Does Health Insurance Mitigate the Consumption Fluctuation under Health Shock of Chronic Disease? Evidence from a Policy Reform in China

2020 ◽  
Author(s):  
Hua Chen ◽  
Yugang Ding ◽  
Lin Tang
Keyword(s):  
Health Insurance ◽  
Chronic Disease ◽  
Policy Reform ◽  
Health Shock

scholarly journals Disability pension among persons with chronic disease: Differential impact of a Danish policy reform

2021 ◽  
Author(s):  
Jimmi Mathisen ◽  
Natasja Koitzsch Jensen ◽  
Jakob Bue Bjorner ◽  
Henrik Brønnum-Hansen ◽  
Ulla Christensen ◽  
...  
Keyword(s):  
Chronic Disease ◽  
Labour Market ◽  
Disability Pension ◽  
Policy Reform ◽  
Disease Type ◽  
Functional Disorders ◽  
Differential Impact ◽  
Hazard Ratios ◽  
Study Population ◽  
The Impact

Abstract Background In 2013, Denmark implemented a reform that tightened the criteria for disability pension, expanded a subsidized job scheme (‘flexi-job’) and introduced a new vocational rehabilitation scheme. The overall aim of the reform was to keep more persons attached to the labour market. This study investigates the impact of the reform among persons with chronic disease and whether this impact differed across groups defined by labour market affiliation and chronic disease type. Methods The study was conducted as a register-based, nationwide cohort study. The study population included 480 809 persons between 40 and 64 years of age, who suffered from at least one of six chronic diseases. Hazard ratios (HR) and 95% confidence intervals (CI) of being awarded disability pension or flexi-job in the 5 years after vs. the 5 years prior to the reform were estimated. Results Overall, the probability of being awarded disability pension was halved after the reform (HR = 0.49, CI: 0.47–0.50). The impact was largest for persons receiving sickness absence benefits (HR = 0.31, CI: 0.24–0.39) and for persons with functional disorders (HR = 0.38, CI: 0.32–0.44). Also, the impact was larger for persons working in manual jobs than for persons working in non-manual jobs. The probability of being awarded a flexi-job was decreased by one-fourth (HR = 0.76, CI: 0.74–0.79) with the largest impact for high-skilled persons working in non-manual jobs. Conclusion Access to disability pension and flexi-job decreased after the reform. This impact varied according to labour market affiliation and chronic disease type.

scholarly journals Structure and Distribution of Health Care Costs across Age Groups of Patients with Multimorbidity in Lithuania

2021 ◽  
Vol 18 (5) ◽  
pp. 2767
Author(s):  
Laura Nedzinskienė ◽  
Elena Jurevičienė ◽  
Žydrūnė Visockienė ◽  
Agnė Ulytė ◽  
Roma Puronaitė ◽  
...  
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Chronic Disease ◽  
National Health Insurance ◽  
Health Care Services ◽  
Age Groups ◽  
Age Group ◽  
Resource Usage ◽  
Care Services ◽  
Care Costs

Background. Patients with multimorbidity account for ever-increasing healthcare resource usage and are often summarised as big spenders. Comprehensive analysis of health care resource usage in different age groups in patients with at least two non-communicable diseases is still scarce, limiting the quality of health care management decisions, which are often backed by limited, small-scale database analysis. The health care system in Lithuania is based on mandatory social health insurance and is covered by the National Health Insurance Fund. Based on a national Health Insurance database. The study aimed to explore the distribution, change, and interrelationships of health care costs across the age groups of patients with multimorbidity, suggesting different priorities at different age groups. Method. The study identified all adults with at least one chronic disease when any health care services were used over a three-year period between 2012 and 2014. Further data analysis excluded patients with single chronic conditions and further analysed patients with multimorbidity, accounting for increasing resource usage. The costs of primary, outpatient health care services; hospitalizations; reimbursed and paid out-of-pocket medications were analysed in eight age groups starting at 18 and up to 85 years and over. Results. The study identified a total of 428,430 adults in Lithuania with at least two different chronic diseases from the 32 chronic disease list. Out of the total expenditure within the group, 51.54% of the expenses were consumed for inpatient treatment, 30.90% for reimbursed medications. Across different age groups of patients with multimorbidity in Lithuania, 60% of the total cost is attributed to the age group of 65–84 years. The share in the total spending was the highest in the 75–84 years age group amounting to 29.53% of the overall expenditure, with an increase in hospitalization and a decrease in outpatient services. A decrease in health care expenses per capita in patients with multimorbidity after 85 years of age was observed. Conclusions. The highest proportion of health care expenses in patients with multimorbidity relates to hospitalization and reimbursed medications, increasing with age, but varies through different services. The study identifies the need to personalise the care of patients with multimorbidity in the primary-outpatient setting, aiming to reduce hospitalizations with proactive disease management.

scholarly journals Willingness to Pay for Seasonal Influenza Vaccination among Children, Chronic Disease Patients, and the Elderly in China: A National Cross-Sectional Survey

Vaccines ◽  
2020 ◽  
Vol 8 (3) ◽  
pp. 405
Author(s):  
Xiaozhen Lai ◽  
Hongguo Rong ◽  
Xiaochen Ma ◽  
Zhiyuan Hou ◽  
Shunping Li ◽  
...  
Keyword(s):  
Health Insurance ◽  
Chronic Disease ◽  
Willingness To Pay ◽  
Influenza Vaccination ◽  
Seasonal Influenza ◽  
The Elderly ◽  
Vaccine Uptake ◽  
Tobit Regression ◽  
Chronic Disease Patients ◽  
The Cost

Background: The disease burden of seasonal influenza is substantial in China, while the vaccination rate is extremely low, and most people have to pay 100% for vaccination. This study aims to examine willingness to pay (WTP) and recommended financing sources for influenza vaccination among children, chronic disease patients, and the elderly in China and determine feasible measures to expand vaccination coverage. Methods: From August to October 2019, 6668 children’s caregivers, 1735 chronic disease patients, and 3849 elderly people were recruited from 10 provinces in China. An on-site survey was conducted via a especially designed PAD system. Tobit regression was adopted to predict the influencing factors of WTP. Results: The average WTP was 127.5 yuan (USD18.0) for children, 96.5 yuan (USD13.7) for chronic disease patients, and 88.1 yuan (USD12.5) for the elderly. Most participants in the three groups thought government subsidies (94.8%, 95.8%, and 95.5%) or health insurance (94.3%, 95.3%, and 94.5%) should cover part of the cost, and nearly four-fifths (80.1%, 79.5%, and 76.8%) believed that individuals should also pay for part. Tobit regression showed that a higher perceived importance of vaccination, knowing about priority groups, and considering that individuals should co-pay were promoters of WTP, while considering price as a hindrance lowered WTP. Conclusions: The WTP for influenza vaccination among children, chronic disease patients, and the elderly in China is fairly high, suggesting that price is not the primary hindrance and there is room to expand immunization. Most participants expected the government and/or health insurance to pay part of the cost, and such supportive funding could act as a promotive policy “signal” to improve vaccine uptake. Influenza-related health education is also needed to expand vaccine coverage.

scholarly journals Disability pension among persons with chronic illness: Differential impact of a Danish policy reform

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
J Mathisen ◽  
N K Jensen ◽  
J B Bjorner ◽  
H Brønnum-Hansen ◽  
U Christensen ◽  
...  
Keyword(s):  
Cohort Study ◽  
Labor Market ◽  
Chronic Disease ◽  
Chronic Illness ◽  
Disability Pension ◽  
Policy Reform ◽  
Differential Impact ◽  
Hazard Ratios ◽  
Cash Benefits ◽  
The Impact

Abstract Background Denmark implemented a reform in 2013 that tightened the disability pension criteria and expanded a subsidized job scheme. Before the reform, disability pensions were most often granted because of chronic disease and more often to persons with low job qualifications. However, no evaluation has assessed whether the effects of the reform differ according to social class. This register-based, nation-wide cohort study investigates potential differential impact of the reform according to labor market affiliation. Methods A pre-post study design was used to compare the probability of being granted disability pension or flexi-jobs five years after vs. five years before the reform. Data were available from 480,809 persons between 40 and 65 years of age who suffered from at least one of six types of chronic disease. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated. Results The probability of being granted disability pension was halved after the reform (HR = 0.49, CI: 0.47 - 0.50). The impact was strongest for persons previously receiving cash benefits (HR = 0.38, CI: 0.33-0.43) or sickness absence benefits (HR = 0.31, CI: 0.24 - 0.39). Also, the impact was stronger for persons working in manual jobs than for persons working in non-manual jobs. The probability of being granted flexi-job decreased by one fourth (HR = 0.76, CI: 0.74 - 0.79). Conclusions After the reform, it was less likely for persons with chronic illness to be awarded disability pension or subsidized job-schemes. The impact on disability pensions was largest among those who were already outside the labor market or work in manual jobs. Key messages The rates of disability pensions and subsidized job-schemes decreased after the reform. The impact was larger for persons outside the labor market and for those working in manual jobs.

scholarly journals Does the self-employment status affect the rural migrants’ health in China: the transmission channel of social health insurance?

2020 ◽  
Author(s):  
Zicheng Wang ◽  
Qiushi Wu ◽  
Juan Ming
Keyword(s):  
Health Insurance ◽  
Chronic Disease ◽  
Health Status ◽  
Causal Effect ◽  
Social Health Insurance ◽  
The Self ◽  
Social Health ◽  
Transmission Channel ◽  
Rural Migrants ◽  
Self Employment

Abstract Background There are growing attentions paid on rural migrants’ health. Previous studies found that rural migrants are more exposed to disease risks. The present study aims to explore the causal effect of self-employment behavior on the rural migrants’ health status, two issues are addressed to discuss: Does self-employment status affect the health of rural migrants? What is the potential mechanism linking the self-employment behavior and health status? Methods The dataset from the 2017 National Migrants Population Dynamic Monitoring Survey (NMPDMS-2017) is applied to explore the causal effect; the Logit regression is performed to make baseline estimation, while the IV-LPM estimation is applied to correct the endogeneity of self-employment. Additionally, the Logit regression is conducted to explore the transmission channel. Results The self-employed are more susceptible to sub-health status (OR= 1.042; 95% CI= 1.001, 1.084) and chronic disease (OR= 1.394; 95% CI= 1.317, 1.476), even when correcting the endogeneity, the causal effect estimation also demonstrates that the self-employed are more vulnerable to suffer sub-health status (Coefficient= 0.067; 95% CI= 0.050, 0.084) and chronic disease (Coefficient= 0.020; 95% CI= 0.008, 0.032). The self-employed are less likely to participate in social health insurance (OR= 0.057; 95% CI= 0.053, 0.061). Conclusion The self-employed are more likely to suffer sub-health status and chronic disease, the self-employment behavior take harmful effect on the rural migrants’ health. Social health insurance may serve as transmission channel linking self-employment and rural migrants’ health, that is, the self-employed are less prone to participate in the urban health insurance program, which induce to an insufficient health service to maintain health.

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