Health Insurance In China Research Articles

Benefit equity of social health insurance in China and its provinces (2014–2020): implications for universal health coverage

IntroductionChina has increased fiscal input into social health insurance (SHI) schemes to achieve universal health coverage. Our study aimed to examine the equity of SHI benefits in the country and...

Does younger children's social health insurance alleviate household impoverishment due to illness?

The ambitious expansion of social health insurance in China has played a crucial role in preventing and alleviating poverty caused by illness. However, there is no government-sponsored health insurance program specifically for younger children and inequities are more pronounced in healthcare utilization, medical expenditure, and satisfaction in some households with severely ill children. This study assessed the effectiveness of child health insurance in terms of alleviating poverty caused by illness. Data were collected from two rounds of follow-up surveys using the China Family Panel Studies 2016 and 2018 child questionnaires to investigate the relationship between child health insurance and household medical impoverishment (MI). Impoverishing health expenditure (IHE) and catastrophic health expenditure (CHE) were measured to quantify "poverty due to illness" in terms of absolute and relative poverty, respectively. Propensity score matching with the difference-in-differences (PSM-DID) method, robustness tests, and heterogeneity analysis were conducted to address endogeneity issues. Social health insurance for children significantly reduced household impoverishment due to illness. Under the shock of illness, the incidences of IHE and CHE were significantly lower in households with insured children. The poverty alleviation mechanism transmitted by children enrolled in social health insurance was primarily driven by hospitalization reimbursements and the proportion of out-of-pocket medical payments among the total medical expenditure for children. Children's possession of social health insurance significantly reduced the likelihood of household poverty due to illness. The poverty-reducing effect of social medical insurance is most significant in rural areas, low-income families, no-left-behind children, and infants. Targeted poverty alleviation strategies for marginalized groups and areas would ensure the equity and efficiency of health system reforms, contributing to the goal of universal health insurance coverage in China.

The effect of air pollution on defensive expenditures: Evidence from individual commercial health insurance in China

To mitigate the substantial losses incurred by air pollution, individuals undertake defensive behaviors in the form of health insurance expenses. Leveraging data from the 2011–2017 China Household Finance Survey (CHFS) encompassing 3033 residents, we estimate the causal impact of air pollution on defensive expenditures. Our findings are as follows: (1) Air pollution exhibits a significantly favorable effect on individual commercial health insurance expenses, with a 1% increase in PM2.5 concentration correlating to an 11.02% rise in personal commercial health insurance expenditure. (2) Demographics such as younger individuals, married populations, lower educational attainment cohorts, and urban residents, displaying higher sensitivity to air pollution, tend to purchase more insurance coverage. (3) Risk perception emerges as a pivotal channel through which air pollution affects commercial health insurance expenditure. Our conclusions underscore the significance of risk perception in defensive expenditures, thereby optimizing individual risk mitigation strategies.

Current Status, Problems and Optimization Suggestions of Financing Mechanism for Urban and Rural Residents' Health Insurance in China

The financing mechanism for urban and rural residents' health insurance has continued to develop, with the financing method further refined on the basis of quota financing, the financing level raised year by year in line with individual contributions and financial subsidies, and the financing responsibility shared by the government and gradually strengthened in terms of individual responsibility. However, the current financing mechanism for urban and rural residents' health insurance is faced with the dilemmas of irrational financing method, insufficient financing level, and unbalanced financing responsibility. In light of this situation, it is recommended that the fixed-ratio financing reform be promoted step by step, that a sound mechanism be established for scientifically determining the financing level, that the sense of individual responsibility be strengthened and the financing responsibility be gradually equalized.

Does Medical Insurance Integration Reduce Frailty Risk? Evidence From Rural Older Adults in China.

This study aimed to assess the impacts of China's health insurance integration reform on frailty among rural older adults. Nationally representative longitudinal data with 2,751 adults aged ≥60 years were analyzed from the China Health and Retirement Longitudinal Study 2011-2015. The integration of the rural New Cooperative Medical Scheme and urban Resident Basic Medical Insurance into the unified Urban and Rural Resident Basic Medical Insurance (URRBMI). Frailty Index (FI) summarizes 32 health deficits, quantifying frailty severity with a range of 0-1. Frailty is defined as FI ≥ 0.25, prefrailty as FI: 0.10-0.25, and robustness as FI < 0.10. Frailty worsening, stability, and improvement from 2011 to 2015 were assessed. Difference-in-differences and propensity score matched difference-in-differences models assessed URRBMI integration effects on frailty severity and risk (FI ≥ 0.25) among rural older adults. URRBMI integration significantly reduced frailty severity by 15.16% and risk by 9.60% points among rural older adults. Reductions were greatest among initially prefrail individuals, with 27.49% lower frailty severity and a 17.62% point reduction in subsequent frailty onset risk after URRBMI integration. In contrast, no significant benefits were observed for initially robust or frail subgroups following integration. Analyses of frailty transitions corroborated selective benefits, with URRBMI integration lowering the risks of worsening frailty among prefrail but no significant reversal of frailty status among those initially frail or prefrail. China's URRBMI integration selectively ameliorated frailty progression among rural older adults with prefrail status. Targeting integrated medical insurance policies toward high-risk populations may optimize frailty prevention effects.

Belief in Religion or Participation in Insurance? The Impact of Religious Beliefs on the Decision to Participate in Social Health Insurance in China

Investigating the factors that influence individual decisions to participate in social health insurance is an essential component of constructing a multi-tiered, comprehensive social health insurance system, and religious beliefs may constitute an important potential factor. Utilising data from the China General Social Survey (CGSS), this study has developed a comprehensive explanatory framework encompassing both macro- and micro-level analyses to ascertain the impact of religious beliefs on individual decisions to participate in social health insurance through quantitative methods. The findings indicate that religious beliefs significantly diminish the likelihood of individuals participating in social health insurance, and the influence varies among different types of religions; endogeneity and robustness tests offer robust support for these conclusions. With respect to heterogeneity, the influence of religious beliefs on the decision to participate in social health insurance exhibits differentiation across dimensions such as educational attainment, social trust levels, income levels, and self-rated health statuses. Furthermore, the social interaction effect and the employment opportunity effect are identified as potential mechanisms driving this influence.

How provider payment methods affect health expenditure of depressive patients? Empirical study from national claims data in China from 2013 to 2017

BackgroundThis study aimed to investigate the associations between provider payment methods and expenditure of depressive patients, stratified by service types and hospital levels. MethodsWe used a 5 % random sample of urban claims data in China (2013–2017), collected by China Health Insurance Research Association. Provider payment methods (fee-for-services, global budget, capitation, case-based and per-diem payments) were the explanatory variables. A generalized linear model was fitted for the associations between provider payment methods and expenditure. All analyses were adjusted for patient“cioeconomic and health-related characteristics. ResultsIn total, 64,615 depressive patient visits were included, 59,459 for outpatients and 5156 for inpatients. Female patients accounted for 63.00 %. The total and out-of-pocket (OOP) expenditure significantly differentiated by provider payments. Among outpatient services, when comparing with fee-for-services, capitation payment was associated with substantial marginal reduction in total and OOP expenditure (−$34.18, −$9.71) in primary institutes, yet increases ($27.26, $24.11) in secondary hospitals. Similarly, global budget was associated with lower total and OOP expenditure (−$13.51, −$1.61) in secondary hospitals, while higher total and OOP expenditure ($7.43, $32.27) in tertiary hospitals than fee-for-services. For inpatients, total and OOP expenditures under per-diem (−$857.65, −$283.48) and case-based payments (−$997.93, −$137.56) were remarkably smaller than those under fee-for-services in primary and secondary hospitals, respectively. Besides, case-base payment was only linked with the largest reduction in OOP expense (−$239.39) in inpatient services of tertiary hospitals. LimitationOnly urban claims data was included in this study, and investigations for rural population still warrant. And updated data are needed for future studies. ConclusionsThere were varying correlations between provider payment methods and expenditure, which differed by service types and hospital levels. These findings provided empirical evidence for optimizing the mixed payment methods for depression in China.

Aftershock: Sentiment and Content Analysis of Weibo Posts about 2023 Health Insurance Reform in the Post Zero-Covid Context

This study investigates the public sentiment and thematic content of Weibo posts regarding the 2023 health insurance reform in China, a topic of heightened discussion in the aftermath of the country's zero-Covid policy. Utilizing a data-driven approach, the research analyzes netizens' reactions using phrase-level sentiment analysis and topic analysis techniques. The paper identifies the financial strains imposed by zero-Covid as a primary driver behind the reform, which led to reduced benefits and increased dissatisfaction among the population. Methodologically, the study employs Support Vector Regressor for sentiment analysis and Word2Vec for content analysis, with data sourced from an open-source Weibo crawler. The findings reveal a discrepancy in sentiment between official and unofficial accounts, pinpoint the sources of negative sentiment, and highlight the interconnection with the zero-Covid policy. The research provides insights into the public's perception of government policies during a transitional period in China's health insurance landscape.

Correlates of residents' enrolment intention toward inclusive commercial health insurance in China: involvement, perceived benefit, perceived sacrifice, and government participation.

As an application of inclusive finance in health insurance, inclusive commercial health insurance (ICHI) is a new public-private partnership-based health insurance scheme and has been vigorously promoted by the Chinese government in recent years to develop China Multi-level Health Insurance System, a system that aims to seek a mix of public and private sources to provide more affordable financial protection to all levels of society in line with their needs. However, the overall enrolment of ICHI scheme is still at a low level, and little is known about what influences residents' enrolment intentions. The aim of this study was to examine the multidimensional factors influencing residents' behavioral intentions and to develop a multivariate conceptual model to explore the psychographic process in the formation of enrolment intention. The empirical data used for model validation were obtained from a cross-sectional study conducted in Nanjing, China, a representative pilot city of ICHI scheme in 2022. Exploratory factor analysis, ANOVA, standard multiple regression, and hierarchical multiple regression were mainly employed for hypothesis testing. The findings revealed that involvement, perceived benefit, and perceived sacrifice are all crucial psychographic process factors in the formation of residents' enrolment intentions. Government participation positively moderates the influence path of "perceived benefit-enrolment intention" but negatively moderates the path of "perceived sacrifice-enrolment intention". Moreover, it was discovered that perceived benefit mediates the effect of involvement on enrolment intention, while perceived sacrifice does not. Improving residents' perceived benefit and involvement degree of the product, as well as reducing their perceived sacrifice, are both key to increasing their enrolment intentions. This study also points out that one of the main dilemmas in the current development of ICHI scheme is the low level of involvement among residents, and that optimizing the product design to make it more relevant to residents' lives is a more beneficial strategy to increase overall involvement.

Analysis of Insurance Anti-fraud Game Based on Random Forest and XGBoost Model

With the rapid development of China's health insurance industry, cases of health insurance fraud are also on the rise year by year, which has had a negative impact on the development of the health insurance industry and social stability. This article analyzes the insurance anti fraud game based on the random forest and XGBoost model. The purpose of game analysis is to use game theory to analyze the occurrence process of health insurance fraud behavior, and then identify the main factors that affect moral hazard and insurance agency expenditure costs. And an insurance anti fraud game model was constructed in the article. Game theory can be used to analyze the process of health insurance fraud and identify the main factors that affect moral hazard. The most common type of health insurance fraud in China is doctor-patient collusion fraud. We will only discuss this type of fraud and not analyze other types. And through research, it has been shown that the XUBoost model has significant advantages in accuracy and recall, while the random forest has a higher accuracy. Obviously, the XUBoost model has good performance.

Problems and Prospects in Medical Insurance System Development

China has experienced remarkable economic growth since its reform and opening-up; the gross domestic product and residents' disposable income have both increased, and the disparity in income distribution has also come to light and become a common concern for all facets of Chinese society. China has already surpassed low-income nations in terms of income level. The level of national welfare should be raised even when the economy is expanding with excellent quality. This essay talks about how China's health insurance system has evolved and how it might be improved to better the lives of its citizens. This paper compiles and analyses the development process and policies of health insurance reform. The effectiveness of the program is assessed by examining if it has raised inhabitants' quality of life and reduced the disparity in income. Moreover, The divergence of economic and policy development between urban and rural areas, and, additionally, the government management fragmentation, are two primary challenges encountered in the implementation of the program. These issues are brought on by the economy's stage of development and the long-standing customs of the policy-making process. The social health insurance system must precisely assist special groups, expand fund investment, enhance social security mechanisms, and foster harmony between urban and rural areas in order to fulfill its mission of fostering social fairness.

Сравнительный анализ систем здравоохранения в Китае и России на фоне социальной трансформации

The article analyzes the healthcare system of China and Russia from the point of view of the functioning of social insurance and the use of medical resources. The aim of the present article – to compare and analyze the values of key indicators in this area in order to guide countries towards strengthening cooperation and ex-change in the field of medicine. The results of the study showed that the concepts of health insurance in China and Russia are fundamentally different due to their focus on different social groups. It was also noted that Chi-na surpasses Russia in a number of indicators (financing, average life expectancy, etc.). The share of public spending on healthcare also exceeds the same indicator in Russia, but when calculated per capita, it does not meet the standards. The PRC has more medical resources than the Russian Federation, but in Russia the health protection of the nation is under the close attention of the government and is expressed in the action of state priority programs “Healthcare” and “Demography”. Conclusion dwells upon the fact that cooperation be-tween China and Russia in the field of healthcare will serve to improve medicine in both countries.

Healthcare Costs and Utilization for Patients With Systemic Lupus Erythematosus in China: A National Claims Database Study

ObjectivesThis study aimed to describe the healthcare resource utilization (HCRU) and healthcare costs associated with systemic lupus erythematosus (SLE) management in China from the patient’s and the payer’s perspective. MethodsHCRU and medical costs (2017 US dollar [USD]) between January 1 and December 31, 2017, were extracted from the national medical insurance claims database, China Health Insurance Research Association (consisting of claims from all public health insurance schemes in China), for adults with ≥ 1 SLE-related claim. The main analysis group comprised all adults with an SLE diagnosis and claim during 2017 (overall group); the annual subgroup (SLE diagnosis and claim in January 2017) informed annual HCRU and costs. ResultsThe overall group consisted of 3645 adults with ≥ 1 SLE-related claim. Outpatient visits constituted 86.9% of healthcare visits. SLE-related healthcare outpatient costs were USD 433 per outpatient, and inpatient costs were USD 2072 per inpatient. Medication costs accounted for 75.0% (USD 42/56) of total costs for outpatient visits and 44.3% (USD 456/1030) for inpatient hospitalizations. Notably, 35.4% of patients had a severe SLE flare; mean SLE-related cost per severe flare was USD 1616. HCRU and costs were similar in the annual subgroup. Female sex, SLE flares, tertiary hospitals, renal involvement, and utilization of anti-infective drugs were associated with higher SLE-related patient costs. ConclusionsSLE in China is associated with considerable HCRU and medical costs, especially for patients experiencing severe SLE flares. Preventing organ involvement, infections, flares, and associated hospitalizations may reduce the burden on patients and healthcare providers in China.

Differences in medical costs between TCM users and TCM nonusers in inpatients with thalassemia

BackgroundThalassemia has brought serious health threats and economic burdens to patients worldwide. There is no sovereign remedy for thalassemia, both conventional and Traditional Medicine (TM) methods have certain effects on this disease. As typical of TM, Traditional Chinese Medicine (TCM) has been widely used in the treatment of thalassemia. Previous studies mainly focused on conventional treatments for thalassemia and patients’ medical burden, but no research has examined the effects of TCM use on the economic burdens for thalassemia inpatients in mainland China. The main objective of this study is to compare the medical cost differences between TCM users and TCM nonusers, furtherly, we will discuss the role of TCM use in the treatment of thalassemia.MethodsWe employed the 2010–2016 Medicare claims database provided by the China Health Insurance Research Association (CHIRA). Chi-square and Mann-Whitney tests were used to analyze the differences between TCM users and TCM nonusers. Multiple regression analysis was performed using the ordinary least squares method to compare the TCM users’ inpatient medical cost with TCM nonusers’, and to further examine the correlation between TCM cost, conventional medication cost and nonpharmacy cost for TCM users.ResultsA total of 588 urban thalassemia inpatients were identified, including 222 TCM users and 366 TCM nonusers. The inpatient medical cost of TCM users was RMB10,048 (USD1,513), which was significantly higher than TCM nonusers (RMB1,816 (USD273)). Total inpatient cost for TCM users was 67.4% higher than those of TCM nonusers (P < 0.001). With confounding factors fixed, we found that the conventional medication cost and nonpharmacy cost were positively correlated with TCM cost.ConclusionTotal hospitalization expenses for TCM users were higher than TCM nonusers. Both the conventional medication cost and nonpharmacy cost of TCM users were all higher than TCM nonusers. We infer TCM plays a complementary role, rather than an alternative, in the treatment of thalassemia due to the lack of cooperative treatment guidelines. It is recommended that a cooperative diagnosis and treatment guidelines should be generated to balance the use of TCM and conventional medicine for treating thalassemia, so as to reduce the economic burdens on patients.

Analysis of Demand for China’s Commercial Health Insurance from the Perspective of Loss Aversion

China's health insurance industry has been developing continuously since its emergence in the 1980s, but at this stage, China's social security system is still at a relatively low level of development, and people's expenses incurred in a variety of medical needs cannot be given by the current social security system, while commercial health insurance has made a good supplement to this, ensuring people's practical interests, and is also its biggest competitive advantage. This paper lays out an overview of its market size, product structure and security degree, followed by effective suggestions of improvement in relation to the behavioral economical concept of loss aversion. The irrational misunderstanding of health insurance and the resulting problems of lack of insurance, insufficient coverage, excess insurance and double insurance have been puzzling the sustainable and healthy development of health insurance, which is also a hot issue of general concern at home and abroad. According to analysis of possible improvement measures about the effect of loss aversion on citizens, optimizing claims and modifying health service models in a desirable way will mitigate the loss aversion effects when purchasing commercial health insurance.

The efficient moral hazard effect of health insurance: Evidence from the consolidation of urban and rural resident health insurance in China

Ex post moral hazard, the additional healthcare utilization induced by health insurance, can be decomposed into an efficient portion generated by the income effect and an inefficient portion caused by the substitution effect, which has been discussed theoretically, but few studies have provided evidence of the efficient moral hazard. In 2016, the Chinese government launched the consolidation of urban and rural resident health insurance at the national level. After the consolidation, insurance benefits for nearly 800 million rural residents got improved. This paper uses a nationally-representative sample of 30,972 individuals from the China Health and Retirement Longitudinal Study (2011–2018) and adopts a 2-step empirical approach with the difference-in-differences method and the fuzzy regression discontinuity design to estimate the efficient moral hazard in the consolidation among rural residents. We find that the price shock contained in the consolidation increases inpatient care utilization, and the corresponding price elasticity is between −0.68 and −0.62. Further analysis shows that the efficient moral hazard resulting in welfare gains accounts for 43.33%–66.36% of the additional healthcare utilization. These findings highlight the necessity of evaluating the efficient moral hazard when analyzing the cost-benefit of health insurance reform.

What has affected the governance effect of the whole population coverage of medical insurance in China in the past decade? Lessons for other countries.

This study aimed to explore the current state of governance of full population coverage of health insurance in China and its influencing factors to provide empirical references for countries with similar social backgrounds as China. A cross-sectional quantitative study was conducted nationwide between 22 January 2020 and 26 January 2020, with descriptive statistics, analysis of variance, and logistic regression models via SPSS 25.0 to analyze the effectiveness and influencing factors of the governance of full population coverage of health insurance in China. The effectiveness of the governance relating to the total population coverage of health insurance was rated as good by 59% of the survey respondents. According to the statistical results, the governance of the public's ability to participate in insurance (OR = 1.516), the degree of information construction in the medical insurance sector (OR = 2.345), the government's governance capacity (OR = 4.284), and completeness of the government's governance tools (OR = 1.370) were all positively correlated (p < 0.05) on the governance effect of the whole population coverage of health insurance. The governance of Chinese health insurance relating to the total population coverage is effective. To effectively improve the effectiveness of the governance relating to the total population coverage of health insurance, health insurance information construction, governance capacity, and governance tools should be the focus of governance to further improve the accurate expansion of and increase the coverage of health insurance.

Formation mechanism of residents' intention to purchase commercial health insurance: the moderating effect of environmental pollution perception.

With the development of the social economy, commercial health insurance in China has gradually been recognized by residents, but it is still in the initial stage of the market. To identify influencing factors of residents' intention to purchase commercial health insurance and to explore the influencing mechanism and heterogeneity of intention, this study aimed to reveal the formation mechanism of intention to purchase commercial health insurance. This study introduced water and air pollution perceptions as moderating variables and, constructed a theoretical framework combining the stimulus-organism-response model and the theory of reasoned action models. The structural equation model was developed, and multigroup analysis and moderating effect analysis were carried out. The results show that advertising marketing and the behavior of relatives and friends positively influence cognition. Cognition, as well as advertising marketing and behavior of relatives and friends, has a positive impact on attitude. Furthermore, purchase intention is positively affected by cognition and attitude. Both gender and residence play a significant moderating role in influencing purchase intention. Air pollution perceptions positively moderate the path from attitude to purchase intention. The validity of the constructed model was verified and could be used to predict the willingness of residents to purchase commercial health insurance. Furthermore, policy recommendations to promote the further development of commercial health insurance were proposed. This study provides a valuable reference for insurance companies to expand the market and for the government to improve commercial insurance policies.

Optimization of medical insurance actuarial based on biometric data

Only a detailed study of the insured in long-term health insurance can better avoid risks and further serve the insured. Biostatistics is a discipline that applies the principles and methods of statistics to study life sciences, reveals the inevitable laws in a large number of random phenomena from the quantitative aspect, and is the application of probability theory and mathematical statistics in the biological field. The research results provide new ideas and methods for actuarial science of social health insurance in China.

PP15 The National Pricing And Reimbursement Process In China, A 2021 Update

IntroductionThe Chinese National Reimbursement Drug List (NRDL) was established in the early 2000’s and includes the drugs both fully and partially covered by National Basic Medicine Insurance. As China’s health system has been reformed over the past decade, it is important for manufacturers to understand the ever-changing reimbursement process and its implications on newly launched drugs. This study provides an updated overview of the process based on research conducted in 2021.MethodsTargeted secondary research was undertaken to evaluate the pricing and reimbursement landscape in China. Primary research was conducted to assess the perspectives of three payers and one policy expert.ResultsNational listing remains the most viable and exclusive pathway to get a product reimbursed by public health insurance in China. Since 2017, the NRDL has been updated annually, and revisions are managed by the National Healthcare Security Administration (NHSA). Insights from 2021 suggests that the process of listing a new product on the NRDL lasts five months (July to November). Manufacturers should ensure that submissions are made when the annual NRDL process formally begins, and clinical and health economic evidence is compulsory. If a successful opinion is made by the assessment board, the manufacturer will be invited to negotiate a price with the NHSA. Data from the NHSA indicated that a total of 704 applications were made in 2020. In addition, 138 exclusive drugs were eligible for price negotiation, of which 96 drugs were successful and added to the NRDL. Findings also suggested that the average discount rate increased from 44.0 percent in 2017 to 50.6 percent in 2020.ConclusionsThe national reimbursement process in China has become more transparent overtime. Even so, NRDL listing remains a challenge, with decisions driven by clinical and pharmacoeconomic evidence, and price. Significant price cuts should be considered and anticipated to ensure successful negotiation outcomes.