Insurance Reform Research Articles

Health Insurance and Self-Rated Health from Adolescence to Early Midlife in the U.S.

Although health insurance is a critical tool for wellbeing across the life course, few studies have explored the long-term health implications of shifts in insurance coverage. This study examined whether changes in insurance types from adolescence to early midlife were associated with early midlife self-rated health. This study used data from Wave I (1994-1995; average age 15.7 years), Wave IV (2008-2009; average age 28.7 years), and Wave V (2016-2018; average age 37.6 years) of Add Health, including 6,765 respondents from 1994-2018. Logistic regression was used to examine the association between health insurance status from adolescence to early midlife and early midlife self-rated health. The analyses were conducted from March - August 2024. Relative to having private insurance in adolescence and early midlife, the following health insurance statuses in adolescence and early midlife were significantly associated with poorer early midlife self-rated health: public in adolescence and early midlife (AOR=3.34; 95% CI=1.89, 5.91); uninsured in adolescence to public at early midlife (AOR=3.29; 95% CI=1.85, 5.85); private in adolescence to public at early midlife (AOR=3.36; 95% CI=2.46, 4.58), and private in adolescence to uninsured at early midlife (AOR=1.68; 95% CI=1.10, 2.55). Health insurance statuses from adolescence to early midlife, specifically having or switching into public insurance, may be associated with poorer health in early midlife among individuals who were adolescents in the early 1990s. More research is needed to explore how insurance reform such as the Children's Health Insurance Program may have mitigated this association in future cohorts.

China’s public long-term care insurance and risky asset allocation among elderly households

China’s elderly households are characterized by higher holdings of cash and cash equivalents and lower holdings of stocks and bonds in their financial portfolios. We utilize the public Long-term Care Insurance (LTCI) reform and data from the China Health and Retirement Longitudinal Study (CHARLS) to examine how LTCI coverage affects risky asset holdings among newly insured elderly households. Employing a difference-in-differences methodology, our findings reveal that LTCI significantly increases the share of risky assets in the financial portfolios of older families. The increased preference for risky assets may be a result of a weakening incentive for precautionary savings. Decomposing risky assets into bonds and stocks, we find that the increase in the share of risky assets following the LTCI pilot comes mainly from bond investments rather than stocks, which indicates that LTCI has a limited effect on risk asset holdings among the Chinese elderly. Our study contributes to understanding the economic impacts of China’s public LTCI by showing that LTCI may lead to changes in asset allocation strategies among elderly households.

Welfare effects of health insurance reform: The role of elastic medical demand

Some medical demand is inelastic to price fluctuations, but not all. This paper examines the role of the price elasticity of medical demand on the welfare effects of public health insurance reform. I develop a computational general equilibrium life-cycle model for heterogeneous agents with varying income, wealth, and health that allows for endogenous medical spending. I calibrate the model for the Japanese economy. If medical spending is totally price-inelastic, increasing copayments will improve the welfare of future generations, but harm all current generations, particularly older people with low income or poor health. In contrast, the welfare gain for newborns is significantly greater in the empirically observed situation where medical spending includes some price-elastic components. Moreover, the reform reduces welfare losses for current individuals and may benefit younger generations.

New rural pension scheme, intergenerational exchange, and intergenerational economic support of the rural elderlies: a study from the perspectives of classical altruism theory and exchange motivation theory

As the severity of rural old-age care in China becomes increasingly evident, the manner in which rural elderly individuals obtain economic support has emerged as a significant societal concern. Central to this paper is the question of whether the new rural pension scheme, as the first government-provided institutional pension, influences the longstanding intergenerational economic support within families. Drawing upon classic altruism theory and exchange motivation theory, this study analyzes the complex rural social reality in China. Using data from the China Health and Retirement Longitudinal Study (CHARLS) for the years 2013 and 2015, we employ a two-part model to examine the policy effects of new rural pension scheme, as well as the 2014 pension insurance reform and pension increase. Our findings reveal that (1) altruism and exchange motivation coexist in the rural Chinese social reality and jointly influence the behaviors of rural families. (2) Intergenerational economic support for the elderly in rural Chinese families primarily depends on the exchange motivation aspect of intergenerational care. Thus, it is vital to strengthen the intergenerational support of the family in addressing the pensions of the elderly in rural China.

A Proposed Condition-Based Risk Adjustment System for the Colombian Health Insurance Program

This article explores the development of a condition-based risk adjustment system for healthcare financing in Colombia, where the current age-, sex-, and geographic-based system faces significant challenges. These shortcomings, including inadequate compensation for high-risk members, necessitate workarounds that compromise efficiency. We propose a condition-based system that provides more accurate and equitable compensation, eliminating the need for special payments. This research discusses the existing issues in the current system, details the construction process of the condition-based risk adjustment system, and assesses its accuracy. This study not only offers an alternative to the current compensation system but also contributes to the broader discourse on health insurance reform.

Impact of medical insurance integration on reducing urban-rural health disparity: Evidence from China

The urban-rural health disparity poses a significant challenge for countries worldwide. China encounters substantial disparities in healthcare services and health outcomes between urban and rural regions. In 2015, the Chinese government integrated the medical insurance schemes for urban and rural residents into a unified program, with the goal of mitigating the disparities and enhancing the sustainability and efficiency of the medical insurance system. Using data from the China Health and Retirement Longitudinal Study (CHARLS), we explored the impact of this integration on health outcomes and the health disparity between urban and rural residents, employing a triple difference approach with propensity score matching. We found that both urban and rural residents benefited from the medical insurance reform, experiencing improvements in their health outcomes to some extent. Urban residents reported better self-reported health, while rural residents exhibited improved health in terms of both self-reported health and number of diagnosed diseases. Notably, the disparity in activities of daily living (ADL) difficulties decreased. However, we also observed a worsening trend in ADL difficulties, especially among the elderly and the working population. This underscores the urgent need for further attention to health behaviors and healthcare resource allocation to these socio-demographic groups.

Evaluating the effect of health insurance reform on health equity and financial protection for elderly in low- and middle-income countries: evidences from China

BackgroundTo achieve Universal Health Coverage (UHC), China have implemented health system reform to expend health coverage and improve health equity. Scholars have explored the implementing effect of this health reform, but gaps remained in health care received by elderly. This study aims to assess the effect of implementing health insurance payment reform on health care received by elderly, as well as to evaluate its effect on cost sharing to identify whether improve financial protection of elderly under this reform.MethodsWe identified hospitalization of 46,714 elderly with cerebral infarction from 2013 to 2023. To examine the determinant role played by DRGs payment reform in healthcare for elderly and their financial protection, this study employs the OLS linear regression model for analysis. In the robustness checks, we validated the baseline results through several methods, including excluding the data from the initial implementation of the reform (2021), reducing the impact of the pandemic, and exploring the group effects of different demographic characteristics.ResultsThe findings proposed that implementing DRGs payment reduces drug expenses but increases treatment expense of chronic disease for elderly in China. This exacerbates healthcare costs for elderly patients and seems to be contrary to the original purpose of health care reform. Additionally, the implementation of DRGs payment reduced the spending of medical insurance fund, while increased the out-of-pocket of patients, revealing a shift in health care expenses from health insurance fund to out-of-pocket.ConclusionsThis study shares the lessons from China’s health reform and provides enlightenment on how to effective implement health reform to improve health equity and achieve UHC in such low- and middle-income countries facing challenges in health financing.

A few thoughts on the transition period of pension insurance reform on the personnel management work of universities in China

A few thoughts on the transition period of pension insurance reform on the personnel management work of universities in China

Using an internet-based platform to provide online and offline healthcare services for discharged patients

BackgroundContinuing care is needed for the growing number of chronically ill patients who struggle with health problems after discharge. This study aims to elucidate the development process, functionalities, service protocols, and utilization of an Internet Plus Care (IPC) platform devised by our hospital to offer healthcare services to discharged patients.MethodsThis was a mixed study. After describing the development process, function and usage of IPC platform, we retrospectively collect data such as the general information of service recipients and service providers, service items, and service prices through the IPC platform from January 2021 to September 2023 to characterize these services.Results69 nurses delivered a total of 788 services to 211 patients through the IPC platform. The majority of services (N = 652, 82.7%) were delivered offline, with almost half of the recipients (N = 384, 48.7%) being elderly individuals. 46.4% of nurses provided services ≥ 3 times. Furthermore, 26.5% of patients received services three or more times. Notably, patients’ care requirements exhibited variations across age groups, with wound care (n = 243, 63.3%), pressure injuries care (n = 50, 13.0%), and replacement of indwelling nasogastric tubes (n = 20, 5.2%) emerging as the top three services favored by the elderly.ConclusionsThe IPC platform demonstrates potential in delivering diverse health services to patients; however, the involvement of nurses and patients needs to be enhanced. It is necessary to implement relevant safeguard policies to promote the effective use of IPC platform for health management of discharged patients in the future.What does this paper contribute to the wider global clinical community?The prevalence of chronic diseases is on the rise, and patients with chronic diseases continue to struggle with health problems after discharge and require extended treatment and rehabilitation. Our study proves that IPC platform presents a promising avenue for addressing these challenges.It is anticipated that governmental authorities will undertake comprehensive policy, legislative, and medical insurance reforms to facilitate the extensive adoption of IPC platform-based services.

Financial Distress in Genitourinary Cancer: Insights From CDC National Health Interview Survey.

This study leverages CDC National Health Interview Survey data to examine Financial Distress (FD) among genitourinary (GU) cancer survivors, specifically prostate cancer (PC), kidney cancer (KC), and bladder cancer (BC). It investigates the economic impacts faced by these patients, especially in relation to disparities in insurance coverage and its effects on material, psychological, and behavioral aspects of FD. We retrospectively analyzed responses from GU cancer survivors, stratifying by cancer status and age (18-64 years, ≥65 years). Medical financial hardship was divided into three domains: material, psychological, and behavioral. Associations between cancer history, hardship, and clinical factors were assessed using generalized ordinal logistic regressions. Significant health care access disparities were found, particularly for mental health services, with 25% of younger BC survivors and 4.7% of younger KC survivors reporting affordability issues, in contrast to 2.7% of noncancer individuals. Dental care was also problematic, with higher avoidance rates among younger BC (27%) and KC (15%) survivors compared with the general population. Surprisingly, noncancer individuals reported more difficulty in affording prescriptions than BC survivors across both age groups. PC survivors, however, showed lower FD across all domains versus noncancer controls, indicating fewer concerns about medical bills and a lesser tendency to forgo care. The study underscores significant gaps in the financial support system for GU cancer survivors, with urgent needs in mental and dental health care access. Policy interventions, including comprehensive insurance reforms, are imperative to alleviate the financial burdens on these individuals.

HPR152 The Impact of Insurance Reform on Health Resource Utilization and Persistence for Chinese Patients With Crohn’s Disease, Taking Ustekinumab as an Example: Evidence From a Natural Experiment Study

HPR152 The Impact of Insurance Reform on Health Resource Utilization and Persistence for Chinese Patients With Crohn’s Disease, Taking Ustekinumab as an Example: Evidence From a Natural Experiment Study

Insurance Disparities in Quality of Care Among Patients With Head and Neck Cancer

Significant insurance status disparities have been demonstrated in head and neck cancer (HNC) outcomes. The effects of insurance status on HNC outcomes may be explained by differential access to high-quality care. To evaluate the association of insurance status with the quality of the treating hospital and receipt of guideline-compliant care among patients with HNC. This retrospective cohort study of data from the California Cancer Registry dataset linked with discharge records and hospital characteristics from the California Department of Health Care Access and Information included adult patients with HNC diagnosed between January 1, 2010, and December 31, 2019. Data were analyzed from May 10, 2023, to March 25, 2024. Insurance status: commercial, Medicare, Medicaid, uninsured, other, or unknown. Quality of the treating hospital (tertiles), receipt of National Comprehensive Cancer Network guideline-compliant care, and overall survival. A total of 23 933 patients (mean [SD] age, 64.8 [12.3] years; 75.3% male) met the inclusion criteria. Treatment in top-tertile hospitals (hazard ratio, 0.87; 95% CI, 0.79-0.95) was associated with improved overall survival compared with treatment in bottom-tertile hospitals. Medicare (odds ratio [OR], 0.78; 95% CI, 0.73-0.84), Medicaid (OR, 0.60; 95% CI, 0.54-0.66), and uninsured (OR, 0.38; 95% CI, 0.29-0.49) status were associated with lower likelihood of treatment in high-quality hospitals compared with commercial insurance. Among patients with advanced disease, Medicaid (OR, 0.72; 95% CI, 0.62-0.83) and uninsured (OR, 0.64; 95% CI, 0.44-0.93) patients were less likely to receive dual-modality therapy. Among patients with surgically resected advanced disease, Medicaid coverage (OR, 0.73; 95% CI, 0.58-0.93) was associated with lower likelihood of receiving adjuvant radiotherapy. This study found significant insurance disparities in quality of care among patients with HNC. These findings highlight the need for continued health insurance reform in the US to improve the quality of insurance coverage, in addition to expanding access to health insurance.

Analysis and discussion on the pharmaceutical centralized procurement implementation - a case study of a large provincial hospital in China.

Unaffordable medical treatment and inflated drug prices have become a challenging issue for lawmakers worldwide. To reduce the financial burden and standardize the pharmaceutical market, the Chinese government has issued several detailed regulations, including the measures of drug recruitment and procurement in one and volume purchasing to not only ensure the high quality of approved drugs but also lower the cost of the production and sell procedure. In this work, to have a thorough overview of the enforcement of these regulations, we attempted to critically analyze the data of our hospital's centralized procurement of drugs from 2019 to 2022. We identified some concerns, such as the difficulty in determining the "quantity" of drug procurement, out-of-stock of collectively procured drugs, difficulty in managing the preallocation of associated funds, incomplete centralized procurement systems, etc. Therefore, it is essential to promote a multidimensional strategy, including the combination of the medical insurance reform and drug centralized procurement policies, strict controlling of the forecast quantity of drugs to ensure stable drug supply, improvement of the relevant policies for retaining the surplus of centralized procurement drug medical insurance funds, secureness of the drug procurement system platform, and available reference and guidance for subsequent centralized quantity procurement of drugs.

Labour market exit routes in high- and low-educated older workers before and after social insurance and retirement policy reforms in Sweden

Labour market exit routes in high- and low-educated older workers before and after social insurance and retirement policy reforms in Sweden

A Blueprint for U.S. Health Insurance Reform.

The current U.S. health insurance "system" was not deliberately planned and constructed but has emerged piecemeal over the past half-century through a series of incremental and haphazard reforms. That policy history also reveals a clear but unfulfilled societal commitment to providing access to essential health care regardless of resources. To fulfill this obligation, the solution proposed in this article has 2 key elements: 1) universal coverage that is automatic, free, and basic, and 2) the option to buy supplemental coverage in a well-designed market. Such a system could, if desired, be created without raising taxes and without disrupting or changing the delivery of medical care.

Older Carers and Social Division of Welfare in China

This study used the social division of welfare approach to analyze how Chinese older carers have access unequally to pensions, medical insurance, and public assistance schemes. Face-to-face interviews were conducted with 40 older carers aged 60 years or above who were taking care of their family members with disabilities or chronic illnesses. The amount of pension and coverage of medical insurance of these respondents and their care recipients was affected by their employment, types of employers, and living locations. Moreover, the older carers’ capacity to address financial and medical burdens was associated with the available support from their family members, especially their adult children. This paper concludes that the social division of welfare amongst older carers was driven by China’s market-oriented pension and medical insurance reforms, decentralization of welfare provisions, and the welfare capacity of families. Future studies can examine the social division of welfare among young and minority ethnic carers and adopt a comparative approach to analyze factors shaping unequal access to welfare benefits among older carers in different countries.

Research on the Strategies for Improving Satisfaction with Outpatient Nursing Services under the Background of Medical Insurance Reform

Research on the Strategies for Improving Satisfaction with Outpatient Nursing Services under the Background of Medical Insurance Reform

Exploring the Obligations to Complete Insurance Reforms in Lesotho

Exploring the Obligations to Complete Insurance Reforms in Lesotho

Gender gap in STEM entrepreneurship: Effects of the Affordable Care Act reform

AbstractResearch SummaryThis article examines whether the Affordable Care Act (ACA) health insurance reform reduced the gender gap in science, technology, engineering, and mathematics (STEM) entrepreneurship. I argue that the ACA mitigated mobility constraints imposed by employer‐provided health insurance and encouraged entrepreneurship with important contingencies: effects were limited to women because of gender differences in supply‐side cost reduction and demand‐side health insurance needs and were specific to women in STEM (vs. non‐STEM) entrepreneurship because of the human and financial capital needed to navigate insurance markets. Leveraging the ACA quasi‐experiment, I find consistent evidence of a reduced gender gap in STEM entrepreneurship. Surprisingly, the effects were driven by increased STEM entrepreneurship for married women founding unincorporated businesses. Qualitative interview insights and empirical findings provide explanations for these patterns.Managerial SummaryThis study examines whether the science, technology, engineering, and mathematics (STEM) entrepreneurial gender gap can be reduced by institutional factors mitigating labor market mobility constraints imposed by employer‐provided work benefits. Through the lens of the US ACA reform, I find that broadened access to more affordable health insurance in the alternative individual insurance markets disproportionately encouraged female (vs. male) STEM (vs. non‐STEM) entrepreneurship, thus reducing the STEM entrepreneurial gender gap. Contrary to common assumptions, this effect is driven by married (vs. unmarried) women and is in unincorporated (vs. incorporated) self‐employment. The findings help discern which groups benefit from policy efforts to promote diversity in STEM entrepreneurship and imply that the effectiveness of employer‐provided work benefits as retention tools is dependent on various worker characteristics.

Reformoptionen der gesetzlichen Rentenversicherung

Abstract Demographic change and thus the ageing of the population is progressing rapidly in Germany. A reform of the statutory pension insurance (GRV) is therefore becoming increasingly urgent, with the German government already promising in its 2021 coalition agreement that “pensions must be reliable and adequate”. Most recently, the German Council of Economic Experts presented several reform options in its annual report, which are intended to ensure adequate old-age provisions with sustainable nancial viability. However, these proposals were not without objections within the Council. The question therefore arises as to how the statutory pension scheme can be reformed to ensure that adequate and a ordable pensions are nanced in a stable and sustainable manner.