Effects of SO2 Pollution on Household Insurance Purchasing in China: A Cross-Sectional Study

There have been considerable concerns regarding the effects of air pollution on health and economy over the past decades across the world. As insurance coverage has been closely related to household welfare, we aim to investigate the influence of air pollution, in particular, the sulfur dioxide (SO2) pollution on household purchases of commercial health insurance using data from the 2017 China Household Financial Survey (CHFS). The results show that the rise in SO2 emission has a significant positive association with tendency of residents to participate in commercial health insurance. The possibility of household commercial health insurance purchasing increases by 4% per 1,000 tons of SO2 emission. In addition, the proportion of commercial health insurance expenditure in household annual income increases by 29% per 1,000 tons of SO2 emission. The effects are also found to differ among resident groups. Residents in eastern parts of China are more likely to buy commercial health insurance facing SO2 pollution compared to those in western parts of China; people with higher income are more likely to be affected compared to those with lower income; families with the household head being female are more likely to be affected compared to those with the household head being male. This research provides baseline information on the formulation and implementation of future operation strategy in commercial health insurance companies of China.

Factors Affecting the Purchase of Commercial Health Insurance: Based on Personal Health Status and the Substitution Effect of Social Insurance

Background: How health status affects residents’ purchase of commercial health insurance and whether social insurance will crowd out the demand of commercial health insurance are important issues related to the development of commercial health insurance. Further, this paper also attempts to answer why people with worse health buy less commercial health insurance through mechanism analysis. Methods: We used Logit model to analyze the impact of self-rated health level on the purchase of commercial health insurance and the crowding out effect of participating in social health insurance on the purchase of commercial health insurance. In addition, we also successively introduced the respondents with worse and worse health status for regression analysis and analyzed the reasons why the poor health groups reduce the purchase of commercial medical insurance. Results: When performing regression analysis on whether to purchase commercial health insurance, the regression coefficient of having social health insurance is -0.497 and the regression coefficient of self-rated health level is -0.182, but the health status has no significant impact on whether to have social health insurance. Conclusions: The expansion of social basic health insurance has a restraining effect on the promotion of commercial health insurance, and self-rated health level has a negative impact on the purchase of commercial health insurance. The reason why individuals with poor health buy less commercial health insurance is that commercial insurance companies often refuse to cover individuals in poor health.JEL: I11, G22

Does the Development of the Insurance Industry Promote the Purchase of Rural Commercial Health Insurance?

Deepening the reform of insurance companies and improving commercial insurance protection capabilities become issues important to national strategy. They involve improving China's multi-tiered social security system to analyze the deep-seated reasons impacting the purchasing behavior of commercial health insurance for rural residents in China. Using the DEA-CCR model, this paper evaluates the development of China's insurance industry, inspects the impact of insurance industry development on purchasing behavior of rural commercial health insurance based on the data of tracking survey projects from China's household, and carries out empirical analysis. The research result shows that the development of the insurance industry has obviously promoted the purchase behavior of commercial health insurance for rural residents. This research has significant practical value on protection and promotion of production and life quality of rural residents, which will also provide beneficial reference on the formulation and implementation of future operation strategy in China's commercial health insurance companies.

The effect of commercial health insurance and health policy incentives on health risk assessment of residents

BACKGROUND: Due to the limitations of social medical insurance, commercial medical insurance is necessary. OBJECTIVE: The study aims to analyze the practical effects of commercial health insurance and health policy incentives. METHODS: The health risk assessment is performed referring to data released by China Health and Retirement Longitudinal Study (CHARLS). RESULTS: The effect coefficient of commercial health insurance for residents’ four-week prevalence is 0.067, with that for residents’ self-evaluation health being –0.032, and that for residents’ rate of medical treatment being 0.094, which is significant at the 0.01 level. Commercial health insurance has different effects on residents’ mental health. The residents who purchase commercial health insurance have 8.2%higher anxiety degree and 7.3%higher depression degree; however, their sleep condition index increases by 5.7%. CONCLUSIONS: Commercial health insurance can’t improve the four-week prevalence or self-evaluation health significantly. Nevertheless, it can improve the medical treatment rate. Commercial health insurance exhibits complicated results in terms of residents’ mental health levels. Although it has definitely improved the quality of sleep and well-being of residents and reduced loneliness, it can negatively affect mental health indexes such as anxiety and depression.

Configurations of Essential Factors Promoting China’s Commercial Health Insurance: A Qualitative Comparative Analysis Based on Technology-Organization-Environment Framework

Background With the improvement in the living standards, China’s health insurance under the social security system cannot satisfy people's diversified and high-level demands. Therefore, it is necessary to promote commercial health insurance (CHI). This study identifies driving paths of CHI in China from configuration perspective. Methods This study innovatively constructs an analysis framework based on the Technology-Organization-Environment theory to investigate the driving path of China's commercial health insurance. Using the data of 31 provincial regions of China in 2018, the fuzzy-set Qualitative Comparative Analysis (QCA) is employed for configuration analysis. For the robustness analysis of necessary condition, we also adopt the Necessary Condition Analysis. Results Three main findings are discovered. First, there is no necessary relationship between any condition and high or not-high performance of CHI and any condition. Nevertheless, there are three sufficient configurations, TOE strategy, GA-EA-CD strategy, and dual EA-CD strategy, to achieve high performance, and another three, TMC-EA-CD strategy, TI-EA strategy, and TI-TMC-EA strategy, to reach not-high performance. Second, technological conditions (TI and TMC) and EA are relatively more important than other conditions. Third, it is confirmed that the financial expenditure of government departments has a negative effect on the development of commercial health insurance. Conclusion There are configurations or pathways to achieve high or not-high performance of promoting CHI and key factors are identified successfully. Each region should choose the driving path suitable for itself, instead of making homogenization policies and replicating policies of regions with high performance. Besides, TC and EA as key factors should be overcome. Finally, the governments should formulate policies to systematically evaluate social insurance and CHI simultaneously and promote their coordinated development.

INCIDENCE OF THROMBOTIC EVENTS IN A COMMERCIALLY-INSURED US POPULATION

Objective: To estimate the US incidence of thrombotic events and related rare diagnoses. Design: Claims-based retrospective cohort study of incidence. Setting: US commercial health insurance administrative claims database. Participants: Adults 25-65 years of age between 2015 and 2019 with a minimum of 12 consecutive thrombosis-free months of continuous enrollment beginning 2014 were selected. Main Outcomes: Age (10 year intervals) and sex stratum specific incidence rates per 100,000 person-years were determined for: venous thromboembolism (VTE), cerebral venous thrombosis (CVT), and any major thrombosis. Incidence also was estimated for immune thrombocytopenic purpura (ITP), hemolytic-uremic syndrome (HUS), and heparin-induced thrombocytopenia (HIT). Results: Among approximately 15 million enrollees per year (half female/male), incidence of any thrombotic event (DVT, PE, CVT, or other thrombosis) was 247.89 per 100,000 person-years (95% CI: 245.96, 249.84). Incidence of VTE was 213.79 with ICD codes alone (95% CI: 211.99, 215.59) and 127.18 (95% CI: 125.80, 128.58) when also requiring a filled anticoagulation prescription. Incidence rates were 6.37 for CVT (95% CI: 6.07, 6.69), 26.06 for ITP (95% CI: 25.44, 26.78), 0.94 for HUS (95% CI: 0.82, 1.06), and 4.82 for HIT (95% CI: 4.56, 5.10). The co-occurrence of CVT with either ITP or HIT (diagnoses within 14 days of one another) was 0.090 (95% CI: 0.06, 0.13). Incidence tended to increase with age and was higher for women under 55. Incidence for CVT, HUS, and CVT with ITP or HIT was higher for women in all age groups. Conclusions: These results are the first US estimates for incidence of thrombotic and rare events in a large, commercially-insured US population. Findings provide a critically important reference for determining excess morbidity associated with COVID-19 and more generally for vaccine pharmacovigilance.

Retention in Medical Care Among Insured Adolescents and Young Adults With Diagnosed HIV Infection, United States, 2010-2014

Objectives Retention in care is a critical component of effective HIV treatment, and adolescents and young adults are at higher risk of inadequate retention than older adults. The objective of our study was to examine the patterns of retention in care among adolescents and young adults with HIV infection by analyzing Medicaid and commercial health insurance claims data. Methods We evaluated retention in care for HIV-diagnosed adolescents and young adults aged 13-24 using the 2010-2014 MarketScan Medicaid and MarketScan Commercial Claims health insurance databases. The study period extended 36 months from the date of the first claim with a code for HIV or AIDS. We determined the unweighted proportion retained in care for the Medicaid and Commercial Claims cohorts for months 0-24 and 25-36. We assessed associations between demographic characteristics and retention in care using logistic regression. Results A total of 378 adolescents and young adults were in the Medicaid cohort and 1028 in the Commercial Claims cohort. In the Medicaid and Commercial Claims cohorts, respectively, 186 (49%) and 591 (57%) adolescents and young adults were retained in care during months 0-24. In the Medicaid cohort, 113 (73%) people retained in care and 69 (45%) people not retained in care during months 0-24 were retained in care during months 25-36. In the Commercial Claims cohort, 313 (77%) and 94 (31%) retained and not retained people, respectively, were found to be in care during months 25-36. Conclusions Notable proportions of HIV-diagnosed adolescents and young adults are not adequately retained in care; public health interventions tailored to this population are needed.