The impact of health insurance on poverty among rural older adults: an evidence from nine counties of western China

Abstract Background Older adults are more prone to various diseases. Health insurance becomes effective mechanism to relieve financial burden when the insured is sick. In China, most older adults live in the countryside, and New Rural Cooperative Medical Scheme is a kind of health insurance system in rural areas. The relationship between New Rural Cooperative Medical Scheme and financial burden due to health expenditure of older adults in China was investigated. This paper aims at the impact of New Rural Cooperative Medical Scheme on the poverty among rural older adults. Methods This study employs Probit model and Tobit model to assess the impact of New Rural Cooperative Medical Scheme on alleviating poverty among rural older adults based on a survey in nine representative counties in western China. Results The findings show that diseases have significantly negative impact on rural elderly poverty. New Rural Cooperative Medical Scheme has impact on alleviating of the health-payment poverty due to catastrophic health expenditure, but the impact is limited. The impact of health insurance on poverty alleviation is greater for men, older adults aged between 60 to 69 and households in in economically poorer area than their counterparts. Conclusions This study show the relationship between New Rural Cooperative Medical Scheme and catastrophic health expenditure of older adults in China. The results draw policy attention to introduce different reimbursement expense ratios for different groups to alleviate them from poverty based on more comprehensive insurance packages.

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Catastrophic Health Expenditure Associated With Frailty in Community-Dwelling Chinese Older Adults: A Prospective Cohort Analysis

Frontiers in Public Health ◽

10.3389/fpubh.2021.718910 ◽

2021 ◽

Vol 9 ◽

Author(s):

Lijun Fan ◽

Xiang-Yu Hou ◽

Yingyan Liu ◽

Sunan Chen ◽

Qian Wang ◽

...

Keyword(s):

Older Adults ◽

Health Insurance ◽

Health Expenditure ◽

Financial Burden ◽

Cohort Analysis ◽

Social Health Insurance ◽

Catastrophic Health Expenditure ◽

Community Dwelling ◽

Geriatric Syndrome ◽

Related Factors

Background: Catastrophic health expenditure (CHE) represents a key indicator for excessive financial burden due to out-of-pocket (OOP) healthcare costs, which could push the household into poverty and is highly pronounced in households with members at an advanced age. Previous studies have been devoted to understanding the determinants for CHE, yet little evidence exists on its association with frailty, an important geriatric syndrome attracting growing recognition. We thus aim to examine the relationship between frailty and CHE and to explore whether this effect is moderated by socioeconomic-related factors.Methods: A total of 3,277 older adults were drawn from two waves (2011 and 2013) of the China Health and Retirement Longitudinal Study (CHARLS). CHE was defined when OOP healthcare expenditure exceeded a specific proportion of the capacity of the household to pay. Frailty was measured following the Fried Phenotype (FP) scale. Mixed-effects logistic regression models were employed to assess the longitudinal relationship between frailty and CHE, and stratification analyses were conducted to explore the moderation effect.Results: The incidence of CHE among Chinese community-dwelling older adults was 21.76% in 2011 and increased to 26.46% in 2013. Compared with non-frail individuals, prefrail or frail adults were associated with higher odds for CHE after controlling for age, gender, residence, education, marriage, income, health insurance, smoking, drinking, and comorbidity (prefrail: odds ratio (OR) = 1.32, 95%CI = 1.14–1.52; frail: OR = 1.67, 95%CI = 1.13–2.47). Three frailty components including weakness, exhaustion, and shrinking contributed to a significantly increased likelihood of CHE (all p < 0.05), while the other two components including slowness and inactivity showed a non-significant effect (all p > 0.05). Similar effects from frailty on CHE were observed across socioeconomic-related subgroups differentiated by gender, residence, education, household income, and social health insurance.Conclusions: Frailty is a significant predictor for CHE in China. Developing and implementing cost-effective strategies for the prevention and management of frailty is imperative to protect households from financial catastrophe.

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Catastrophic health expenditure incidence and its equity in China: a study on the initial implementation of the medical insurance integration system

BMC Public Health ◽

10.1186/s12889-019-8121-2 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Huan Liu ◽

Hong Zhu ◽

Jiahui Wang ◽

Xinye Qi ◽

Miaomiao Zhao ◽

...

Keyword(s):

Health Insurance ◽

Health Services ◽

Low Income ◽

Health Expenditure ◽

Concentration Index ◽

Medical Insurance ◽

Catastrophic Health Expenditure ◽

Integration System ◽

Integration Policies ◽

The Impact

Abstract Background By 2013, several regions in China had introduced health insurance integration policies. However, few studies addressed the impact of medical insurance integration in China. This study investigates the catastrophic health expenditure and equity in the incidence of catastrophic health expenditure by addressing its potential determinants in both integrated and non-integrated areas in China in 2013. Methods The primary data are drawn from the fifth China National Health Services Survey in 2013. The final sample comprises 19,788 households (38.4%) from integrated areas and 31,797 households (61.6%) from non-integrated areas. A probit model is employed to decompose inequality in the incidence of catastrophic health expenditure in line with the methodology used for decomposing the concentration index. Results The incidence of catastrophic health expenditure in integrated areas is higher than in non-integrated areas (13.87% vs. 13.68%, respectively). The concentration index in integrated areas and non-integrated areas is − 0.071 and − 0.073, respectively. Average household out-of-pocket health expenditure and average capacity to pay in integrated areas are higher than those in non-integrated areas. However, households in integrated areas have lower share of out-of-pocket expenditures in the capacity to pay than households in non-integrated areas. The majority of the observed inequalities in catastrophic health expenditure can be explained by differences in the health insurance and householders’ educational attainment both in integrated areas and non-integrated areas. Conclusions The medical insurance integration system in China is still at the exploratory stage; hence, its effects are of limited significance, even though the positive impact of this system on low-income residents is confirmed. Moreover, catastrophic health expenditure is associated with pro-poor inequality. Medical insurance, urban-rural disparities, the elderly population, and use of health services significantly affect the equity of catastrophic health expenditure incidence and are key issues in the implementation of future insurance integration policies.

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Challenges with Pain Treatment for Rural Older Adults: Family Caregivers' Views

Innovation in Aging ◽

10.1093/geroni/igab046.3220 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 893-894

Author(s):

Hyunjin Noh ◽

Cho Rong Won ◽

Zainab Suntai

Keyword(s):

Older Adults ◽

Health Insurance ◽

Family Caregivers ◽

Rural Areas ◽

Pain Treatment ◽

Financial Burden ◽

Insurance Coverage ◽

Health Insurance Coverage ◽

Thinking Skills ◽

Rural Older Adults

Abstract Family caregivers face various challenges in assisting older adults experiencing pain and difficult symptoms. Living in rural areas poses additional obstacles to their caregiving. The purpose of this study was to explore family caregivers’ lived experiences in caring for older adults with pain and discomfort in rural communities. A qualitative research design was adopted to capture the common essence of participants’ experiences through a phenomenological method. Purposeful sampling was used, and the participant criteria was: age 18+, have good thinking skills, resident of Alabama, provide unpaid assistance to a family/relative who has chronic/serious health conditions and experienced pain/discomfort in the last 3 months. Ten participants were recruited from rural counties of Alabama. Individual semi-structured interviews were conducted via phone and were recorded and transcribed verbatim. Inductive, thematic analysis of the data revealed themes in five categories: 1) impact of pain (physical and psychological/emotional toll), 2) coping strategies (faith/contentment with life/logistical adaptation), 3) impact of Covid-19 (physical health/social interaction/mental health/added caregiving), 4) challenges in pain treatment (transportation (time/distance/driver/cost) and non-transportation related problems (healthcare provider issues/health insurance/financial burden)), and 5) suggestions (transportation-related (more transportation options/tailored services) and non-transportation-related support (home-based services/better health insurance coverage)). Findings of this study highlight rural family caregivers’ unique experiences in assisting older adults’ access to pain treatment, particularly during the Covid-19 pandemic. Policy- and program-level intervention is called for to increase individualized transportation options, improve health insurance coverage, and expand financial support for rural older adults experiencing pain and their caregivers.

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The impact of National Health Insurance upon accessibility of health services and financial protection from catastrophic health expenditure: a case study of Savannakhet province, the Lao People’s Democratic Republic

Health Research Policy and Systems ◽

10.1186/s12961-019-0493-3 ◽

2019 ◽

Vol 17 (1) ◽

Cited By ~ 1

Author(s):

Somdeth Bodhisane ◽

Sathirakorn Pongpanich

Keyword(s):

Health Insurance ◽

Health Service ◽

Health Expenditure ◽

Democratic Republic ◽

Catastrophic Health Expenditure ◽

Health Service Utilisation ◽

Service Utilisation ◽

Financial Protection ◽

The Government ◽

The Impact

Abstract Introduction Many schemes have been implemented by the government of the Lao People’s Democratic Republic to provide equity in health service utilisation. Initially, health service utilisations were fully supported by the government and were subsequently followed by the Revolving Drug Fund. In the 2000s, four health financing schemes, namely the Social Security Organization, the State Authority for Social Security, the Health Equity Fund and Community-Based Health Insurance (CBHI), were introduced with various target groups. However, as these voluntary schemes have suffered from a very low enrolment rate, the government decided to pilot the National Health Insurance (NHI) scheme, which offers a flat, co-payment system for health service utilisation. This study aims to assess the effectiveness of the NHI in terms of its accessibility and in providing financial protection from catastrophic health expenditure. Methods The data collection process was implemented in hospitals of two districts of Savannakhet province. A structured questionnaire was used to retrieve all required information from 342 households; the information comprised of the socioeconomics of the household, accessibility to health services and financial payment for both outpatient and inpatient department services. Binary logistic regression models were used to discover the impact of NHI in terms of accessibility and financial protection. The impact of NHI was then compared with the outcomes of the preceding, voluntary CBHI scheme, which had been the subject of earlier studies. Results Under the NHI, it was found that married respondents, large households and the level of income significantly increased the probability of accessibility to health service utilisation. Most importantly, NHI significantly improved accessibility for the poorest income quantile. In terms of financial protection, households with an existing chronic condition had a significantly higher chance of suffering financial catastrophe when compared to households with healthy members. As probability of catastrophic expenditure was not affected by income level, it was indicated that NHI is able to provide equity in financial protection. Conclusion The models found that the NHI significantly enhances accessibility for poor income households, improving health service distribution and accessibility for the various income levels when compared to the CBHI coverage. Additionally, it was also found that NHI had enhanced financial protection since its introduction. However, the NHI policy requires a dramatically high level of government subsidy; therefore, there its long-term sustainability remains to be determined.

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Does the Health Insurance Program Reduce Health-Induced Poverty?: New Evidence From the China Household Income Project

Innovation in Aging ◽

10.1093/geroni/igab046.1373 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 355-355

Author(s):

Yalu Zhang ◽

Qin Gao

Keyword(s):

Older Adults ◽

Household Income ◽

Fixed Effects ◽

Financial Burden ◽

Experimental Studies ◽

Estimation Method ◽

Healthcare Services ◽

Catastrophic Health Expenditure ◽

Middle Aged ◽

The Impact

Abstract The growing cost of healthcare services has been a concern for many countries in the world. In China, medical expenditures can account for as much as 65% of per capita income in some low-GDP counties in 2011. One of the primary goals of the New Rural Cooperative Medical Insurance (NRCMI) is to provide financial protection and alleviate the financial burdens of rural residents in China. This paper examined whether NRCMI participation impacted the incidence of catastrophic health expenditure (CHE) among middle-aged and older adults (45 years old and above) using the China Household Income Project 2007 rural data and an instrumental variable estimation method in two provinces where there was heterogeneity in NRCMI implementation schedule. The results show that NRCMI enrollment could not impact the likelihood of experiencing CHE among middle-aged and older adults. However, NRCMI participation increased the actual amount of medical expenses in one province but not in the other. Although none of the prior studies have used instruments and village fixed effects or take endogeneity issues into account to investigate the impact of NRCMI on relative financial burden among recipients, the results found in this study are generally aligned with the prior findings, especially with those using quasi-experimental studies. Findings from this study provide empirical evidence to the policymakers that the effect of NRCMI participation on financial protections is limited despite its broad population coverage. The limited effects are probably due to the low reimbursement rate and more utilization of expensive healthcare services.

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Catastrophic Health Expenditure Incidence and Its Equity in China: A Study on the Initial Implementation of the Medical Insurance Integration System

10.21203/rs.2.11043/v1 ◽

2019 ◽

Author(s):

huan liu ◽

hong zhu ◽

jiahui wang ◽

xinye qi ◽

miaomiao zhao ◽

...

Keyword(s):

Health Insurance ◽

Health Services ◽

Health Expenditure ◽

Concentration Index ◽

Medical Insurance ◽

The Elderly ◽

Catastrophic Health Expenditure ◽

Primary Data ◽

Integration System ◽

The Impact

Abstract Introduction: By 2013, several regions in China have introduced health insurance integration policies. However, few studies have addressed the impact of medical insurance integration in China. This study investigates catastrophic health expenditure and equity in the incidence of catastrophic health expenditure by addressing its potential determinants in both integrated areas and non-integrated areas in China in 2013. Methods: The primary data are drawn from the fifth China National Health Services Survey in 2013. The final sample comprises 19,788 households (38.4%) from integrated areas and 31,797 households (61.6%) from non-integrated areas. A probit model is employed to decompose the inequality of the incidence of catastrophic health expenditure in line with the methodology used for decomposing the concentration index. Results: The incidence of catastrophic health expenditure in integrated areas is higher than in non-integrated areas (13.87% vs. 13.68%, respectively). The concentration index in integrated areas and non-integrated areas is -0.071 and -0.073, respectively. Average household out-of-pocket health expenditure and average capacity to pay in integrated areas are higher than in non-integrated areas. However, households in integrated areas have lower out-of-pocket expenditures share in capacity to pay than households in non-integrated areas. The majority of the observed inequalities in catastrophic health expenditure can be explained by differences in the health insurance and householders’ educational attainment both in integrated areas and non-integrated areas. However, compared with non-integrated areas, the inequity caused by integrated medical insurance has been significantly reduced in integrated areas. Conclusions: The medical insurance integration system in China is still at the exploring stage; hence, its effects are of limited significance. Regardless of the area, catastrophic health expenditure is associated with pro-poor inequality. Medical insurance, urban-rural disparities, the elderly population, and the use of health services significantly affect the equity of catastrophic health expenditure incidence. Keywords: Catastrophic health expenditure, Medical insurance integration system, Equity, Influencing factors

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Public Health Insurance, Non-Farm Labor Supply, and Farmers’ Income: Evidence from New Rural Cooperative Medical Scheme

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16234865 ◽

2019 ◽

Vol 16 (23) ◽

pp. 4865 ◽

Cited By ~ 3

Author(s):

Jin Liu ◽

Yufeng Lu ◽

Qing Xu ◽

Qing Yang

Keyword(s):

Public Health ◽

Health Insurance ◽

Labor Supply ◽

Public Health Insurance ◽

Farm Income ◽

Farm Labor ◽

Labor Time ◽

Cooperative Medical Scheme ◽

The Impact ◽

The Relationship

The major source of income of Chinese farmers is non-farm income, especially wages and salaries. Based on the economics theory of health and healthcare, their non-farm labor supply behavior could be affected by health insurance policies. The work presented in this paper focuses on the impact of the New Rural Cooperative Medical Scheme (NRCMS) on farmers’ non-farm labor supply behavior in China. A four-part model regression approach was used to examine the relationship. Our dataset comprised of 8273 people, aged 45 or above, from the China Health and Retirement Longitudinal Study (CHARLS) conducted in 2011 and 2013. The empirical results showed that NRCMS significantly reduced non-farm labor force participation and employment. Compared to non-participants of the NRCMS, the non-farmer labor time of these participants reduced, but the supplementary medical insurance and immediate reimbursement of the NRCMS increased the participants’ non-farm labor time. Our results have contributed to the reform of China’s public health insurance and farms’ income growth, and it would be necessary to actively promote immediate reimbursement, gradually simplify reimbursement procedures for medical treatment in non-registered places, and eliminate the non-portability of NRCMS.

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Estimating the effectiveness of national health insurance in covering catastrophic health expenditure: Evidence from South Korea

PLoS ONE ◽

10.1371/journal.pone.0255677 ◽

2021 ◽

Vol 16 (8) ◽

pp. e0255677

Author(s):

Hyunwoo Jung ◽

Junhyup Lee

Keyword(s):

Health Insurance ◽

National Health Insurance ◽

National Health ◽

Health Expenditure ◽

Low Cost ◽

Financial Burden ◽

Insurance Coverage ◽

Catastrophic Health Expenditure ◽

Cost Burden ◽

Out Of Pocket Payments

The catastrophic health expenditure (CHE) indicator has been used to measure the medical cost burden of households. Many countries have institutionalized their health insurance systems to reduce out-of-pocket payments, the main contributor to the financial burden. However, there is no method to estimate how the insurance coverage reduces the CHE. This study proposes an approach to evaluate the effectiveness of insurance in reducing the CHE impacts in terms of incidence and gap, which are based on a modified calculation method of CHE. Additionally, we apply these methods to data from the Korea Health Panel Survey (2011–2016). The results are as follows. First, under the setting of a threshold of 10%, the CHE incidence rate was 19.26% when the Korean national health insurance benefits reduced the CHE’s incidence for 15.17% of the population in 2017. Second, the results of the concentration index of CHE showed that the intensity approach of CHE is better than the incidence approach. Third, the new approach we applied revealed that health insurance reduces the burden of CHE to some degree, although it was not an efficient way to reduce CHE. In conclusion, this study provides new policy approaches to save the finances of national health insurance and reduce the intensity of CHE at the same time by raising the low-cost burden of medical services and lowering that of high cost. Moreover, we suggest that policymakers should focus on income level of the households rather than specific diseases.

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Catastrophic Health Expenditure Incidence and Its Equity in China: A Study on the Initial Implementation of the Medical Insurance Integration System

10.21203/rs.2.11043/v2 ◽

2019 ◽

Author(s):

huan liu ◽

hong zhu ◽

jiahui wang ◽

xinye qi ◽

miaomiao zhao ◽

...

Keyword(s):

Health Insurance ◽

Health Services ◽

Low Income ◽

Health Expenditure ◽

Concentration Index ◽

Medical Insurance ◽

Catastrophic Health Expenditure ◽

Integration System ◽

Integration Policies ◽

The Impact

Abstract Introduction: By 2013, several regions in China had introduced health insurance integration policies. However, few studies addressed the impact of medical insurance integration in China. This study investigates the catastrophic health expenditure and equity in the incidence of catastrophic health expenditure by addressing its potential determinants in both integrated and non-integrated areas in China in 2013. Methods: The primary data are drawn from the fifth China National Health Services Survey in 2013. The final sample comprises 19,788 households (38.4%) from integrated areas and 31,797 households (61.6%) from non-integrated areas. A probit model is employed to decompose inequality in the incidence of catastrophic health expenditure in line with the methodology used for decomposing the concentration index. Results: The incidence of catastrophic health expenditure in integrated areas is higher than in non-integrated areas (13.87% vs. 13.68%, respectively). The concentration index in integrated areas and non-integrated areas is -0.071 and -0.073, respectively. Average household out-of-pocket health expenditure and average capacity to pay in integrated areas are higher than those in non-integrated areas. However, households in integrated areas have lower share of out-of-pocket expenditures in the capacity to pay than households in non-integrated areas. The majority of the observed inequalities in catastrophic health expenditure can be explained by differences in the health insurance and householders’ educational attainment both in integrated areas and non-integrated areas. Conclusions: The medical insurance integration system in China is still at the exploratory stage; hence, its effects are of limited significance, even though the positive impact of this system on low-income residents is confirmed. Moreover, catastrophic health expenditure is associated with pro-poor inequality. Medical insurance, urban-rural disparities, the elderly population, and use of health services significantly affect the equity of catastrophic health expenditure incidence and are key issues in the implementation of future insurance integration policies. Keywords: Catastrophic health expenditure, Medical insurance integration system, Equity, Influencing factors

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The Impact of Weather and Seasons on Falls and Physical Activity among Older Adults with Glaucoma: A Longitudinal Prospective Cohort Study

Sensors ◽

10.3390/s21103415 ◽

2021 ◽

Vol 21 (10) ◽

pp. 3415

Author(s):

Hursuong Vongsachang ◽

Aleksandra Mihailovic ◽

Jian-Yu E ◽

David S. Friedman ◽

Sheila K. West ◽

...

Keyword(s):

Physical Activity ◽

Older Adults ◽

Fall Prevention ◽

Regression Models ◽

Activity Promotion ◽

Injurious Fall ◽

Multivariable Regression ◽

Multivariable Regression Models ◽

The Impact ◽

The Relationship

Understanding periods of the year associated with higher risk for falling and less physical activity may guide fall prevention and activity promotion for older adults. We examined the relationship between weather and seasons on falls and physical activity in a three-year cohort of older adults with glaucoma. Participants recorded falls information via monthly calendars and participated in four one-week accelerometer trials (baseline and per study year). Across 240 participants, there were 406 falls recorded over 7569 person-months, of which 163 were injurious (40%). In separate multivariable regression models incorporating generalized estimating equations, temperature, precipitation, and seasons were not significantly associated with the odds of falling, average daily steps, or average daily active minutes. However, every 10 °C increase in average daily temperature was associated with 24% higher odds of a fall being injurious, as opposed to non-injurious (p = 0.04). The odds of an injurious fall occurring outdoors, as opposed to indoors, were greater with higher average temperatures (OR per 10 °C = 1.46, p = 0.03) and with the summer season (OR = 2.69 vs. winter, p = 0.03). Falls and physical activity should be understood as year-round issues for older adults, although the likelihood of injury and the location of fall-related injuries may change with warmer season and temperatures.

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