Urban Resident Basic Medical Insurance Research Articles

Incidence and prevalence of systemic lupus erythematosus in urban China, 2013–2017: A nationwide population-based study

Systemic lupus erythematosus (SLE) is becoming a growing public health concern due to increasing disease and economic burdens. Epidemiological information about SLE, especially its incidence rate, is limited in developing countries. In the current study, we sought to investigate the incidence, prevalence, and economic burdens of SLE in urban China. We conducted a nationwide population-based cohort study using databases from Urban Employee Basic Medical Insurance and Urban Resident Basic Medical Insurance between 2013 and 2017, covering approximately 300 million residents in 23 provincial regions in China. Incidence rate and prevalence were standardized by age and gender to China’s 2010 national census data. Additionally, we calculated the average annual costs and hospital visit rates. A total of 132,258 SLE patients were identified during the study period, with a mean age of 43.03 years (standard deviation: 15.29 years). Of these patients, 81.33% were women. In 2017, the standardized incidence rate of SLE in China was 14.09 (95% confidence interval (CI), 11.95–16.41) per 100,000 person-years, with a higher incidence in women than in men (26.41 vs. 5.92 per 100,000 person-years). Standardized prevalence in 2017 was 47.61 (41.77–53.83), 94.16 (80.67–108.69), and 17.86 (13.84–22.38) per 100,000 people in the overall, female, and male populations, respectively. The average annual rates of increase in prevalence were 21.50%, 19.72%, and 25.67% from 2013 to 2017 in the overall, female, and male populations, respectively. The age-specific incidence rates peaked at 30–49 years old in women and 40–59 years old in men. SLE incident and prevalent cases were most common in North-West China and less common in southern and eastern China. Distinct variations in incidence rates across different regions are also consistent with the varying levels of ultraviolet radiation exposure in China. Additionally, the average estimated annual per-capita cost was 1599.34 US dollars in SLE patients, with the highest costs observed in adolescent and young adult patients among different age groups. The SLE population in China is rapidly expanding, and younger at onset, especially in women, which has placed significant burdens on China’s healthcare system.

Can provincial-pooling of urban and rural resident basic medical insurance improve the health performance of migrant population?

Enhancing the pooling level of medical insurance is an inevitable requirement to strengthen the mutual assistance capability of funds and achieving national health. In China, with the continuous expansion of the migrant population seeking medical treatment in other regions, the role of provincial-pooling of basic medical insurance is becoming increasingly prominent. While there is limited research on the impact and mechanism of provincial-pooling of basic medical insurance on the health of migrant population. Therefore, this study aims to explore the impact of provincial-pooling of basic medical insurance on the health performance of migrant population and analyze the mediating role of social integration. Using data of three waves (2014, 2016 and 2018) of the China Labor force Dynamics Survey, this study focuses on a sample of migrant population enrolled in Urban and Rural Resident Basic Medical Insurance and employs the estimation methods of time-varying difference-in-difference and mediating effect model. The results of time-varying difference-in-difference show that provincial-pooling of basic medical insurance improves the health performance of migrant population by 9.6% (p < 0.05), and the event study method and placebo test all indicate that the research results are robust. The mediating effect analysis demonstrates that the provincial-pooling of basic medical insurance enhances health performance by fostering the subjective and objective social integration, and neighbourhood assistance, social equity, life happiness and trust in the majority are specific intermediary channels. The results of heterogeneity analysis indicates that provincial-pooling of basic medical insurance is more effective in improving the health performance of high-income (β = −0.090; P < 0.05), new-generation (β = −0.116; P < 0.1) and highly-educated (β = 0.130; p < 0.05) migrant population. Our results call for accelerating the promotion of provincial-pooling of basic medical insurance to improve health performance of migrant population.

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.

Does hospital competition improve the quality of outpatient care? - empirical evidence from a quasi-experiment in a Chinese city

BackgroundAlthough countries worldwide have launched a series of pro-competition reforms, the literature on the impacts of hospital competition has produced a complex and contradictory picture. This study examined whether hospital competition contributed to an increase in the quality of outpatient care.MethodsThe dataset comprises encounter data on 406,664 outpatients with influenza between 2015 and 2019 in China. Competition was measured using the Herfindahl-Hirschman index (HHI). Whether patients had 14-day follow-up encounter for influenza at any healthcare facility, outpatient facility, and hospital outpatient department were the three quality outcomes assessed. Binary regression models with crossed random intercepts were constructed to estimate the impacts of the HHI on the quality of outpatient care. The intensity of nighttime lights was employed as an instrumental variable to address the endogenous relationship between the HHI and the quality of outpatient care.ResultsWe demonstrated that an increase in the degree of hospital competition was associated with improved quality of outpatient care. For each 1% increase in the degree of hospital competition, an individual’s risk of having a 14-day follow-up encounter for influenza at any healthcare facility, outpatient facility, and hospital outpatient department fell by 34.9%, 18.3%, and 20.8%, respectively. The impacts of hospital competition on improving the quality of outpatient care were more substantial among females, individuals who used the Urban and Rural Residents Basic Medical Insurance to pay for their medical costs, individuals who visited accredited hospitals, and adults aged 25 to 64 years when compared with their counterparts.ConclusionThis study demonstrated that hospital competition contributed to better quality of outpatient care under a regime with a regulated ceiling price. Competition is suggested to be promoted in the outpatient care market where hospitals have control over quality and government sets a limit on the prices that hospitals may charge.

A potential pathway for identifying hypertension among urban residents aged 60+ years in China: the role of health insurance.

Identification is the first step for treatment of hypertension. However, the awareness rate of hypertension was not high globally. This study aimed to examine the potential role of health insurance for early-identifying hypertension among urban older residents in China. In this cross-sectional study, urban residents aged 60+ years were chosen from Nanjing municipality of China in 2018. The outcome measure was hypertension status ("no hypertension," "diagnosed hypertension" or "un-diagnosed hypertension"). Independent variable was health insurance ("Urban Employee Basic Medical Insurance scheme, UEBMI" or "Urban Resident Basic Medical Insurance scheme, URBMI"). Logistic regression models were introduced to estimate odds ratio (OR) and 95% confidence interval (CI) to examine the association between health insurance and hypertension. Totally, 19,742 participants completed the study. Among overall, URBMI and UEBMI participants, 47.2% (95%CI = 46.5, 47.9%), 38.4% (95%CI = 37.3, 39.6%) and 52.1% (95%CI = 51.2, 53.0%), separately, were diagnosed with hypertension, while the prevalence of un-diagnosed hypertension was 12.7% (95%CI = 12.2, 13.2%), 18.5% (95%CI = 17.6, 19.4%) and 9.6% (95%CI = 9.1, 10.1%), respectively. For overall participants, those with UEBMI were more likely to have hypertension identified (OR = 1.20; 95%CI = 1.11, 1.29) and at lower odds to experience un-diagnosed hypertension (OR = 0.68; 95%CI = 0.61, 0.76) compared to their counterparts with URBMI after control for potential confounders. Moreover, such associations of health insurance with diagnosed and un-diagnosed hypertension were also observed among participants stratified by age and gender. Favorable health insurance may be a pathway for identifying hypertension among urban older residents in China. This study has important public health implications that hypertension may be identified early through favorable health insurance policies for older residents in China.

Risk and attributable fraction estimation for the impact of exposure to compound drought and hot events on daily stroke admissions.

The projection indicates that compound drought and hot events (CDHEs) will intensify, posing risks to cardiovascular health by potentially increasing stroke incidents. However, epidemiological evidence on this topic remains scarce. This study investigates the association between exposure to CDHEs and the risk of daily stroke admissions, specifically examining the effects on various stroke categories such as Subarachnoid Hemorrhage (SAH), Intracerebral Hemorrhage (ICH), Ischemic Stroke (IS), Transient Ischemic Attack (TIA), and other types of stroke. Data on daily stroke admissions from 2010 to 2015 were obtained from the Urban Employee Basic Medical Insurance (UEBMI) and Urban Resident Basic Medical Insurance (URBMI) claims databases in Guangzhou, China. Hot events were identified as days when the daily mean temperature exceeded the 75th percentile during the warm season (May to October) over the study period. The Standardized Precipitation Evapotranspiration Index (SPEI) was utilized to identify drought conditions, with thresholds set at -1 and -1.5 for low-severity and high-severity drought events, respectively. Through a generalized additive model (GAM), we analyzed the cumulative effects of CDHE exposure on daily stroke admissions and calculated the Attributable Fraction (AF) related to CDHEs. The analysis included 179,963 stroke admission records. We observed a significant increase in stroke admission risks due to exposure to hot events coupled with high-severity drought conditions (RR = 1.18, 95%CI: 1.01-1.38), with IS being the most affected category (RR = 1.20, 95%CI: 1.03-1.40). The AF of total stroke admission attributed to hot events in conjunction with high-severity drought conditions was 24.40% (95%CI: 1.86%-50.20%). The combination of hot events with high-severity drought conditions is likely linked to an increased risk of stroke and IS admissions, which providing new insights into the impact of temperature and climate-related hazards on cardiovascular health.

Inequality in benefit distribution of reducing the outpatient cost-sharing: evidence from the outpatient pooling scheme in China.

The implementation of the outpatient pooling scheme in China has substantially elevated the compensation levels for outpatient expenses. This study aims to assess whether socioeconomically disadvantaged enrollees benefit proportionally compared to their non-disadvantaged counterparts. A cohort comprising 14,581 Urban and Rural Resident Basic Medical Insurance (URRBMI) enrollees and 830 Urban Employee Basic Medical Insurance (UEBMI) enrollees was derived from the China Health and Retirement Longitudinal Study 2018. Outpatient pooling scheme benefits were evaluated based on two metrics: the probability of obtaining benefits and the magnitude of benefits (reimbursement amounts and ratios). Two-part models were employed to adjust outpatient benefits for healthcare needs. Inequality in benefit distribution was assessed using the concentration curve and concentration index (CI). Following adjustments for healthcare needs, the CI for the probability of receiving outpatient benefits for URRBMI and UEBMI enrollees were - 0.0760 and - 0.0514, respectively, indicating an evident pro-poor pattern under the outpatient pooling scheme. However, the CIs of reimbursement amounts (0.0708) and ratio (0.0761) for URRBMI recipients were positive, signifying a discernible pro-rich inequality in the degree of benefits. Conversely, socioeconomically disadvantaged UEBMI enrollees received higher reimbursement amounts and ratios. Despite a higher likelihood of socioeconomically disadvantaged groups receiving outpatient benefits, a pro-rich inequality persists in the degree of benefits under the outpatient pooling scheme in China. Comprehensive strategies, including expanding outpatient financial benefits, adopting distinct reimbursement standards, and enhancing the accessibility of outpatient care, need to be implemented to achieve equity in benefits distribution.

Effects of the Resident Basic Medical Insurance Reform on Household Consumption in China

AbstractThis paper investigates the causal relationship between the Urban and Rural Resident Basic Medical Insurance (URRBMI) reform and household consumption in urban China using data from the Chinese Household Income Project survey and employing combination of the propensity score matching and difference‐in‐differences methods. The results yield three conclusions. First, the reform affected both the amount and share of household consumption. Specifically, the reform led to an increase in total household consumption, encompassing both medical and nonmedical expenditures. Among these, the proportion of medical consumption increased, while the proportion of nonmedical consumption reduced. Second, the impact of the URRBMI reform varied across consumption categories within nonmedical expenditure. Specifically, consumption for education and entertainment industries are positively impacted by the URRBMI reform in terms of both quantity and proportion. Third, low‐income households benefit more from the URRBMI reform compared to middle‐ and high‐income households. The main channels through which the URRBMI reform affects household consumption were the price effect and the crowding out effect on precautionary savings.

Healthcare costs for patients with rare diseases: Evidence from China.

Rare diseases cause a huge financial burden to countless patients and families. It is an important public health issue that requires widespread attention. This study analyzes medical expenses composition and the change in trends of out-of-pocket (OOP) expenses for patients with Amyotrophic lateral sclerosis (ALS) and explores the factors influencing these changes. Data were obtained from the Chinese Medical Insurance Department database from 2018 to 2020, including 857 patients with ALS in 60 cities across 30 provinces. We used descriptive methods to analyse the baseline characteristics and medical expenses of outpatients and inpatients with ALS. And we used quantile regression to analyse the differences in patient OOP ratio and the factors influencing them. In China, 80.3% of ALS patients chose tertiary hospitals, with an annual direct medical cost of 11,339.7 RMB per patient and an OOP ratio of 41.6%. The annual medical cost for outpatients was 345.1 RMB per patient, with an OOP ratio of 36.7%. The annual medical cost for inpatients was 28,139.8 RMB per patient, with an OOP ratio of 41.7%. Compared to outpatients, inpatients had higher medical costs but lower actual reimbursement rates. The OOP ratio of ALS patients decreased, then increased over time. And the OOP ratio was influenced by medical institution, medical insurance, and age (p<0.05). Patients who chose tertiary hospitals, those who were covered by the urban resident basic medical insurance and younger patients had relatively higher OOP ratio. In recent years, although China has begun to pay attention to the rights and interests of patients with rare diseases, the government has provided some healthcare security to patients with rare diseases. However, the level of medical insurance coverage was still low, the equity of protection was still insufficient and the financial burden on patients was high. Therefore, the government should further improve the healthcare system to provide full life-cycle and affordable healthcare services to patients with rare diseases.

The association between Urban and Rural Resident Basic Medical Insurance and instrumental activity of daily living disability among middle-aged and older adults in China

BackgroundPrevious studies have not investigated the association between medical insurance and instrumental activity of daily living (IADL) disability. To fulfill this research gap, this study aims to explore the association between Urban and Rural Resident Basic Medical Insurance (URRBMI) and IADL disability among middle-aged and older adults in China.MethodsThe data of this study were sourced from the 2018 wave of China Health and Retirement Longitudinal Study (CHARLS). Logit regression models were used to analyze the association between URRBMI and odds of suffering from IADL disability. Furthermore, we used IV-Probit regression model to address the potential endogeneity problem. Moreover, propensity score matching and generalized random forest model were employed to conduct robustness checks.ResultsThe logit regression results reveal that URRBMI participation was significantly related to reduced odds of suffering from IADL disability by 39.86% after adjusting for the control variables (p < 0.01). The results of IV-Probit estimation show that URRBMI was an exogenous variable. Further robustness checks reported similar estimation results. The results of heterogeneity analysis reveal that URRBMI produced a statistically stronger effect on IADL disability for the older adults (OR = 0.5815, p < 0.01) when compared with the middle-aged adults (OR = 0.5690, p < 0.05). The results of impact channel analysis indicate that physical exercise was a channel involving the effect of URRBMI on IADL disability.ConclusionThis study finds that the middle-aged and older adults who were covered by URRBMI had a reduced possibility of suffering from IADL disability when compared with those without URRBMI. Furthermore, it is found that URRBMI produced a statistically stronger effect on IADL disability for the older adults when compared with the middle-aged adults. Moreover, we obtain evidence indicating that physical exercise was a channel involving the effect of URRBMI on IADL disability.

Effects of basic medical insurance integration on subjective wellbeing of residents in China: empirical evidence from a quasi-experiment.

Enhancing the wellbeing of residents through universal health coverage (UHC) is a long-term policy goal for China. In 2016, China integrated the New Rural Cooperative Medical Scheme (NRCMS) and the Urban Resident Basic Medical Insurance (URBMI) into the Urban and Rural Resident Basic Medical Insurance (URRBMI) to address the problem of fragmentation. The objective of this study was to investigate whether the integration of basic medical insurance had an impact on the subjective wellbeing of Chinese residents. Using the China Household Finance Survey data of 2015 and 2019, we empirically estimated the influence of the integration of basic medical insurance on Chinese residents through the difference-in-difference method based on propensity score matching (PSM-DID). Our findings indicate that the integration of basic medical insurance improved the subjective wellbeing of the insured population. Additionally, through heterogeneity testing, we validated that the integration increased the subjective wellbeing of residents from less developed regions in West China and rural areas, as well as those with older adult dependents. However, the subjective wellbeing of low-income groups, who were expected to benefit more from the URRBMI, did not improve significantly, at least in the short term. According to our research, the integration of basic medical insurance in China supports the country's objective of achieving equality and providing universal benefits for its residents. The introduction of the URRBMI has had a positive impact on the subjective wellbeing of insured individuals. This is particularly beneficial for disadvantaged groups in less developed regions, as well as for residents with older adult dependents. However, the subjective wellbeing of the middle-income group has improved significantly, whereas that of the low-income group, despite being the intended beneficiaries of the integration, did not show significant improvement. From a funding perspective, we recommend establishing a dynamic adjustment funding system that links residents' medical insurance funding standards with their disposable income. Regarding the utilization of the URRBMI, the benefit packages should be expanded, particularly by covering more outpatient services through risk pooling. We call for further research with additional data and continued efforts on improving wellbeing of residents, particularly for disadvantaged populations.

Ex-ante moral hazard and health insurance: Evidence from China's urban residence basic medical insurance scheme.

This study examines whether implementing Urban Residents Medical Insurance Scheme decreased an individual's risky lifestyle behavior before illness, termed ex-ante moral hazard. Ex-ante moral hazard is predicted by the classical economic theory suggesting that health insurance coverage reduces an individual's incentive to take preventive efforts to remain healthy. Studies have provided mixed evidence for this prediction. China's 2006 nationwide social experiment of implementing the Urban Residents Basic Medical Insurance Scheme offers an excellent opportunity for examining the effect of the transition from uninsured to insured on an individual's health behaviors. We exploit the longitudinal dimension of a representative survey data for 2007-2010 and employ the instrumental variable technique, thereby addressing the issue of self-selection into voluntary health insurance schemes. The results do not provide evidence for and contrast the prediction of the ex-ante moral hazard. Significant differences exist between insured and uninsured groups with respect to smoking, drinking habits, and being overweight. People with insurance care more about their health than people without insurance do. The main results still hold if we use alternative estimation methods and other robustness tests.

Evidence From the China Family Panel Studies Survey on the Effect of Integrating the Basic Medical Insurance System for Urban and Rural Residents on the Health Equity of Residents: Difference-in-Differences Analysis.

The fragmentation of the medical insurance system is a major challenge to achieving health equity. In response to this problem, the Chinese government is pushing to establish the unified Urban and Rural Resident Basic Medical Insurance (URRBMI) system by integrating the New Rural Cooperative Medical Scheme and the Urban Resident Basic Medical Insurance. By the end of 2020, URRBMI had been implemented almost entirely across China. Has URRBMI integration promoted health equity for urban and rural residents? This study aims to examine the effect of URRBMI integration on the health level of residents and whether the integration can contribute to reducing health disparities and promoting health equity. We used the staggered difference-in-differences method based on the China Family Panel Studies survey from 2014 to 2018. Our study had a nationally representative sample of 27,408 individuals from 98 cities. We chose self-rated health as the measurement of health status. In order to more accurately discern whether the sample was covered by URRBMI, we obtained the exact integration time of URRBMI according to the official documents issued by local governments. Finally, we grouped the sample by urban and rural areas, regions, and household income to examine the impact of the integration on health equity. We found that overall, the URRBMI integration has improved the health level of Chinese residents (B=0.066, 95% CI 0.014-0.123; P=.01). In terms of health equity, the results showed that first, the integration has improved the health level of rural residents (B=0.070, 95% CI 0.012-0.128; P=.02), residents in western China (B=0.159, 95% CI 0.064-0.255; P<.001), and lower-middle-income groups (B=0.113, 95% CI 0.004-0.222, P=.04), so the integration has played a certain role in narrowing the health gap between urban and rural areas, different regions, and different income levels. Through further mechanism analysis, we found that the URRBMI integration reduced health inequity in China by facilitating access to higher-rated hospitals and increasing reimbursement rates for medical expenses. However, the integration did not improve the health of the central region and low-income groups, and the lack of access to health care for low-income groups was not effectively reduced. The role of URRBMI integration in promoting health equity among urban and rural residents was significant (P=.02), but in different regions and income groups, it was limited. Focusing on the rational allocation of medical resources between regions and increasing the policy tilt toward low-income groups could help improve the equity of health insurance integration.

Association of public health insurance with cancer-specific mortality risk among patients with nasopharyngeal carcinoma: a prospective cohort study in China.

Health insurance programs are effective in preventing financial hardship in patients with cancer. However, not much is known about how health insurance policies, especially in Southwest China with a high incidence of nasopharyngeal carcinoma (NPC), influence patients' prognosis. Here, we investigated the association of NPC-specific mortality with health insurance types and self-paying rate, and the joint effect of insurance types and self-paying rate. This prospective cohort study was conducted at a regional medical center for cancer in Southwest China and included 1,635 patients with pathologically confirmed NPC from 2017 to 2019. All patients were followed up until May 31, 2022. We determine the cumulative hazard ratio of all-cause and NPC-specific mortality in the groups of various insurance kinds and the self-paying rate using Cox proportional hazard. During a median follow-up period of 3.7 years, 249 deaths were recorded, of which 195 deaths were due to NPC. Higher self-paying rate were associated with a 46.6% reduced risk of NPC-specific mortality compared to patients with insufficient self-paying rate (HR: 0.534, 95% CI: 0.339-0.839, p = 0.007). For patients covered by Urban and Rural Residents Basic Medical Insurance (URRMBI), and for patients covered by Urban Employee Basic Medical Insurance, each 10% increase in the self-paying rate reduced the probability of NPC-specific death by 28.3 and 25%, respectively (UEBMI). Results of this study showed that, despite China's medical security administration improved health insurance coverage, NPC patients need to afford the high out-of-pocket medical costs in order to prolong their survival time.

Does the integration of urban and rural health insurance influence the functional limitations of the middle-aged and elderly in rural China?

In January 2016, the Chinese government integrated the two systems of urban resident basic medical insurance and new rural cooperative medical system to establish a unified Urban and Rural Resident Medical Insurance. The integration of medical insurance is purported to enhance access for the rural population; however, a dearth of literature exists regarding its effect on functional impairment among middle-aged and elderly residing in rural areas. This study aims to evaluate the impact of urban-rural health insurance integration on functional limitation among middle-aged and elderly individuals in rural China. A longitudinal survey was conducted among 7855 middle-aged and elderly individuals in rural China. Using a nonequivalent control group pretest-posttest design, we exploit these policy changes to evaluate their impact on middle-aged and elderly individuals’ functional limitation. The results showed that the integration of urban and rural health insurance systems was significantly associated with reduced functional limitation (Odds ratio .742; 95%CI 0.603, 0.914) among middle-aged and elderly individuals in rural China. Our findings also indicate that prevalent behaviors such as tobacco use, and alcohol consumption may exacerbate functional limitation among middle-aged and elderly individuals. These findings suggest that the integration of urban and rural health insurance systems can have a positive impact on the functional limitation of middle-aged and elderly individuals in rural China and could be an important factor in improving the health and well-being of middle-aged and elderly individuals in rural areas.

Association between weather and hip fracture in adults: a nationwide study in China 198 cities.

Hip fractures represent a significant public health issue due to high incidence in aging society. Evidence of the short-term effects of weather on the risk of hip fracture is limited and inconsistent. We aimed to examine the associations between weather conditions and daily hospital admissions for hip fracture in adults in China. A national time-series analysis between 2014 and 2017 was conducted. Data on daily hospital admissions for hip fracture were obtained from the database of Urban Employee Basic Medical Insurance (UEBMI) and Urban Resident Basic Medical Insurance (URBMI). Weather conditions were acquired from the China Meteorological Data Sharing Service Center. Based on a time-stratified case-crossover design, conditional Poisson regression was used to estimate the impact on relative risk (RR) of weather conditions on hospital admissions for hip fracture. During the study period, a total of 137,504 hospital admissions for hip fractures were identified. All analyzed weather conditions showed consistent significant associations at lag 0 day for each 10 mm increase in precipitation, 10 m/s in wind speed, and 10°C in temperature, with the RR value being 1.079 (95% CI, 1.074-1.083) for precipitation, 1.404 (95% CI, 1.346-1.465) for wind speed, and 1.558 (95% CI, 1.546-1.570) for temperature. Women were more vulnerable to be affected by precipitation and temperature. In conclusion, increased risk for hip fractures in adults is associated with weather conditions. The improved understanding of the relationship between weather conditions and hip fractures hospital admission can be useful for resource allocation and provider preparedness.

Incidence and cost of vertebral fracture in urban China: a 5-year population-based cohort study.

Osteoporotic vertebral fractures cause pain and disability, which result in a heavy socioeconomic burden. However, the incidence and cost of vertebral fractures in China are unknown. We aimed to assess the incidence and cost of clinically recognized vertebral fractures among people aged 50 years and older in China from 2013 to 2017. This population-based cohort study was conducted by using Urban Employee Basic Medical Insurance (UEBMI) and Urban Resident Basic Medical Insurance (URBMI) data in China from 2013 to 2017, which covered more than 95% of the Chinese population in urban areas. Vertebral fractures were identified by the primary diagnosis (i.e. International Classification of Diseases code or text of diagnosis) in UEBMI and URBMI. The incidence and medical cost of these clinically recognized vertebral fractures in urban China were calculated. A total of 271981 vertebral fractures (186428, 68.5% females and 85553, 31.5% males) were identified, with a mean age of 70.26 years. The incidence of vertebral fractures among patients aged 50 years and over in China increased ~1.79-fold during the 5 years, from 85.21 per 100000 person-years in 2013 to 152.13 per 100000 person-years in 2017. Medical costs for vertebral fractures increased from US$92.74 million in 2013 to US$505.3 million in 2017. Annual costs per vertebral fracture case increased from US$3.54 thousand in 2013 to US$5.35 thousand in 2017. The dramatic increase in the incidence and cost of clinically recognized vertebral fractures among patients aged 50 and over in urban China implies that more attention should be given to the management of osteoporosis to prevent osteoporotic fractures.

The effect of public insurance policy on the private insurance market: New evidence from a quasi-experiment in China

Analyzing the net social welfare of a public health insurance policy necessitates an accurate estimation of its impact on the private health insurance market. This paper presents new evidence of the effect of public health insurance on private health insurance market by exploiting a quasi-experiment of Urban Resident Basic Medical Insurance (URBMI) in China. Our findings indicate that the implementation of URBMI has no significant effect on the aggregated private health insurance market. However, upon dividing the private health insurance market into medical and illness insurance markets, we observe a significant crowding-out effect of URBMI on the former but not the latter. This finding may help explain the mixed results in the literature, which typically lumps all segments of private health insurance markets together. In terms of the possible channels, we find that the crowding-out effect of public health insurance on private health insurance is through lowering the cost of health services, raising the accessibility to health services or reducing health risks.

Updates in psoriasis diagnosis and treatment status in China: results from the National Psoriasis Center Registry.

Updates in psoriasis diagnosis and treatment status in China: results from the National Psoriasis Center Registry.

The impact of integrated urban and rural resident basic medical insurance on health service equity: Evidence from China.

Many countries and regions worldwide are improving their healthcare systems through the integration and unification of health insurance programs covering different groups of people. In China, the past 10 years has been the time when Chinese government promote the Urban and Rural Residents Basic Medical Insurance (URRBMI) by integrating the Urban Residents' Basic Medical Insurance (URBMI) and New Rural Cooperative Medical Scheme (NRCMS). To evaluate the impact of the URRBMI on equity in relation to health services. The quantitative data used in this study were obtained from the CFPS 2014-2020 database, and all respondents with health insurance type UEBMI, URBMI, and NRCMS were included. UEBMI respondents were set as the control group and URBMI or NRCMS as the intervention group, and a DID method model was used to analyze the impact of integrating health insurance on health service utilization, costs and health status. Heterogeneity analysis was also conducted after stratifying the sample according to income level and chronic disease status. This was done to investigate whether there were differences in the effects of the integrated health insurance program across different social groups. The implementation of URRBMI is found to be associated with a significant increase in inpatient service utilization (OR = 1.51, P < 0.01) among rural Chinese residents. Regression results by income stratum show that the utilization of inpatient services increased in rural areas for high-, middle- and low-income groups, with the fastest increase (OR = 1.78, P < 0.05) emerging for low-income groups. Analysis by chronic disease status shows that rural residents with chronic disease are associated with a higher increase in hospitalization rates (OR = 1.64, P < 0.01). The implementation of URRBMI is found to have improved health insurance's ability to withstand risks and effectively improve access to health services for rural residents. In this regard, it can be considered as playing a positive role in bridging the gap in health service utilization between rural and urban areas and in improving regional equity.