Does Social Medical Insurance Achieve a Poverty Reduction Effect in China?

This paper aims to explore the impact of social medical insurance (SMI) on poverty reduction (PR) in China. Considering the time-varying characteristics of factors, this paper uses the bootstrap Granger full sample causality and subsample rolling window model to find the relationship between SMI and PR. The results highlight that in some periods, there is a bidirectional causal link between SMI and PR. Influenced by the medical insurance reform and medication measures. Social medical insurance does not have a positive impact on poverty reduction in some periods. These results are supported by the Utility Maximization Model of Insurance Consumption, which highlights that individuals make utility maximization choices when choosing insurance. The effect of medical insurance on poverty alleviation depends on whether an individual's investment in medical insurance can maximize its utility. If the proportion of social medical insurance reimbursement is too low, individuals will give up buying social medical insurance. Thus, the anti-poverty effect of social medical insurance is difficult to achieve. Therefore, authorities need to pay attention to specific contexts and social medical insurance policies and further improve the social medical insurance system to promote the realization of the anti-poverty of social medical insurance.

Impact of Catastrophic Health Expenditures on Chinese Household Consumption

China has built a social medical insurance system that covers the entire population so as to reduce the impact of diseases on individuals and families. Although the decline in the incidence of catastrophic health expenditures (CHEs) in China is encouraging, this issue remains important. On the basis of considering selectivity bias and heterogeneity, we applied propensity score matching (PSM) to analyze the 2018 data from the China Family Panel Studies. We assigned CHE households and non-CHE households to the treatment group and the control group, respectively, and used non-random data to simulate a randomized trial to investigate the impact of CHE on household consumption in China. The results of this study indicate that, when the threshold is set at 40%, the consumption of households experiencing CHEs (CHE household) is significantly lower than that of households not experiencing CHEs (non-CHE households) and that CHEs have a significant negative impact on other household consumption and a significant impact on the household property and debt. This effect still exists when the threshold is set lower, with household essential consumption most affected. The occurrence of CHEs leads to a reduction in household consumption and a significantly worsening financial situation for the CHE households, impacting the basic quality of life of the families. Therefore, it is necessary to further reform the medical and health system to reduce the high medical expenses.

Migrant Economic Behaviors: Causal Effects of Health Education on Saving Rates, Social Medical Insurance, and House Purchasing

BackgroundsHealth China as the essentials policy with advancing Global Health, contributing to decline the inequality between rural and urban health education, and recovering the domestic markets after Coronavirus. The goal of this study is to evaluate the economic returns on health educations in a developing country. MethodsWe combine life cycle mechanisms and safety beliefs to evaluate continuous values of health education from 720,900 migrants’ economic behaviors through the ERM model, average treatment effects, and heterogeneous treatment effects robust empirically approach.ResultsWe find that health education positively affects participation in social medical insurance and house purchasing. In contrast, the relationship between health education and saving rates is an inverted ‘U’ shape. Heterogeneous treatment effect empirically robust account for heterogeneity in the previous generation and young generation; urban citizenship and rural citizenship continuous effects of health education. ConclusionThe finding suggests that health education stimulates immigrant consumption behaviors; however, extra health education is not a wise policy. Rural-urban citizenship acquisition bias is a significant factor of health education effects differential.JEL CLASSIFICATIONI15; D14; R23

The benefits of an integrated social medical insurance for health services utilization in rural China: evidence from the China health and retirement longitudinal study

Background Improving health equity is a fundamental goal for establishing social health insurance. This article evaluated the benefits of the Integration of Social Medical Insurance (ISMI) policy for health services utilization in rural China. Methods Using the China Health and Retirement Longitudinal study (2011‒2018), we estimated the changes in rates and equity in health services utilization by a generalized linear mixed model, concentration curves, concentration indices, and a horizontal inequity index before and after the introduction of the ISMI policy. Results For the changes in rates, the generalized linear mixed model showed that the rate of inpatient health services utilization (IHSU) nearly doubled after the introduction of the ISMI policy (8.78 % vs. 16.58 %), while the rate of outpatient health services utilization (OHSU) decreased (20.25 % vs. 16.35 %) after the implementation of the policy. For the changes in inequity, the concentration index of OHSU decreased significantly from − 0.0636 (95 % CL: −0.0846, − 0.0430) before the policy to − 0.0457 (95 % CL: −0.0684, − 0.0229) after it. In addition, the horizontal inequity index decreased from − 0.0284 before the implementation of the policy to − 0.0171 after it, indicating that the inequity of OHSU was further reduced. The concentration index of IHSU increased significantly from − 0.0532 (95 % CL: −0.0868, − 0.0196) before the policy was implemented to − 0.1105 (95 % CL: −0.1333, − 0.0876) afterwards; the horizontal inequity index of IHSU increased from − 0.0066 before policy implementation to − 0.0595 afterwards, indicating that more low-income participants utilized inpatient services after the policy came into effect. Conclusions The ISMI policy had a positive effect on improving the rate of IHSU but not on the rate of OHSU. This is in line with this policy’s original intention of focusing on inpatient service rather than outpatients to achieve its principal goal of preventing catastrophic health expenditure. The ISMI policy had a positive effect on reducing the inequity in OHSU but a negative effect on the decrease in inequity in IHSU. Further research is needed to verify this change. This research on the effects of integration policy implementation may be useful to policy makers and has important policy implications for other developing countries facing similar challenges on the road to universal health coverage.

Environmental pollution, population aging and social medical insurance fund expenditure

Although China's economy has maintained rapid growth since 21st century, the problem of environmental pollution has become increasingly serious. Environmental pollution has a serious impact on people in all aspects of clothing, food, housing and transportation. Based on the panel data of 31 provinces and regions in China from 2005 to 2017, this paper establishes a fixed-effect model and divides China into three regions of central, east and west and analyzes the impact of environmental pollution and the population aging on the expenditure of China's social medical insurance funds (SMIF). The study found that the more severe environmental pollution, the worse health status of the residents, then induces the higher SMIF; the more serious aging of population, the higher risk of disease and cause higher SMIF. It is recommended to innovate clean energy technologies, increase environmental governance, in order to reduce health care expenditures and restrain the increase of the health care cost.

Associations Between Geodemographic Factors and Access to Public Health Services Among Chinese Floating Population

Background: The floating population in urban China is facing multiple barriers to access to comprehensive, affordable, and culturally effective public health services. However, little is known about the role of geodemographic factors. This study aimed to assess the associations between geodemographic factors and access to public health services among the Chinese floating population.Methods: This study employed the data from the 2015 Migrant Dynamic Monitoring Survey data in China. Descriptive statistical analysis and principal component analysis were used to provide basic characteristics of the main variables. Multiple logistic models were used to analyze how province-level units, economic regions, and economic zones had significant associations with residential health records establishment, social medical insurance, and types and methods of health knowledge attainment in urban China. Using multiple indicator multiple cause models, the association between geodemographic factors and types and methods of health knowledge attainment was studied.Results: The results indicated that there was regional unbalance in the case of residential health records. Regional differences were significantly associated with social medical insurance. Provincial differences were significantly associated with health knowledge attainment. There were regional differences in the methods of health knowledge attainment. In the most provincial units, geodemographic factors had significant associations with types and methods of health knowledge attainment.Conclusions: This study confirmed empirical associations between geodemographic factors and access to public health services among Chinese floating population. The relevant suggestion was that provincial units with less-developed public health services should enhance their capabilities to equalize public health services.

PROBLEMS AND WAYS TO IMPROVE THE ORGANIZATION OF CARDIOLOGICAL CARE TO THE RURAL POPULATION, IN THE CARDIOLOGISTS OPINION

The aim: to study the state, problems and ways of improving the organization of cardialogical care for the rural population in Ukraine based on the materials of a sociological survey of cardiologists. Material and methods The sociological research was carried out according to a specially developed program and covered 352 cardiologists from all regions of Ukraine. Results The main directions for improving the organization of cardialogical care, according to cardiologists opinion, are to increase funding for health care institutions (91,5±1,5%), increase wages (87,2±1,8%), introduce social medical insurance (81,8±2,1%) and mechanisms for economic motivation of personnel (89,8±1,6%); equipping health care institutions with modern medical and diagnostic equipment (73,9±2,3%); improving the quality of postgraduate training of cardiologists (78,2±1,9%); introduction of a health care qua-lity monitoring system (66,9±4,9%); an increase in the economic and legal independence of health care institutions (78,1±2,2); introduction of public-private partnership mechanisms with preservation of health care institutions in state ownership (79,3±2,2%). Conclusions The sociological study found that the main parameters of the organization of cardialogical care for the rural population of Ukraine do not correspond to the economic realities of the time and require modernization.

THE FINANCIAL AND LEGAL ASPECTS OF REGULATION OF COMPULSORY SOCIAL MEDICAL INSURANCE IN UKRAINE

The article, by analyzing the legal acts and the results of research in the field of regulation of relations on compulsory social health insurance, considers some legal aspects of financial and legal regulation of health insurance in Ukraine. The author emphasizes the importance of introducing the institution of compulsory social health insurance, as its development and introduction of financial and legal mechanism for regulating relations in this area is a guarantee of balanced budget spending on medicine, proper implementation of citizens' rights to health care. It is determined that all these issues concerning the formation of financial funds formed in health insurance, their replenishment, distribution and use, have a public financial nature, and therefore require and are subject to financial and legal regulation. The conclusion on the content of financial and legal regulation of compulsory social health insurance as a system of legal means of government regulation of the organization and activities of subjects and objects of management in the field of health care.