Medical Care Consumption Research Articles

Public hospital reform, family health consumption and health inequality: evidence from China Family Panel Studies.

In 2017, China launched a comprehensive reform of public hospitals and eliminated drug markups, aiming to solve the problem of expensive medical treatment and allow poor and low-income people to enjoy basic health opportunities. This study attempts to evaluate the policy impact of public hospital reform on the health inequality of Chinese residents and analyze its micro-level mechanism from the perspective of household consumption structure. Studying the inherent causal connection between public hospital reform and health inequality is of paramount significance for strengthening China's healthcare policies, system design, raising the average health level of Chinese residents, and achieving the goal of ensuring a healthy life for individuals of all age groups. Based on the five waves of data from the China Family Panel Studies (CFPS) conducted in 2012-2020, We incorporates macro-level statistical indicators such as the time of public hospital reforms, health insurance surplus, and aging, generating 121,447 unbalanced panel data covering 27 provinces in China for five periods. This data was used to explore the impact of public hospital reform on health inequality. Logical and empirical tests were conducted to determine whether the reform, by altering family medical care and healthy leisure consumption expenditures, affects the micro-pathways of health inequality improvement. We constructed a two-way fixed model based on the re-centralized influence function (RIF_CI_OLS) and a chained mediation effects model to verify the hypotheses mentioned above. Public hospital reform can effectively improve the health inequality situation among Chinese residents. The reform significantly reduces household medical expenses, increases healthy leisure consumption, promotes the upgrading of family health consumption structure, and lowers the health inequality index. In terms of indirect effects, the contribution of the increase in healthy leisure consumption is relatively greater. Public hospital reform significantly alleviates health inequality in China, with household health consumption serving as an effective intermediary pathway in the aforementioned impact. In the dual context of global digitization and exacerbated population aging, enhancing higher education levels and vigorously developing the health industry may be two key factors contributing to this effect.

Household health and medical care consumption decisions considering intertemporal uncertainty

To assist residents in exploring the optimal household health and medical care consumption decision-making strategies in an intertemporal uncertain environment, a consumption decision model based on a three-dimensional (3D) path planning PSO-GA-ACO was constructed. The results showed significant differences in the average optimal paths for household health and medical care consumption decisions among residents with different consumption preferences during the three different periods of the Covid-19 pandemic. During the Covid-19 period, the gap in household health and medical care consumption narrowed among residents with different consumption preferences, especially between steady and impulsive consumers. When comparing the post-Covid-19 period with the pandemic period, the monthly health and medical care consumption amounts decreased for both conservative and impulsive consumers, while it continued to rise for steady consumers. The 3D path planning PSO-GA-ACO algorithm improved the speed and accuracy of searching for optimal solutions and better described the decision-making behavior of household health and medical consumption compared to the traditional 3D path planning algorithms PSO, GA, and ACO. This study not only provides optimal household health and medical care consumption decision-making strategies for residents facing complex and uncertain environments but also offers scientific evidence for healthcare manufacturers and suppliers to take effective production and supply actions.

How internet healthcare information overflow affects farmers' healthcare consumption: insights from China.

In the context of the deep coupling and synergistic development of digital villages and healthy villages, the development of China's rural society harbors a huge potential for medical and healthcare consumption. On the basis of theoretical research, a framework was constructed to analyze the influence mechanism of farmers' medical and healthcare consumption in the context of Internet medical information overflow, and empirically examines the research and analysis framework by using the 2020 China Household Tracking Survey data with the OLS model, mediation effect model, and instrumental variable method. It is found that Internet medical information spillover has a "crowding-in effect" on farmers' healthcare consumption; Medical attendance behavior, economic capital utilize the intermediary effect between Internet medical information spillover and farmers' healthcare consumption. And there is age group heterogeneity in the effect of Internet medical information spillover on farmers' healthcare consumption, The ability of rural middle-aged and old-aged groups to recognize new things such as Internet medical information needs to be improved, so the overflow of Internet medical information will induce rural middle-aged and old-aged groups to generate a certain amount of medical and health care consumption. However, the impact on healthcare consumption is not sensitive to the youth cohort group. The sinking of Internet medical resources should be accelerated in the future to promote the high-quality development of rural medical and health services, at the same time the "Internet + healthcare services" should be optimized to promote scientific and rational stratification of farmers' access to healthcare, and economic capital for farmers' access to health care should be improved in order to alleviate the burden of health care, etc.

The landscape of medical care consumption in Israel: a nationwide population cross-sectional study

BackgroundThe Ecology of medical care was first published in 1961. The graphical square model showed that 75% of the population in the US and England experience a feeling of illness during a given month, 25% seek medical help and only one percent are hospitalized. In 2001, Green and colleagues found the same findings despite the many changes that occurred over the past decades. The frequency of illness, the desire for assistance and the frequency of seeking and getting medical assistance may differ in different populations due to cultural, economic, social, demographic background and local Health policy. This work describes the ecology of medical care consumption in Israel for the first time and examines the socio-demographic effects on consumption.MethodsThis is a Nationwide cross-sectional study. A telephone survey was conducted among a representative sample of the adult population (> 15 years) in Israel. Subjective morbidity rate in the preceding month, the rate of those considering medical assistance and those who got assistance were calculated. Correlation between socio-demographic variables and patterns of morbidity and medical care consumption was examined using a t-test and chi square for continuous quantitative and categorical variables. Logistic regression was used for multivariate analysis.ResultsA total of 1862 people participated; 49.5% reported having symptoms in the previous month, 45% considered seeking medical advice, 35.2% sought out medical assistance and only 1.5% were hospitalized. The vast majority chose to contact their family physician (58%) and the primary care setting provided their needs in 80% of the cases; Subjective morbidity and medical care consumption differed significantly between Israeli Jews and Arabs. Gaps in the availability of medical services were observed as residents of the periphery forewent medical services significantly more than others (OR = 1.42, p = 0.026).ConclusionsSubjective morbidity is less common in Israel than in other countries, but paradoxically consumption of medical services is higher. An Israeli who feels ill will usually consider receiving assistance and will indeed receive assistance in most cases. However, a greater tendency to forego medical services in the periphery indicates barriers and inequality in the provision of health services. Different cultural perceptions, lack of knowledge and low accessibility to medical services in the periphery probably contribute to the contrast shown between low consumption of medical services and high prevalence of chronic illness in Arab society. The prevailing preference for family medicine and its ability to deal with most requests for assistance suggest that strengthening family medicine in the periphery may reduce those barriers and inequalities.

The Effects of Social Network and Institutional Embeddedness on Household Consumption: Evidence from China Household Finance Survey

Consumer behavior is embedded in a certain social structure and social networks, and the scale and density of household social networks will be likely to affect consumption expenditure. To explore the impact of social networks and institutional embeddedness on household consumption, this study constructs a model of consumption influencing factors, and devises an empirical study using the data of China Household Finance Survey (CHFS). The results show some innovation. (1) The impact of household social networks on total household consumption is significant. A 1% increase in social networks spending boosts household consumption spending by 0.364%. (2) The institutional embeddedness will affect household consumption. Every 1% increase of social security account balance (the proxy variable of institutional embeddedness) can boost household consumption by 0.196%. This proves that the social insurance institution can enhance consumer confidence and promote current consumption growth. (3) The results of the robustness test confirmed that even after replacing the dependent variable with “the proportion of developmental consumption in total household consumption,” the influence of social networks and institutional embeddedness on consumption is still significant. Using the variable “communication expenses” instead of “gift income and expenditure” as the proxy variable of social networks, the estimation result is still robust. (4) Social networks have a significant influence on all types of household consumption except medical care consumption, but the degree of influence is different. Further discussion revealed that the estimation results are different for different regions in China, but the coefficients of core independent variables are not significantly different. This conclusion is different from people’s intuition, which holds that people in regions with low economic development rely more on social communication and spend more on social communication to maintain a certain social status. The conclusion of this paper is of great significance for formulating policies and institutions affecting residents’ consumption.

Socioeconomic Disparities in Health Care Consumption: Using the 2018-China Family Panel Studies.

The existing research on residents’ health care consumption mostly covers medical care consumption and seldom regards residents’ health care consumption as an independent research object. This article takes residents’ healthcare consumption as the research object and aims to explore the impact of socioeconomic status on healthcare consumption and its mechanisms. The data of this study came from the 2018-China Family Panel Studies (CFPS). The binary probit regression model and the Tobit model explored the impact mechanism of residents’ income, education, occupation, and physical activity on health care consumption decision-making and health care expenditure, respectively. The research results showed that, from the perspective of the direct influence mechanism, residents’ work income (0.029, p < 0.01) and education level (811.149, p < 0.01) had a significant positive impact on health care consumption. Residents whose occupations (−99.697, p < 0.01) tend to be more skilled and also have higher health care consumption. From the perspective of the mediating mechanism, residents’ physical exercise duration had a significant positive impact on their participation in healthcare consumption (0.005, p < 0.01) but had a weaker impact on healthcare consumption expenditure (21.678, p < 0.1). In general, socioeconomic status represented by income, education, and occupation had a significant positive impact on residents’ health care consumption. The duration of physical exercise also played an important mediating role.

Moral hazard and its implications on health insurance sector – overview of impact of COVID-19 pandemic

Kenneth J. Arrow’s disruptive work, 'Medical Uncertainty and Welfare Economics’, published in 1963, was one of the first studies investigating the effects of moral hazard on the healthcare sector. Since then, countless works exploring that subject have been published. The history of research on moral hazard in medical insurance shows that this concept is defined differently in other areas of the economy than healthcare. Purpose – The proposed work is an attempt to understand and conceptualize the moral hazard in health insurance. As uncommon circumstances marked 2020, we now consider health insurance through the impact of the SARS-CoV-2 pandemic. This work discusses the results of an investigation of the impact of moral hazard and its implications on the health insurance sector during COVID-19. Research method – The author designed and conducted a study that presented several metrics involving the distribution of medical expenditures, the effect of price on medical care consumption, the PLS (profit and loss sharing) concept, and their mediating and moderating effect on moral hazard in the insurance sector. Results – There is a statistically significant and very strong relationship with a positive sign (β = 0.79; p &lt;0.001) between the price effect and the moral hazard. The analyses show also that the price effect coexists statistically with the PLS, and the relationship between these variables is moderately strong and positive (β = 0.79; p &lt;0.001). Originality – Insignificant relationship between the PLS and the moral hazard can be seen while the price is entered into the model (β = 0.03; p = 0.450). The lack of mediation could confirm that the price effect plays a major role in a moral hazard.

The effect of education level on intensity of using medical care by women of reproductive age

The education is often considered as one of the basic social determinants of population health, but its impact on the need for medical care is to be studied. The purpose of the study is to analyze effect of education as health social determinant on intensity of medical care consumption by women of reproductive age. The sampling consisted of 566 non-pregnant women aged 18-49 years residing in Samara and being monitored in municipal antenatal clinics. The level of territorial accessibility of medical care for all women participating in the study did not differ reliably. The data was obtained using anonymous survey with adapted questionnaire "Research of social determinants of health". The first comparison group included 306 women with higher or incomplete higher education (high educational status). The second comparison group included 260 women with secondary or specialized secondary education (lower educational status). Each of the groups was divided into four subgroups based on age characteristic (18-25, 26-34, 35-42, 43-49 years). In the group of women with a high educational status, volume of consumption of out-patient medical care were higher and decreasing of health self-rating was accompanied by decreased rate of visits to ambulatory physicians (r = -0.67). Whereas in women with low educational status, decreasing of health self-rating is accompanied by decreased rates of visits to ambulatory physicians (r=0.5). With age increased, volume of out-patient medical care consumption in group of women with high educational status increases, while in group of women with low educational status this volume decreases. The lower rate of out-patient medical care consumption results in increasing of volume of in-patient medical care consumption in the group of women with low educational status. Despite the same increasing dynamics of volume of consumption of in-patient medical care in women with different educational statuses, gain rate of demand is significantly higher in group of women with low educational status (1.42% versus 2.54% of annual gain in consumption). More significant increase in consumption of emergency medical care was observed in group of women with low educational status (annual increase 3% versus 0.22%).

The application of smart fibers and smart textiles

In recent years, domestic and foreign research on smart fibers and smart textiles has achieved many results, and has been increasingly widely used in the textile field. This article introduces the functions of smart fibers and the main seven types of smart fibers, as well as a brief description of shape memory textiles, color-changing textiles, smart temperature control textiles, waterproof and moisture-permeable textiles, self-cleaning textiles, and electronic information smart textiles. At present, smart fibers and smart textiles are mainly used in the fields of medical health care, military protection, entertainment sports, and clothing consumption. At the same time, their prospects and markets are pointed out. Smart fibers and smart textiles have unlimited development potential and prospects.

How Do Health, Care Services Consumption and Lifestyle Factors Affect the Choice of Health Insurance Plans in Switzerland?

In compulsory health insurance in Switzerland, policyholders can choose two main features, the level of deductible and the type of plan. Deductibles can be chosen among six levels, which range from CHF 300 to 2500. While the coverage and benefits are identical, insurers offer several plans where policyholders must first call a medical hotline, consult their family doctor, or visit a doctor from a defined network. The main benefit of higher deductibles and insurance plans with limitations is lower premiums. The insureds’ decisions to opt for a specific cover depend on observed and unobserved characteristics. The aim of this research is to understand the correlation between insurance plan choices and lifestyle through the state of health and medical care consumption in the setting of Swiss mandatory health insurance. To do so, we account for individual health and medical health care consumption as unobserved variables employing structural equation modeling. Our empirical analysis is based on data from the Swiss Health Survey wherein lifestyle factors like the body mass index, diet, physical activity, and commuting mode are available. From the 9301 recorded observations, we find a positive relationship between having a “healthy” lifestyle, a low consumption of doctors’ services, and choosing a high deductible, as well as an insurance plan with restrictions. Conversely, higher health care services’ usage triggers the choice of lower deductibles and standard insurance plans.

ИНСТИТУЦИОНАЛЬНЫЕ УСЛОВИЯ И МЕХАНИЗМЫ СГЛАЖИВАНИЯ СОЦИАЛЬНОГО НЕРАВЕНСТВА ПОТРЕБИТЕЛЕЙ МЕДИЦИНСКОЙ ПОМОЩИ В РОССИЙСКОМ ОБЩЕСТВЕ

В статье рассматриваются практические подходы к снижению степени дифференциации потребления медицинской помощи в современном российском обществе. Актуальность исследования продиктована необходимостью создания доступного и эффективного пространства здравоохранения в России. Новизна работы заключается в определении противоречия между явными функциями и реальными интересами различных агентов в системе здравоохранения. Особое внимание уделяется последствиям сокращения государственного участия в сфере здравоохранения. Доказывается, что в основном интересы государства и потребителей в сфере медицинского обеспечения сходятся. Однако общество до сих пор ожидает поддержки и заботы со стороны государства, а государство постепенно снижает степень своего участия. Автором выделены теоретические и методологические предпосылки социологического понимания социальных различий в сфере потребления медицинской помощи, а также определен комплекс мер позитивизации поведенческих стратегий акторов в контексте трансформации института здравоохранения в современной России. Сглаживание дифференциации потребления медицинской помощи зависит от функционирования регулирующего, интериоризирующего и воспроизводящего институциональных механизмов. Показано, что институциональный механизм – это система согласования и упорядочения интересов различных агентов посредством разработки и установления формальных и неформальных социальных норм в сфере здравоохранения с их последующей интериоризацией и социальным воспроизводством. Особое внимание уделяется анализу поведенческих и структурных измерений неравенства в доступности медицинской помощи. Обосновывается идея о том, что усиление государственного контроля − необходимая мера в сфере медицинского обеспечения, но стимулы к модернизации здравоохранения в бюджетно-страховой модели крайне слабы. Автор приходит к выводу о возможности сглаживания социального неравенства потребителей медицинской помощи посредством конкретизации гарантий бесплатной медицинской помощи и ответственности агентов, сокращения непосредственных платежей пациентов, интеграции процесса лечения, социального диалога и инфосоциализации агентов.

Nurses′ experiences of using WeChat to assist health education for patients with PICC-line: a qualitative study

Objective To examine nurses′ experiences regarding the benefits and obstacles of using WeChat in health education for patients with PICC-line. Methods A semi-structured interview was conducted with 12 nurses who using WeChat to assist health education for patients with PICC-line. Data were analyzed based on Colaizzi′s phenomenological research method. Results Ten themes of three aspects were extracted: the benefits of using WeChat in health education include reduction in medical care consumption and costs, reduction in workload, facilitating improvement in the quality of care, promotion of the nurse–patient relationship, improvement in self-worth and professional knowledge; the obstacles of using WeChat in health education include perceived risk, disturbance to personal life, Sense of uncertainty; the advice of using WeChat in health education. Conclusions Exploring the experiences and obstacles of nurses regarding using WeChat in health education for patients with PICC-line can help improve the quality of health education and meanwhile provide the reference and basis for clinical health education. Key words: Catheterization; Central venous; WeChat; Health education; Qualitative research; Nurses

The role of housing wealth, financial wealth, and social welfare in elderly households' consumption behaviors in China

China is facing great challenges in providing decent living conditions for the elderly. The effects of housing wealth and the social welfare system on elderly households' consumption behaviors have been widely explored, but little is known about the heterogeneous effects of various wealth sources on consumptions of different economic groups of the elderly. Taking into account regional differences, this paper investigated the extent to which housing wealth, financial wealth, and social welfare influence the consumption behaviors of the elderly of various economic status. We employed the linear mixed model estimation and quantile regression by using the China Household Finance Survey data collected from 2011 to 2015. Results showed that a large urban–rural gap exists between the eastern, central, and western regions of China. Housing wealth exerts limited effects on the urban elderly households' consumption behaviors but has significant positive effects on the rural elderly households' consumption. The financial wealth and pension may offset part of the consumption inequality generated from annual household income. An increasing pension contributes more to medical and health care consumption for the poor households. Policymakers need to enhance the social welfare system to take care of the most vulnerable elderly group in the first place.

Механизмы дифференциации потребления медицинской помощи в России: методологический поворот в современных социологических исследованиях

Механизмы дифференциации потребления медицинской помощи в России: методологический поворот в современных социологических исследованиях

INSURANCE‐INDUCED MORAL HAZARD: A DYNAMIC MODEL OF WITHIN‐YEAR MEDICAL CARE DECISION MAKING UNDER UNCERTAINTY

AbstractThis study quantifies the moral hazard effect of health insurance on medical expenditure by estimating a dynamic model of within‐year medical care consumption that allows for insurance selection, endogenous health transitions, and individual uncertainty about medical care prices in an environment where insurance has nonlinear cost‐sharing features. The results suggest that moral hazard accounts for 53.1%, on average, of total annual medical expenditure when insured. This estimate is significantly different, and generally larger, than that produced by an alternative model that is representative of the annual medical care decision‐making models commonly found in the literature.

An Analytical Model of Demand for Hospital Inpatient Care

This paper presents an analytical model of demand for curative care such as hospital inpatient care. In this essay, a person's illness is used as a measure of the person's health status. Medical care and non-medical consumption are the choice variables in a consumer’s constrained utility-maximization problem. Methodologically, this model of demand for medical care does not rely on capital theory, common in the literature. All else equal, a person's demand for hospital inpatient care depends on how ill the person is. That is, the demand is a function of the severity of the person's illness. The model is static and deterministic, and is based on the fact that, by definition, only sick persons demand curative medical care. One implication of distinguishing curative care from other types of care is the possibility of satiation when the person is healthy. Satiation diminishes differences in medical care expenditures between wealthy and poor persons and can help explain the empirically observed low income elasticity of demand for hospital inpatient care.

Reference Health and the Demand for Medical Care

We propose that health in prior periods, termed reference health, is theoretically and empirically relevant to the demand for medical care. To address non‐normality in the distributions of medical care spending, consumption, and health, we use a conditional density estimator nested in a finite mixture framework. We find that reference health can help explain the variation in spending among individuals with the same contemporaneous health, particularly in the top tail of the spending distribution. We demonstrate that omitting reference health understates the potential cost‐savings of healthy aging initiatives by 50%.

Anti-osteoporotic treatments in France: initiation, persistence and switches over 6years of follow-up.

This epidemiological, longitudinal study described first-line treatment initiation, persistence, switches to second-line treatment, and medical care consumption in osteoporotic patients in France during the 2007-2013 period. Patients aged ≥50years, who were recorded in a French claims database and did not die during the observation period, were included if they met ≥1 inclusion criteria for osteoporosis in 2007 (≥1 reimbursement for anti-osteoporotic treatment, hospitalisation for osteoporotic fracture (spine, hip, femur, forearm bones, humerus, wrist), or ≥1 reimbursement for long-term osteoporosis-associated status). We collected data on consumption of anti-osteoporotic treatment (alendronic acid, ibandronic acid, risedronic acid, zoledronic acid, raloxifene, strontium ranelate, teriparatide) and of osteoporosis-related medical care after the date of first reimbursement for anti-osteoporotic treatment. We obtained 2219 patients with a 6-year follow-up and 1387 who initiated an anti-osteoporotic treatment in 2007 and who can be selected for the treatment regimen analysis. The most frequently used first-line treatments were alendronic acid (32.7%), risedronic acid (22.4%), strontium ranelate (19.3%), ibandronic acid (13.1%) and raloxifene (12.2%). Among patients who received these treatments, the highest persistence after 6years was observed for raloxifene (37.3%), alendronic acid (35.1%) and risedronic acid (32.3%). Treatment discontinuations were reported for 35.5% (raloxifene) to 53.4% (strontium ranelate) and treatment switches for 27.4% (alendronic acid) to 56.6% (ibandronic acid) of these patients. This study showed that persistence with anti-osteoporotic treatment was relatively low in France, with high proportions of treatment discontinuations and switches, and that patients with osteoporosis were insufficiently monitored by bone specialists.

Using the age-based insurance eligibility criterion to estimate moral hazard in medical care consumption

This paper uses fuzzy regression discontinuity design to estimate the moral hazard effect in health care consumption in the population of young adults. We use invoice data for outpatient hospital services from a regional hospital in Croatia.The estimation is complicated by the fact that the data set consists only of users of medical services, which would tend to underestimate the moral hazard effect. To address this issue we use a modified version of the instrumental variables approach.We find a 92% reduction in the number of hospital visits for individuals who lost insurance coverage when crossing the 18th birthday threshold.

Nurses' experiences of using a smart mobile device application to assist home care for patients with chronic disease: a qualitative study.

To examine nurses' experiences regarding the benefits and obstacles of using a smart mobile device application in home care. The popularity of mobile phones and Internet technology has established an opportunity for interaction between patients and health care professionals. Line is an application allowing instant communication that is available for free globally. However, the literature relating to use of Line in this area is limited. A qualitative study involving individual in-depth interviews. Participants included community nurses (N=17) from six home care facilities in southern Taiwan who had used Line for home care of chronically ill patients for at least six months. The study was conducted using semi-structured in-depth interviews, which were recorded and converted into transcripts for content analysis. Seven themes emerged from data analysis: reduction in medical care consumption and costs, reduction in workload and stress, facilitating improvement in the quality of care, promotion of the nurse-patient relationship, perceived risk, lack of organisational incentives and operating procedures and disturbance to personal life. Nurses considered Line valuable for use in home care. While this application has diverse functions, its video transfer function could in particular help nursing staff make prompt decisions about patients' problems and promote nurse-patient relationships. However, there might be hidden risks including legal consequences, safety risks to patients, possible violations of professionalism and increased risk of nurse burnout. Increasing nursing staff awareness of using mobile messaging software applications is necessary. This study provides relevant information about the benefits, disadvantages, risks and limitations of nurses' use of Line. The study also provides suggestions for software programmers and future organisational strategy and development.