation is applied to correct the endogeneity of self-employment. Additionally, the Logit regression is conducted to explore the transmission channel. Results The self-employed are more susceptible to sub-health status (OR= 1.042; 95% CI= 1.001, 1.084) and chronic disease (OR= 1.394; 95% CI= 1.317, 1.476), even when correcting the endogeneity, the causal effect estimation also demonstrates that the self-employed are more vulnerable to suffer sub-health status (Coefficient= 0.067; 95% CI= 0.050, 0.084) and chronic disease (Coefficient= 0.020; 95% CI= 0.008, 0.032). The self-employed are less likely to participate in social health insurance (OR= 0.057; 95% CI= 0.053, 0.061). Conclusion The self-employed are more likely to suffer sub-health status and chronic disease, the self-employment behavior take harmful effect on the rural migrants’ health. Social health insurance may serve as transmission channel linking self-employment and rural migrants’ health, that is, the self-employed are less prone to participate in the urban health insurance program, which induce to an insufficient health service to maintain health.

scholarly journals Effect of self-employment on the sub-health status and chronic disease of rural migrants in China

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jian Zhou ◽  
Qiushi Wu ◽  
Zicheng Wang
Keyword(s):  
Health Insurance ◽  
Chronic Disease ◽  
Health Status ◽  
Causal Effect ◽  
Social Health Insurance ◽  
Social Health ◽  
Transmission Channel ◽  
Rural Migrants ◽  
Logit Regression ◽  
Self Employment

Abstract Background Rural migrants usually suffer from major disease risks, but little attention had been paid toward the relationship between self-employment behavior and health status of rural migrants in China. Present study aims to explore the causal effect of self-employment behavior on rural migrants’ sub-health status and chronic disease. Two research questions are addressed: does self-employment status affect the sub-health status and chronic disease of rural migrants? What is potential mechanism that links self-employment behavior and health status among rural migrants in China? Methods The dataset from the 2017 National Migrants Population Dynamic Monitoring Survey (NMPDMS-2017) was used to explore the causal effect. Logit regression was performed for the baseline estimation, and linear probability model with instrument variable estimation (IV-LPM) was applied to correct the endogeneity of self-employment. Additionally, logit regression was conducted to explore the transmission channel. Results Self-employed migrants were more susceptible to sub-health status and chronic disease, even when correcting for endogeneity. Moreover, self-employed migrants were less likely to enroll in social health insurance than their wage-employed counterparts in urban destinations. Conclusion Self-employed migrants were more likely to suffer from sub-health status and chronic disease; thus, their self-employment behavior exerted a harmful effect on rural migrants’ health. Social health insurance may serve as a transmission channel linking self-employment and rural migrants’ health status. That is, self-employed migrants were less prone to participate in an urban health insurance program, a situation which leaded to insufficient health service to maintain health.

Oral Health Status and Oral Health Services Utilization of Myanmar Residents in Japan

2019 ◽  
Vol 31 (1) ◽  
pp. 81-86
Keyword(s):  
Health Insurance ◽  
Health Status ◽  
Oral Health ◽  
Periodontal Disease ◽  
Health Care Services ◽  
Health Knowledge ◽  
Oral Health Status ◽  
Services Utilization ◽  
Periodontal Index ◽  
The Status

The purpose of this study was to investigate oral health status and oral health care services utilization among Myanmar residents in Japan. A crosssectional epidemiological study was performed among 152 Myanmar residents aged 18 to 67 years in Tokyo, Japan. Clinical oral examinations and questionnaire surveys were conducted from June to July, 2017. Caries prevalence for all participants was 70.4% with mean decayed, missing, and filled teeth (DMFT) of 2.72±2.91. The prevalence of periodontal disease (Community Periodontal Index - CPI code 1) for all participants was 93.4%. A total of 67 participants (44.1%) had the experience of dental visits in Japan. Most participants (84.2%) had Japanese health insurance, and the participants with health insurance had a significantly higher number of filled teeth than those without (p=0.036). DMFT (p=0.020) and the prevalence of periodontal disease (p=0.049) were significantly lower in participants with health insurance than in those without. Further, self-perceived oral health was better in participants with health insurance than those without (p=0.001). The status of health insurance was indicated to influence on oral health status. In order to promote oral health and facilitate on owning health insurance to Myanmar residents in Japan, oral health education also should be provided to enhance their oral health knowledge.

scholarly journals Self-Rated Health Status Based on the Type of Health Insurance: A Socioeconomic Perspective

2021 ◽  
Vol 58 ◽  
pp. 004695802110281
Author(s):  
Minsung Sohn ◽  
Minsoo Jung ◽  
Mankyu Choi
Keyword(s):  
Socioeconomic Status ◽  
Health Insurance ◽  
Health Status ◽  
Regression Models ◽  
Private Health Insurance ◽  
Public And Private ◽  
Logistic Regression Models ◽  
Self Rated Health ◽  
Interaction Terms ◽  
Healthcare Coverage

To investigate the effects of public and private health insurance on self-rated health (SRH) status within the National Health Insurance (NHI) system based on socioeconomic status in South Korea. The data were obtained from 10 867 respondents of the Korea Health Panel (2008-2011). We used hierarchical panel logistic regression models to assess the SRH status. We also added the interaction terms of socioeconomic status and type of health insurance as moderators. Medical aid (MA) recipients were 2.10 times more likely to have a low SRH status than those who were covered only by the NHI, even though the healthcare utilization was higher. When the interaction terms were included, those not covered by the NHI and had completed elementary school or less were 16.59 times more likely to have a low SRH status than those covered by the NHI and had earned a college degree or higher. Expanding healthcare coverage to reduce the burden of non-payment and unmet use to improve the health status of MA beneficiaries should be considered. Particularly, the vulnerability of less-educated groups should be focused on.

scholarly journals Health Status, Health Insurance, and Health Care Utilization Patterns of Immigrant Black Men

2003 ◽  
Vol 93 (10) ◽  
pp. 1740-1747 ◽  
Author(s):  
Jacqueline W. Lucas ◽  
Daheia J. Barr-Anderson ◽  
Raynard S. Kington
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Status ◽  
Health Care Utilization ◽  
Black Men ◽  
Care Utilization ◽  
Utilization Patterns

Abstract P149: Retention of Participants in Longitudinal Research: The Multi-Ethnic Study of Atherosclerosis

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Sandi Shrager
Keyword(s):  
Cardiovascular Disease ◽  
Socioeconomic Status ◽  
African American ◽  
Health Insurance ◽  
Health Status ◽  
Marital Status ◽  
Ethnic Minority ◽  
Ethnic Groups ◽  
Longitudinal Research ◽  
Minority Participants

Background: Retention of participants is a critical component of ensuring the scientific goals of longitudinal research studies. Differential rates of attrition for ethnic minority participants can be particularly problematic in the fields of health and cardiovascular research, where ethnic minorities are shown to have disproportionately higher rates of both cardiovascular disease and risk factors for heart disease such as diabetes, hypertension, and obesity. The ability to explore the underlying causes of these differences is adversely affected when attrition in a study occurs at a higher rate among the ethnic minority subject participants. Understanding and preventing the causes of subject drop-out to improve retention among all ethnic groups is therefore a vital endeavor of any longitudinal research or cohort study. Methods: We analyzed data on ten-year retention rates of Caucasian, Chinese, Hispanic, and African-American participants in the Multi-Ethnic Study of Atherosclerosis (MESA). 6814 participants were recruited into the study in 2000, and 5,865 participants were still alive for the fifth in-person examination ten years later. Of these, 4651 participants returned for this examination. Logistic regression was used to examine the association between retention in the study, race/ethnicity and various baseline demographic characteristics, including age, gender, marital status, income, employment, education, language, place of birth, health insurance status and overall health status as measured by a 10-year predicted cardiovascular disease rate. Results: Racial differences in retention were observed, with Chinese, African-American, and Hispanic participants having 30-40% lower odds of being retained than Caucasian participants. However, after adjusting for demographic variables, these differences were primarily explained by indicators of socioeconomic status. Higher income, higher education, employment status, availability of health insurance and health status were significantly associated with ten-year retention in the study across all racial/ethnic groups. Marital status, gender, age, and birthplace (US vs non-US) were not associated with retention. Conclusions: Although minority participants were retained at lower rates in MESA, this can be primarily explained by differences in socioeconomic status and health status. Individuals with higher SES indicators may have life circumstances making participation in an examination taking much of a full day more plausible. Future studies should consider how these findings may inform developing support services or incentives which make follow-up participation in clinical research more persuasive for these individuals.

The Role of Race and Ethnicity in the State Children’s Health Insurance Program (SCHIP) in Four States: Are There Baseline Disparities, and What Do They Mean for SCHIP?

PEDIATRICS ◽  
2003 ◽  
Vol 112 (Supplement_E1) ◽  
pp. e521-e532
Author(s):  
Laura P. Shone ◽  
Andrew W. Dick ◽  
Cindy Brach ◽  
Kim S. Kimminau ◽  
Barbara J. LaClair ◽  
...  
Keyword(s):  
Health Care ◽  
New York ◽  
Health Insurance ◽  
Health Status ◽  
Race And Ethnicity ◽  
Minority Groups ◽  
Ethnic Disparities ◽  
Racial And Ethnic Disparities ◽  
Hispanic Children ◽  
White Children

Background. Elimination of racial and ethnic disparities in health has become a major national goal. The State Children’s Health Insurance Program (SCHIP) has the potential to reduce disparities among the children who enroll if they exhibit the same disparities that have been documented in previous studies of low-income children. To determine the potential impact of SCHIP on racial and ethnic disparities, it is critical to assess baseline levels of health disparities among children enrolling in SCHIP. Objective. To use data from the Child Health Insurance Research Initiative (CHIRI) to 1) describe the sociodemographic profile of new enrollees in SCHIP in Alabama, Florida, Kansas, and New York; 2) determine if there were differences in health insurance and health care experiences among white, black, and Hispanic SCHIP enrollees before enrollment in SCHIP; and 3) explore whether race or ethnicity, controlled for other factors, affected pre-SCHIP access to health coverage and health care. Setting. SCHIP programs in Alabama, Florida, Kansas, and New York, which together include 26% of SCHIP enrollees nationwide. Design. Telephone interview (mailed survey in Alabama) about the child’s health, health insurance, and health care experiences conducted shortly after SCHIP enrollment to assess experience during the time period before SCHIP. Sample. New SCHIP enrollees (0–17.9 years old in Alabama, Kansas, and New York and 11.5–17.9 years old in Florida). Stratified sampling was performed in Kansas and New York, with results weighted to reflect statewide populations of new SCHIP enrollees. Measures. Sociodemographic characteristics including income, education, employment, and other characteristics of the child and the family, race and ethnicity (white non-Hispanic, black non-Hispanic, and Hispanic [any race]), prior health insurance, health care access and utilization, and health status. Analyses. Bivariate analyses were used to compare baseline measures upon enrollment for white, black, and Hispanic SCHIP enrollees. Multivariate analyses were performed to assess health status and health care access measures (prior insurance, presence of a usual source of care (USC), and use of preventive care), controlling for demographic factors described above. Weighted analyses (where appropriate) were performed by using SPSS, STATA, or SUDAAN. Results. Racial and ethnic composition varied across the SCHIP cohorts studied, with black and Hispanic children comprising the following proportion of enrollees, respectively: Alabama, 33% and <1%; Florida, 16% and 26%; Kansas, 12% and 15%; and New York, 24% and 36%. Black and Hispanic children were more likely to reside in single-parent and lower-income families. With some variation by state, children from minority groups were more likely to report poorer health status than were white children. Relative to white children, children from minority groups in Florida and New York were more likely to have been uninsured for the entire year before SCHIP enrollment. In all states, children from minority groups who had prior coverage were more likely to have previously been enrolled in Medicaid than in private health insurance and were less likely to have had employer-sponsored coverage compared with white children. Except in Alabama, there was a difference in having a USC, with children from minority groups less likely to have had a USC before SCHIP enrollment compared with white children. No consistent pattern of health care utilization before SCHIP was noted across states with respect to race or ethnicity. Findings from multivariate analyses, controlling for sociodemographic factors, generally confirmed that black and Hispanic children were more likely to have lacked insurance or a USC before enrollment in SCHIP and to have poorer health status compared with white children. Conclusions. SCHIP is enrolling substantial numbers of racial and ethnic minority children. There are baseline racial and ethnic disparities among new enrollees in SCHIP, with black and Hispanic children faring worse than white children on many sociodemographic and health system measures, and there are differences among states in the prevalence and magnitude of these disparities. After controlling for sociodemographic factors, these disparities persisted. Implications for Monitoring and Improving SCHIP. SCHIP has the potential to play a critical role in efforts to eliminate racial and ethnic disparities in health among the children it serves. However, study findings indicate that programmatic efforts are necessary to ensure that disparities are not perpetuated. Program effectiveness and outcomes should be monitored by race and ethnicity to ensure equity in access, use, and outcomes across all racial and ethnic groups. Assessing the health characteristics and needs of new SCHIP enrollees can provide a benchmark for evaluating the program’s impact on eliminating racial and ethnic disparities in health and inform service delivery enhancements.

scholarly journals Assessment of State of Health and Healthcare Expenditure by Single-Person Households

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
A Tur-Sinai ◽  
R Magnezi ◽  
H Grinvald-Fogel
Keyword(s):  
Health Insurance ◽  
Health Status ◽  
Indirect Effects ◽  
Health Expenditure ◽  
Healthcare Expenditure ◽  
Equation Modeling ◽  
State Of Health ◽  
Expenditure Patterns ◽  
Single Person ◽  
The Eu

Abstract Background The latest statistics on household size in the EU show that in 2017 around one third of households in the EU comprised single adults without children. The study documents a direct relationship between individuals’ health and patterns of healthcare expenditure by isolating single-person households and creating a new reference group in which household healthcare expenditure is based on one person’s expenditure patterns in accordance with his or her own state of health. Methods The study matched two surveys using Propensity Score Matching based on single-person household, age, and gender. Structural Equation Modeling (SEM) explores paths of relation between the population’s income and socioeconomic level and its health self-assessment and expenditure. Results Single-person households’ health expenditure increases with age and the differences in most expenditure categories are significant. The current study looks into the direct and indirect effects of income, gender, and SES on health insurance and other out-of-pocket health expenses among single-person households. A direct link exists between income, gender, and socioeconomic status (SES) and several aspects of health expenditure, depending on the specific age group. The indirect effects are attested via health status assessment, in which a negative correlation is found between self-assessed health status and various health-expenditure categories. Conclusions The last-mentioned result may support the general perception that single-person households who feel that they are doing better than their near-equals enjoy better health. This line of inquiry yields a better examination of how a single-person household’s state of health affects expenditure patterns without assuming ab initio that expenditure patterns attest to state of health. Key messages Healthcare system and policymakers have to be mindful of the profile of single-person households and should ensure to examine these households’ patterns of healthcare expenditure as a function of age. Policymakers should seek alternative sources of funding for the single-person households’ health-insurance outlays and should examine alternative ways of restraining their expenditure on dental care.

scholarly journals Unmet Healthcare Needs, Catastrophic Health Expenditure, and Health in South Korea’s Universal Healthcare System: Progression Towards Improving Equity by NHI Type and Income Level

Healthcare ◽  
2020 ◽  
Vol 8 (4) ◽  
pp. 408 ◽  
Author(s):  
Minsung Sohn ◽  
Xianhua Che ◽  
Hee-Jung Park
Keyword(s):  
Health Insurance ◽  
Health Status ◽  
Low Income ◽  
Health Expenditure ◽  
Income Level ◽  
Catastrophic Health Expenditure ◽  
Poor Health ◽  
Medical Aid ◽  
Healthcare Needs ◽  
Unmet Healthcare Needs

This study examined the effects of healthcare inequality on personal health. It aimed to determine how health insurance type and income level influence catastrophic health expenditure and unmet healthcare needs among South Koreans. Unbalanced Korean Health Panel data from 2011 to 2015, including 33,374 adults, were used. A time-trend and panel regression analysis were performed. The first to identify changes in the main variables and, the second, mediating effects of unmet healthcare needs and catastrophic health expenditure on the relationship between health insurance type, income level, and health status. The independent variables were: high-, middle-, low-income employee insured, high-, middle-, low-income self-employed insured, and medical aid. The dependent variable was health status, and the mediators were unmet needs and catastrophic health expenditure. The medical aid beneficiaries and low-income self-employed insured groups demonstrated a higher probability of reporting poor health status than the high-income, insured group (15.6%, 2.2%, and 2.3%, respectively). Participants who experienced unmet healthcare needs or catastrophic health expenditure were 10.7% and 5.6% higher probability of reporting poor health, respectively (Sobel test: p < 0.001). National policy reforms could improve healthcare equality by integrating insurance premiums based on income among private-sector employees and self-employed individuals within the health insurance network.

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