Insurance In China Research Articles

Mediated Agency and Funeral Insurance in China

AbstractThis article examines attempts to set up a market for funerary insurance in China. Anthropologists and sociologists analyzing the insurance industry often emphasize the cultural aspects of the business, suggesting that “visions” or “imaginaries” of what insurance is and how insurance should work play a guiding role in other aspects of the business. In the case of funerary insurance in China, however, the imaginary of how the insurance should work evolved very rapidly in response to other factors. While not denying the role of cultural imaginaries in the insurance business, this article argues for a more mediated vision of the agency of these imaginaries.

How Did the Introduction of Deposit Insurance Affect Chinese Banks? An Investigation of Its Wealth Effects

ABSTRACTThe latest introduction of deposit insurance in China gives us a chance to explore the stock market reaction to the major regulatory policy change in banking. Our results show the average abnormal returns of all listed banks in China are significantly negative on the announcement day. It indicates the introduction of deposit insurance has an adverse wealth effect on the banking industry in China. We also find that among bank characteristics such as asset size, z-score, and ROE, only size has a statistically significant positive impact on the abnormal returns of the Chinese listed banks on the announcement day. The results mean the introduction of deposit insurance in China creates a redistribution of wealth from small banks to those with larger size.

Association between ambient air pollution and daily hospital admissions for ischemic stroke: A nationwide time-series analysis.

BackgroundEvidence of the short-term effects of ambient air pollution on the risk of ischemic stroke in low- and middle-income countries is limited and inconsistent. We aimed to examine the associations between air pollution and daily hospital admissions for ischemic stroke in China.Methods and findingsWe identified hospital admissions for ischemic stroke in 2014–2016 from the national database covering up to 0.28 billion people who received Urban Employee Basic Medical Insurance (UEBMI) in China. We examined the associations between air pollution and daily ischemic stroke admission using a two-stage method. Poisson time-series regression models were firstly fitted to estimate the effects of air pollution in each city. Random-effects meta-analyses were then conducted to combine the estimates. Meta-regression models were applied to explore potential effect modifiers. More than 2 million hospital admissions for ischemic stroke were identified in 172 cities in China. In single-pollutant models, increases of 10 μg/m3 in particulate matter with aerodynamic diameter <2.5 μm (PM2.5), sulfur dioxide (SO2), nitrogen dioxide (NO2), and ozone (O3) and 1 mg/m3 in carbon monoxide (CO) concentrations were associated with 0.34% (95% confidence interval [CI], 0.20%–0.48%), 1.37% (1.05%–1.70%), 1.82% (1.45%–2.19%), 0.01% (−0.14%–0.16%), and 3.24% (2.05%–4.43%) increases in hospital admissions for ischemic stroke on the same day, respectively. SO2 and NO2 associations remained significant in two-pollutant models, but not PM2.5 and CO associations. The effect estimates were greater in cities with lower air pollutant levels and higher air temperatures, as well as in elderly subgroups. The main limitation of the present study was the unavailability of data on individual exposure to ambient air pollution.ConclusionsAs the first national study in China to systematically examine the associations between short-term exposure to ambient air pollution and ischemic stroke, our findings indicate that transient increase in air pollution levels may increase the risk of ischemic stroke, which may have significant public health implications for the reduction of ischemic stroke burden in China.

The Price of Growth: Consumption Insurance in China 1989–2009

We exploit a novel and unique opportunity to document the transmission of income risk to consumption in a growing economy. Our laboratory is China, an economy that has witnessed enormous and sustained growth. We build a long panel of household-level consumption and income data. We find that consumption insurance deteriorates along the growth process with a transmission of permanent income shocks to consumption that at least triples from 1989 to 2009. Although preliminary, our welfare analysis suggests that the loss of consumption insurance can have first-order implications for the welfare assessment of economic growth. (JEL D12, E21, O12, O47, P24, P25, P36)

PCN76 - BUDGET IMPACT ANALYSIS OF AFATINIB FOR THE FIRST-LINE TREATMENT OF ADVANCED OR METASTATIC NON–SMALL-CELL LUNG CANCER IN CHINA

Afatinib is approved in China for the first-line treatment of patients with advanced or metastatic non–small-cell lung cancer (NSCLC) whose tumors have epidermal growth factor receptor (EGFR) mutations. The objective of this study is to evaluate the budget impact of adding afatinib to the National Reimbursement Drug List (NRDL) covered by basic health insurance (BHI) in China. A simple model was developed to evaluate the budget impact over a 5-year time horizon. The number of patients eligible for treatment was estimated using published incidence data. Therapies included in the model were afatinib, erlotinib, gefitinib (including a generic drug), and icotinib. Drug-acquisition costs were retail price or reimbursement payment standard. Market share of tyrosine kinase inhibitors (TKIs) was estimated by market-research data. The mean time for patients using TKIs was assumed to be 11 months, based on progression-free survival data from clinical trials. Using the base-case parameter assumptions, the total budget would increase by ¥79 million, ¥147 million, ¥172 million, ¥169 million, and ¥152 million in the first 5 years of afatinib on NRDL. This translates into small increases in the per-patient-per-year (PPPY) cost of ¥757, ¥1,255, ¥1,430, ¥1,363, and ¥1,188; and increases in the per-member-per-year (PMPY) costs of ¥0.06, ¥0.11, ¥0.13, ¥0.13, and ¥0.11 in years 1 through 5, respectively. Afatinib is likely to have a marginal impact on the BHI budget in China. Considering that afatinib is the only drug that has demonstrated improvement in overall survival versus chemotherapy in the del19 population and has shown superiority in progression-free survival versus gefitinib in this setting, afatinib is a budget-neutral way of improving cancer care for patients with EGFR+ NSCLC in China. Further analysis needs to consider progression-free and overall survival times of patients, costs of managing adverse reactions, and additional disease management costs.

Exploring the relationship between migrants\u2019 purchasing of commercial medical insurance and urbanisation in China

BackgroundOver the past 40 years, the Chinese government has diligently promoted the market-oriented reform of the health insurance system. However, as it is affected by the urban-rural dual structure, most rural-to-urban migrants are excluded from local public health services and medical insurance schemes in the cities in which they live. Buying local commercial medical insurance (CMI) is an important way for migrants to obtain local medical services. Therefore, this study’s purposes were to explore the city factors that affect migrants’ purchase of CMI and to investigate the relationship between urbanisation and migrants’ purchase of CMI.MethodsThis study used the 2013 National Floating Population (Migrants) Dynamic Monitoring Survey data, which covered 31 provinces, municipalities, and autonomous regions in China. The respondents were migrants (15–59 years; n = 164,752) who lived in the inflow areas for more than a month without obtaining a local household registration record. We used city factors, neighbourhood factors, and individual factors that affect residents’ purchase of CMI to construct a theoretical framework and examined the effect of urbanisation on migrants’ choice of CMI using multilevel logistic regression.ResultsThe proportion of migrants who had local or hometown CMI was 5.70%; most migrants had no CMI (94.30%). Of these, 4.42% had CMI in the city in which they live (i.e. local CMI) and 1.64% had CMI in their hometown (i.e. hometown CMI). Migrants living in first-tier and third-tier cities were less likely to have CMI than those in second-tier cities (odds ratio [OR] = 0.454, 95% confidence interval [CI]: 0.395–0.521; OR = 0.588, 95% CI: 0.464–0.746). Furthermore, the regression results revealed a U-shaped relationship between the odds of migrants having CMI and the urbanisation rate of the prefecture-level cities. The findings also indicated that with higher socioeconomic status, there was a greater probability of purchasing CMI.ConclusionsThe improvement of urbanisation has a positive effect on migrants’ purchase of CMI. However, China’s medical insurance market is still underdeveloped. It is necessary for the Chinese government to increase migrants’ participation rate in CMI to cover soaring medical expenses.

PCV60 - Analysis of Anticoagulation Therapy In Patients With Pulmonary Embolism Among The Population With Urban Basic Health Insurance In China

To analyze the anticoagulation therapy of patients with pulmonary embolism (PE) among the population with urban basic health insurance in China in 2014. This retrospective analysis identified patients diagnosed with PE in 2014 in the China Health Insurance Research Association (CHIRA) claims database, which is the largest nationwide claims database in mainland China. All of the patients were included if they were aged 18 years and older and their diagnosis included PE based on the ICD-10 codes or the physician’s notes. Patients’ demographic characteristics, prescription drug information and healthcare expenses were also collected from the database. Descriptive statistics of anticoagulation prescription were conducted. A total of 475 PE patients with 1090 hospital visits were identified in 2014 (mean age of 65.87 ± 14.62 years, 47.2% male). Of all patients’ hospital visits, 74.1% were outpatient treatment and 25.9% were inpatient treatment.Of all inpatient visits, 52.1% didn’t receive any anticoagulant therapy, 14.5% received low-molecular-weight (LMWH) and warfarin, 7.8% received unfractionated heparin (UFH) only, 5.3% received LMWH only, 5.3% received warfarin only, 4.3% received LMWH and UFH, 3.5% received UFH and warfarin and 7.1% received other anticoagulant drugs.Of all outpatient visits, 66.3% didn’t receive any anticoagulant therapy, 28.8% received warfarin only, 1.9% received LMWH only, 0.4% received UFH only, 0.1% received LMWH and warfarin, as well as 2.5% received other anticoagulant drugs. More than half of PE patients’ hospital visits didn’t receive any anticoagulant treatment. For PE patients with inpatient treatment, LMWH and warfarin was the most used anticoagulant treatment; while, for PE patients with outpatient treatment, warfarin was the most used anticoagulant treatment.

Evaluating the demand for aquaculture insurance: An investigation of fish farmers' willingness to pay in central coastal areas in China

Despite the remarkable development in its fishery sector, the penetration rate of fishery insurance in China is considerably low. This paper examines the key factors that contribute to the poor performance of fishery insurance, in particular aquaculture insurance, in China. The double-bounded dichotomous choice contingent valuation method (DB DCCVM) is used to investigate fish farmers’ willingness to pay (WTP) for an insurance program, based on a survey of 1280 fish farmers in three coastal cities in China. The results indicate that fish farmers’ decisions on adoption of an insurance scheme depend on various factors, among which magnitude of loss, fish farmers’ awareness toward insurance and their education all have a positive impact. However, income and farming years are more likely to have a negative effect. In addition, the mean WTP for aquaculture insurance is estimated to be CNY 579 (US$ 90.05) 22The exchange rate of 1 US Dollar to Chinese Yuan was 6.43 on 18th June 2018 from Bank of China. per household, which is equivalent to 1.5% of fish farmers' mean annual income. These results provide several policy implications for not only the Chinese government but also researchers as well as insurance companies.

Can Insurance Activity Act as a Stimulus of Economic Growth? Evidence from Time-Varying Causality in China

ABSTRACTThis article investigates the nexus between insurance and economic growth in China with a dynamic interactive mechanism to study different time periods. Using quarterly data from 1999 to 2015, the rolling-window causality test provides evidence of bidirectional causality between insurance activity and economic growth. However, the “supply-leading” pattern tends to dominate the “demand-following” pattern, which implies that in China insurance acts as a stimulus of economic growth during most of the period. Property insurance is more effective than life insurance in stimulating economic growth. Some temporary negative impacts from the development of the insurance sector show that China is in the midst of a transition from a closed economy to a more open economy and policy interventions by the government to liberalize the insurance sector. These findings offer several useful insights for policy makers in transition economies and developing countries.

Is the “One Province One Rate” premium policy reasonable for Chinese crop insurance? The case in Jilin Province

Crop insurance in China is currently adopting the premium pricing strategy of “One Province One Rate”, which appears to be in line with the systematic risk characteristics within crop insurance. This research aims to investigate the theoretical rationalization of this pricing strategy and its implications using the spatial lag model and the county-level data from the 45 corn plant counties of Jilin Province, China. Results corroborate that: (1) the spatial spillover effect of the corn yield risk is significant in Jilin but decreases rapidly when the risk unit includes more than eight counties; and (2) separating Jilin Province into eight risk zones for corn insurance will significantly reduce the high cross-subsidy phenomenon arising from the “One Province One Rate” strategy and shall benefit poor peasants in the region as well. This paper not only proves the existence of a systematic risk of crop insurance but also reveals that the spatial correlation and systemic features of the crop yield risk do not create a solid foundation for the current pricing strategy of “One Province One Rate”. These conclusions will undoubtedly provide important references and empirical evidence for the role of China's crop insurance in poverty alleviation.

Study on Development Plans for Different Types of Internet Insurance in China

중국의 보험시장에는 전통 보험사의 직영 플랫폼, 종합적인 전자상거래 플랫폼, 전문 보험중개 모델, 보험 겸업대리점 모델, 전문 인터넷보험 모델 등 5개 비즈니스 유형이 있다. 본 논문은 유형별 대표적인 회사를 선정하여 사례분석을 진행하고, 각 모델의 장점 및 한계점을 분석하였다. 그 결과, 종합적인 전자 상거래 플랫폼 및 전문 인터넷 보험사 모델은 앞으로 중요한 인터넷보험 운영 모델이 될 것으로 전망된다. 사용자 수와 트래픽면에서 타오바오와 같은 종합적인 전자 상거래 플랫폼 모델이 큰 우세를 보이고 있으며, 전문 인터넷 보험사 모델은 혁신적인 제품에 기반한 경쟁력이 우수하다고 볼 수 있다.Insurance companies or third-party companies insurance are providers of internet insurance product and its service online to customers. There have been five types of business model in China: direct management platform of traditional insurance companies, comprehensive e-commerce platform, professional insurance intermediary, sideline insurance agency, and professional internet insurance. In this papers, each representative company was selected from those five models and analyzed its strength and weakness; and then solutions for current problems in the field were proposed.

Are Farmers’ Behaviors Rational When They Pay Less for Social Endowment Insurance? Evidence from Chinese Rural Survey Data

ABSTRACTIn recent years, farmers have had high participation rate in the rural social endowment insurance in China, for which personal contribution and government subsidy are the main funding source. There have been increasingly more farmers participating into the program. However, their enthusiasm for high premium payment was rather low as most of them selected the minimum premium for insurance. In this article, the discounted utility theory from behavioral economics was adopted to analyze insurance selection behaviors of farmers; in addition, a discounted incremental utility model with a hyperbolic discounting function was also further constructed to describe their insurance decision-making processes. Based on the investigation of time preferences of farmers, their insurance participation behaviors of diverse natures were simulated. The corresponding results indicated that active insurance participation and low insurance premium payment were rational choices for most farmers; in comparison, for the elders with higher income, different choices can be made. Therefore, policy makers could formulate differentiated subsidy policies directing at farmers from different groups, so as to stimulate their enthusiasm for premium payment.

The effect of critical illness insurance in China.

Critical illness insurance to reduce the incidence of catastrophic health expenditure was implemented in China in 2012. The aim of this study is to explore the implementation status and medical guarantee effect of critical illness insurance in various cities.We extracted insurance reimbursement data for 2014 from the critical illness insurance information systems of 4 cities. Characteristics of the critical illness insurance system were used to describe the implementation status. The share of medical expenses reimbursed by insurance and the percentage of individuals suffering catastrophic health expenditures were calculated to evaluate the effect of critical illness insurance.The share of medical expenses reimbursed by insurance was 58.93%, 47.29%, 62.05%, and 61.75% in Beijing, Siping, Yichang, and Zhaoqing, respectively; those shares increased by 5.29 percentage points, 7.72 percentage points, 13.30 percentage points, and 22.63 percentage points, respectively, after the introduction of critical illness insurance. The percentage of individuals suffering catastrophic health expenditures was unchanged in Beijing, but decreased by 7.04 percentage points in Siping, 11.22 percentage points in Yichang, and 2.19 percentage points in Zhaoqing.China's critical illness insurance increases the level of medical guarantee to some extent, but its effect on reducing the incidence of catastrophic health expenditure is somewhat limited.

Reducing the medical economic burden of health insurance in China: Achievements and challenges.

The aims of this study were to describe health insurance reforms initiated by the Chinese government over the past two decades, to review their achievements in reducing the medical economic burden, and to summarize the challenges that still exist regarding a further reduction in out-of-pocket expenditures in this country. China has successfully attained the goal of providing health insurance coverage to almost the entire population by developing a mixed health insurance system, which consists of Urban Employees Basic Medical Insurance (UEBMI), Urban Resident Basic Medical Insurance (URBMI), New Rural Cooperative Medical Scheme (NCMS), and supplementary Catastrophic Health Insurance. Despite this achievement, China is still facing the challenges of a disparity in the medical economic burden by region and by health insurance scheme, relatively little protection from financial risk compared to developed countries, as well as low efficiency and quality of care under current payment systems. To further reduce the disparity in the medical economic burden and to increase the overall protection from financial risk in China, the Government should increase central government transfers to NCMS and URBMI enrollees in poor regions and increase the total amount of government subsidies to NCMS. In addition, China should improve the efficiency and quality of health insurance by further reforming the payment system.

Development of Commercial Health Insurance in China: A Systematic Literature Review.

Facing difficulties like increasing health burden and health inequity, China government started to promote commercial health insurance (CHI) in recent decades. Several policies and announcement have been issued to build up a favorable environment for development of commercial health insurance. Meanwhile, scholar tried to investigate the related issues in purpose to further improve the situation in China. Therefore, we performed this systematic review in order depict a comprehensive picture on the current evidence-based researches of CHI in China. We searched PubMed, ScienceDirect, and CNKI, supplemented with hand search in reference lists, for eligible studies published from 1990 January to 2018 April. Also, hand search was conducted to select suitable articles from international organization and reference list of eligible articles. Two independent reviewers extracted the data from eligible articles and input into a standardized form. Based on the inclusion criteria, 35 articles were included in this systematic review. Most of the studies were quantitative researches with topics such as the development level of commercial health insurance in China, the demand and supply issues related, and the relationship and influence of social health insurance, as well as the moral issues evolved from commercial health insurance system. In summary, CHI in China is still at the early development stage. Among those few evidence-based articles, the findings suggested several policy implication and different market strategy. With the initiation of new health reforms and implementation of taxes policy, more empirical researches should be conducted on issues relating to the practical operation of CHI.

Social health insurance vs private health insurance in China: Revisit crowd-out effect based on a multiple mediation analysis.

Plenty of scholars have studied social health insurance and private health insurance in different economies, and many concentrate on crowd-out effect. Different results have been presented due to various data choices and empirical methodologies, but few of them have revealed the transaction mechanism. We study this issue based on updated Chinese provincial panel data from 2002 to 2014 and improved methods. We focus on how the crowd-out effect happens through 3 channels-saving, demographic factor, and medical expenditure using multiple mediator models. Besides, we apply Panel VAR model to study magnitude of the impact these 3 channels contribute, corporately and respectively. Results clearly show that social health insurance has crowd-out effect in penetration but crowd-in effect in density caused by different mediation variables. In addition, the 3 channels have shown lasting and dynamic influences on the crowd-out (in) effect. Finally, our paper provides the anti-crowd-out solutions from both perspectives according to our empirical analyses. For social health insurance system, it is necessary to improve the efficiency and fairness of the funds. For the private health insurance companies, insurance products innovation and privilege policy should be made to decrease the negative impact of saving and medical service overuse.

Descriptions of self-treatment for the middle-aged and elderly in Shanxi, China.

ObjectivesSelf-treatment is a widespread practice among patients with common symptoms and ailments; it is necessary to explore multiple aspects of it. Notably, there is little research into self-treatment among middle-aged and elderly people, who are more likely to fall ill. Our goals are to provide a comprehensive description of self-treatment and explore associated factors with insurance utilization and expenditures among the middle-aged and elderly populations in China.MethodsA survey was conducted in July 2016 in Shanxi, China. A stratified sampling scheme was applied to achieve representativeness. A total of 972 subjects were surveyed. Descriptive statistics, t- and Chi-squared tests, multivariate logistic regression, and multivariate linear regression were utilized.ResultsIn our study, 772 (79.4%) of the surveyed subjects self-treated during the previous twelve months. Among them, 253 (32.8%) used health insurance. Subjects’ characteristics were associated with insurance utilization and expenditures for self-treatment. Total cost was positively associated with insurance utilization. The subjects with a junior high education (p-value < 0.001, aOR = 0.049) and senior high education (p-value = 0.020, aOR = 0.146) had a lower probability of using insurance. For both total costs and out-of-pocket costs, subjects who were 51 to 60 years old had lower costs. The subjects who were seriously sick and had a primary school education, as well as enterprise occupations, had higher costs. Self-treatment times were also positively associated with costs. Finally, it was found that subjects who didn’t use insurance had lower total costs.ConclusionsThe prevalence of self-treatment was high (79.4%). Some characteristics were associated with insurance utilization and expenditures in self-treatment. Our results may be helpful for policy interventions, which are needed to further improve the effectiveness of health insurance in China.

PHS103 - Medical Expenditures for Patients with Pulmonary Embolism Among the Population with Urban Basic Health Insurance in China

PHS103 - Medical Expenditures for Patients with Pulmonary Embolism Among the Population with Urban Basic Health Insurance in China

Understanding why Chinese contractors are not willing to purchase construction insurance

PurposeConstruction insurance has been advocated as a useful financial means to transfer risks and mitigate potential project losses. However, there is a general reluctance to purchase construction insurance in China. The purpose of this paper is to develop an extended theory of planned behavior (TPB) model to understand and predict contractors’ construction insurance purchasing intention.Design/methodology/approachQuantitative data were collected through a questionnaire survey. The respondents comprise 130 project directors/managers and contract managers/administrators who were involved in or familiar with the construction insurance purchasing or managing. Data were analyzed using structural equation modeling.FindingsThis study developed an extended TPB model to explain the contractors’ intention formation. The results indicated that the insurance purchasing intention was mainly influenced by attitudes and subjective norm, rather than perceived behavioral control. The analyses also revealed that the added variables (risk perception and past experience) had a significant impact on the attitudes and perceived behavioral control.Originality/valueThis study identified the factors leading to Chinese contractors’ low willingness to purchase construction insurance by extending the TPB model to the context of construction insurance purchasing. The extended TPB model may serve as a theoretical framework and basis for the Chinese contractors, insurers, and regulators to understand the root causes of contractors’ low willingness to purchase construction insurance and make joint efforts to address the risks and insurance in the construction industry.

Reimbursement for injury-induced medical expenses in Chinese social medical insurance schemes: A systematic analysis of legislative documents

Social medical insurance schemes are crucial for realizing universal health coverage and health equity. The aim of this study was to investigate whether and how reimbursement for injury-induced medical expenses is addressed in Chinese legislative documents relevant to social medical insurance. We retrieved legislative documents from the China National Knowledge Infrastructure and the Lawyee databases. Four types of social medical insurance schemes were included: urban employee basic medical insurance, urban resident basic medical insurance, new rural cooperative medical system, and urban and rural resident medical insurance. Text analyses were conducted on all identified legislative documents. As a result, one national law and 1,037 local legislative documents were identified. 1,012 of the 1,038 documents provided for reimbursement. Of the 1,012 documents, 828 (82%) provided reimbursement only for injuries without a legally responsible person/party or not caused by self-harm, alcohol use, drug use, or other law violations, and 162 (16%) did not include any details concerning implementation. Furthermore, 760 (92%) of the 828 did not provide an exception clause applying to injuries when a responsible person/party could not be contacted or for situations when the injured person cannot obtain reimbursement from the responsible person/party. Thus, most Chinese legislative documents related to social medical insurance do not provide reimbursement for medical expenses from injuries having a legally responsible person/party or those caused by illegal behaviors. We argue that all injury-induced medical expenses should be covered by legislative documents related to social medical insurance in China, no matter what the cause of the injury. Further research is needed to explore the acceptability and feasibility of such policy changes.