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Zhang J, Hu M, Jia Y, Gu Y, Chen W. How should regulatory schemes be optimized to enhance deterrence against medical insurance fraud by enrollees? Evidence from a discrete choice experiment in China. Soc Sci Med 2024; 354:117059. [PMID: 38968901 DOI: 10.1016/j.socscimed.2024.117059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 06/10/2024] [Accepted: 06/16/2024] [Indexed: 07/07/2024]
Abstract
Medical insurance fraud (MIF) poses a substantial global financial challenge, necessitating effective regulatory strategies, especially in China, where such measures are in a critical developmental phase. This study investigates the effectiveness of various regulatory components in deterring MIF among enrollees and explores preference heterogeneity among individuals with different characteristics, utilizing a discrete choice experiment survey. Grounded in deterrence theory, our conceptual framework incorporates five attributes: intensity of economic penalties, restrictions on medical insurance benefits, deterioration of social reputation, and certainty and celerity of penalties. Employing a D-efficiency design, 24 choice sets were generated and blocked into three versions. A multistage stratified sampling method was adopted to collect data from the basic medical insurance enrollees in Shanghai. The survey was conducted from September to October 2022. The sample representativeness was further improved via the entropy balancing approach. Data from the final sample of 1034 respondents were analyzed using mixed logit models (MIXLs), incorporating interactions with individual characteristics to assess preference heterogeneity. Results reveal that escalating economic penalties, suspending insurance benefits, listing individuals as unfaithful parties, ensuring penalty certainty, and expediting enforcement significantly enhance the deterrent effect. We observed preference heterogeneity across different demographics, including age, gender, education, health status, and employment status. The study underscores the pivotal role of economic penalties in deterring MIF, while also acknowledging the significance of non-economic measures such as enforcement efficiency and social sanctions. These findings offer valuable insights for policymakers to tailor and strengthen regulatory schemes against MIF, contributing to the advancement of more effective and precise healthcare policies.
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Affiliation(s)
- Jinsui Zhang
- School of Public Health, Fudan University, 130 Dong'an Road, Xuhui District, Shanghai, China.
| | - Min Hu
- School of Public Health, Fudan University, 130 Dong'an Road, Xuhui District, Shanghai, China.
| | - Yusheng Jia
- School of Public Health, Fudan University, 130 Dong'an Road, Xuhui District, Shanghai, China; Department of Public Health Sciences, University of Rochester Medical Center, 265 Crittenden Blvd, Rochester, NY, 14642, USA.
| | - Yuanyuan Gu
- Macquarie University Centre for the Health Economy, Australian Institute of Health Innovation & Macquarie Business School, Level 5, 75 Talavera Road, Macquarie University, NSW, 2109, Australia.
| | - Wen Chen
- School of Public Health, Fudan University, 130 Dong'an Road, Xuhui District, Shanghai, China.
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Duru EE, Ben-Umeh KC, Mattingly TJ. Cost of long-term care and balancing caregiver wellbeing: a narrative review. Expert Rev Pharmacoecon Outcomes Res 2024:1-15. [PMID: 39030716 DOI: 10.1080/14737167.2024.2383406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Accepted: 07/18/2024] [Indexed: 07/21/2024]
Abstract
INTRODUCTION Long-term care (LTC) refers to care and support services that are required by individuals who lack the ability to perform important daily routines and may be dependent on others for personal, social, and medical needs over a sustained period of time. LTC may be broadly categorized into formal and informal care, where formal care is provided by professionals who are compensated to provide these services and informal care captures the care services provided without compensation by family members, friends, or other unpaid individuals. AREAS COVERED In this narrative review, we identify and synthesize evidence to evaluate the cost of long-term care while balancing the needs of caregivers. We searched Embase and EconLit for studies published from 2010 to November 2023. Our search strategy used a combination of keywords such as 'long-term care,' 'caregiver burden,' 'caregiver support,' 'cost of care,' and 'caregiver wellbeing.' We include both formal and informal LTC, as well as predictors of caregiver wellbeing. EXPERT COMMENTARY This review highlights the global variability in LTC costs and the significant burden on caregivers, emphasizing the need for policy interventions and comprehensive insurance schemes. Future research should focus on standardized assessment tools, intervention effectiveness, and integrating caregiver support into healthcare models, ensuring holistic and sustainable LTC solutions.
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Affiliation(s)
- Emeka Elvis Duru
- Department of Pharmacotherapy, University of Utah College of Pharmacy, UT, Salt Lake City, USA
| | - Kenechukwu C Ben-Umeh
- Department of Pharmacotherapy, University of Utah College of Pharmacy, UT, Salt Lake City, USA
| | - T Joseph Mattingly
- Department of Pharmacotherapy, University of Utah College of Pharmacy, UT, Salt Lake City, USA
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Yu F, Jiao L, Chen Q, Wang Q, De Allegri M, Cao Z, Chen W, Ma X, Wang C, Wachinger J, Jin Z, Bunker A, Geldsetzer P, Yang J, Xue L, Bärnighausen T, Chen S. Preferences regarding COVID-19 vaccination among 12,000 adults in China: A cross-sectional discrete choice experiment. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003387. [PMID: 38990924 PMCID: PMC11239003 DOI: 10.1371/journal.pgph.0003387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 05/28/2024] [Indexed: 07/13/2024]
Abstract
Understanding public preferences concerning vaccination is critical to inform pandemic response strategies. To investigate Chinese adults' preferences regarding COVID-19 vaccine attributes, we conducted a cross-sectional online survey in 12,000 Chinese adults in June-July, 2021. Participants were requested to answer a series of discrete choice questions related to hypothetical COVID-19 vaccines. Using mixed logit models, our analysis revealed that participants had a higher preference for COVID-19 vaccines with longer duration of protection (coefficient: 1.272, 95% confidence interval [1.016 to 1.529]) and higher efficacy (coefficient: 1.063, [0.840, 1.287]). Conversely, participants demonstrated a lower preference associated with higher risk of rare but serious side-effects (coefficient: -1.158, [-1.359, -0.958]), oral administration (coefficient: -0.211, [-0.377, -0.046]), more doses (coefficient: -0.148, [-0.296, 0.000]) and imported origin (coefficient: -0.653, [-0.864, -0.443]). Moreover, preferences were heterogeneous by individual factors: highly educated participants were more sensitive to the negative vaccine attributes including price (coefficient -0.312, [-0.370, -0.253]) and imported vaccine (coefficient -0.941, [-1.186, -0.697]); there was also substantial heterogeneity in vaccine preferences with respect to age group, marital status, work status, income, chronic diagnosis history, COVID-19 vaccination history and geographic regions. As the first study of examining the public preferences for COVID-19 vaccine in China with a large nationwide sample of 12,000 adults, our results indicate that future vaccine should pose lower risk, possess longer protection period, have higher efficacy, be domestically produced, and have lower costs to increase the COVID-19 vaccination coverage. Our current study findings from this study provide insights and recommendations for not only COVID-19 vaccine design but also vaccine attribute preferences to increase vaccine uptake in potential future pandemics.
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Affiliation(s)
- Fengyun Yu
- Interdisciplinary Centre for Scientific Computing, University of Heidelberg, Heidelberg, Germany
| | - Lirui Jiao
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Qiushi Chen
- The Harold and Inge Marcus Department of Industrial and Manufacturing Engineering, The Pennsylvania State University, University Park, Pennsylvania, United States of America
| | - Qun Wang
- Faculty of Humanities and Social Sciences, Dalian University of Technology, Dalian, China
| | - Manuela De Allegri
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Zhong Cao
- State Key Lab of Intelligent Technologies and Systems, Department of Automation, Tsinghua University, Beijing, China
| | - Wenjin Chen
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xuedi Ma
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Chao Wang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jonas Wachinger
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Zhangfeng Jin
- School of Economics, Zhejiang University of Technology, Hangzhou, China
| | - Aditi Bunker
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Pascal Geldsetzer
- Department of Medicine, Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, United States of America
- Chan Zuckerberg Biohub – San Francisco, San Francisco, California, United States of America
| | - Juntao Yang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Lan Xue
- Institute for AI International Governance, Tsinghua University, Beijing, China
- School of Public Policy and Management, Tsinghua University, Beijing, China
| | - Till Bärnighausen
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Simiao Chen
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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Jiang B, Li M, Dai P, Cao Y, Liu Y, Shu X, Yang W, Feng L. Employees' seeking preference towards influenza vaccination in organization: A discrete choice experiment in China. Heliyon 2024; 10:e30432. [PMID: 38756589 PMCID: PMC11096921 DOI: 10.1016/j.heliyon.2024.e30432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 04/16/2024] [Accepted: 04/25/2024] [Indexed: 05/18/2024] Open
Abstract
To clarify the preferences of employees seeking influenza vaccination, a discrete choice experiment aims to understand the essential factors that close the gap between intention and behavior. A total of 866 employees with vaccination willingness willing to participated in a discrete choice experiment (DCE) between October 31st and December 6th, 2022 in China including the following attributes: price, vaccination setting, appointment mode, and service time. The data was analyzed using mixed logit models. Employees from smaller enterprises were more likely to get vaccinated collectively. For employees willing to get the influenza vaccine, 95.08 % of their choice was dominated by price. Employees' behavior varied according to their socioeconomic characteristics. Only female employees strongly favored work-site-based vaccination. Price was the primary factor considered by employees for getting the influenza vaccine. DCE would help to develop influenza vaccination intervention targeted at different groups in future studies.
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Affiliation(s)
- Binshan Jiang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Mu Li
- China National Biotec Group Company Limited, Beijing, 100024, China
| | - Peixi Dai
- Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, 102206, China
| | - Yanlin Cao
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Yuxi Liu
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Xiang Shu
- China National Biotec Group Company Limited, Beijing, 100024, China
| | - Weizhong Yang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Luzhao Feng
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
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Liu Y, Du S, Liu C, Xue T, Tang Y. Preference of primary care patients for home-based healthcare and support services: a discrete choice experiment in China. Front Public Health 2024; 12:1324776. [PMID: 38699415 PMCID: PMC11063295 DOI: 10.3389/fpubh.2024.1324776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 04/08/2024] [Indexed: 05/05/2024] Open
Abstract
Importance This research, utilizing discrete choice experiments, examines the preferences and willingness to pay for home-based healthcare and support services among residents in China, a country grappling with severe aging population, an area often underexplored in international scholarship. Objectives This study aims to solicit the preferences of primary care patients for home-based healthcare and support services in China. Design setting and participants A discrete choice experiment (DCE) was conducted on 312 primary care patients recruited from 13 community health centers in Wuhan and Kunming between January and May 2023. The experimental choice sets were generated using NGene, covering five attributes: Scope of services, health professionals, institutions, insurance reimbursements, and visiting fees. Main outcomes and measures The choice sets were further divided into three blocks, and each participant was asked to complete one block containing 12 choice tasks. Mixed logit models were established to estimate the relevant importance coefficients of and willingness to pay for different choices, while Latent Class Logit (LCL) modeling was conducted to capture possible preferences heterogeneity. Results The relevant importance of the scope of services reached 67.33%, compared with 19.84% for service institutions and 12.42% for health professionals. Overall, respondents preferred physician-led diagnostic and treatment services. LCL categorized the respondents into three groups: Group one (60.20%) was most concerned about the scope of services, prioritizing disease diagnosis and treatment over preventive care and mental health, while group two (16.60%) was most concerned about care providers (hospitals and medical doctors were preferred), and group three (23.20%) was most concerned about financial burdens. Conclusion Primary care patients prefer physical health and medical interventions for home-based healthcare and support services. However, heterogeneity in preferences is evident, indicating potential disparities in healthcare and support at home services in China.
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Affiliation(s)
- Yaqing Liu
- School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Sixian Du
- School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Chaojie Liu
- Department of Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Tianqin Xue
- School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yuqing Tang
- School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, Hubei, China
- Key Research Institute of Humanities and Social Sciences of Hubei Provincial Department of Education, Wuhan, Hubei, China
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Qin Q, Tseng C, Chen W, Tseng CL. Best practices for implementing biosafety inspections in a clinical laboratory: Evidence from a multi-site experimental study. PLoS One 2023; 18:e0292940. [PMID: 37831670 PMCID: PMC10575490 DOI: 10.1371/journal.pone.0292940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 10/03/2023] [Indexed: 10/15/2023] Open
Abstract
OBJECTIVES To explore the key components when designing best practice inspection interventions, so as to induce high compliance with safety guidelines for laboratory workers. METHODS Five key components of an inspection intervention, identified from a focus group discussion, were used as the attributes of a discrete choice experiment (DCE). In the DCE, participants were presented with two hypothetical scenarios and asked to choose the scenario in which they were more willing to comply with the laboratory safety guidelines. Data were collected from 35 clinical laboratories in seven healthcare institutes located in Chengdu, China. In total, 188 laboratory workers completed the DCE. The collected data were analyzed using conditional logit regression and latent class analysis. RESULTS Five key attributes were identified as the most important ones to best ensure laboratory safety: the inspector, the inspection frequency, the inspection timing, the communication of the inspection outcome, and a follow-up with either a reward or a punishment. By investigating the laboratory workers' responses to the attributes, properly implementing the five attributes could improve the workers' compliance from 25.86% (at the baseline case) to 74.54%. Compliance could be further improved with the consideration of the laboratory workers' heterogeneous reactions. In this study, two classes of workers, A and B, were identified. Compliance percentages for Classes A and B would be improved to 85.48% and 81.84%, respectively, when the key attributes were properly implemented for each class. The employment type and the size of the laboratory could be used to predict class membership. CONCLUSION The findings indicate the importance of an employee-centered approach in encouraging a worker's compliance. This approach also supports the design of tailored interventions by considering the laboratory workers' heterogeneous responses to the interventions.
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Affiliation(s)
- Qiaoling Qin
- University of Electronic Science and Technology of China, Chengdu, China
| | - Cynthia Tseng
- Cornell University, New York, New York, United States of America
| | - Wenlin Chen
- University of Electronic Science and Technology of China, Chengdu, China
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Lobanov-Rostovsky S, He Q, Chen Y, Liu Y, Wu Y, Liu Y, Venkatraman T, French E, Curry N, Hemmings N, Bandosz P, Chan WK, Liao J, Brunner EJ. Growing old in China in socioeconomic and epidemiological context: systematic review of social care policy for older people. BMC Public Health 2023; 23:1272. [PMID: 37391766 PMCID: PMC10311713 DOI: 10.1186/s12889-023-15583-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 04/01/2023] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND From 2020 to 2050, China's population aged ≥65 years old is estimated to more than double from 172 million (12·0%) to 366 million (26·0%). Some 10 million have Alzheimer's disease and related dementias, to approach 40 million by 2050. Critically, the population is ageing fast while China is still a middle-income country. METHODS Using official and population-level statistics, we summarise China's demographic and epidemiological trends relevant to ageing and health from 1970 to present, before examining key determinants of China's improving population health in a socioecological framework. We then explore how China is responding to the care needs of its older population by carrying out a systematic review to answer the question: 'what are the key policy challenges to China achieving an equitable nationwide long-term care system for older people?'. Databases were screened for records published between 1st June 2020 and 1st June 2022 in Mandarin Chinese or English, reflecting our focus on evidence published since introduction of China's second long-term care insurance pilot phase in 2020. RESULTS Rapid economic development and improved access to education has led to widescale internal migration. Changing fertility policies and household structures also pose considerable challenges to the traditional family care model. To deal with increasing need, China has piloted 49 alternative long-term care insurance systems. Our findings from 42 studies (n = 16 in Mandarin) highlight significant challenges in the provision of quality and quantity of care which suits the preference of users, varying eligibility for long-term care insurance and an inequitable distribution of cost burden. Key recommendations include increasing salaries to attract and retain staff, introduction of mandatory financial contributions from employees and a unified standard of disability with regular assessment. Strengthening support for family caregivers and improving smart old age care capacity can also support preferences to age at home. CONCLUSIONS China has yet to establish a sustainable funding mechanism, standardised eligibility criteria and a high-quality service delivery system. Its long-term care insurance pilot studies provide useful lessons for other middle-income countries facing similar challenges in terms of meeting the long-term care needs of their rapidly growing older populations.
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Affiliation(s)
| | - Qianyu He
- Department of Medical Statistics & Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510275 P.R. China
- Sun Yat-sen Global Health Institute, School of Public Health, Institute of State Governance, Sun Yat-sen University, Guangzhou, 510275 P.R. China
| | - Yuntao Chen
- Department of Epidemiology & Public Health, University College London, London, WC1E 7HB UK
| | - Yuyang Liu
- Department of Medical Statistics & Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510275 P.R. China
- Sun Yat-sen Global Health Institute, School of Public Health, Institute of State Governance, Sun Yat-sen University, Guangzhou, 510275 P.R. China
- Shenzhen Health Development Research and Data Management Center, Shenzhen, China
| | - Yanjuan Wu
- Department of Medical Statistics & Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510275 P.R. China
- Sun Yat-sen Global Health Institute, School of Public Health, Institute of State Governance, Sun Yat-sen University, Guangzhou, 510275 P.R. China
| | - Yixuan Liu
- Department of Medical Statistics & Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510275 P.R. China
- Sun Yat-sen Global Health Institute, School of Public Health, Institute of State Governance, Sun Yat-sen University, Guangzhou, 510275 P.R. China
| | - Tishya Venkatraman
- Department of Epidemiology & Public Health, University College London, London, WC1E 7HB UK
| | - Eric French
- Faculty of Economics, University of Cambridge, CB3 9DD Cambridge, UK
- Institute for Fiscal Studies, University of Cambridge, London, WC1E 7AE UK
| | - Natasha Curry
- Policy Department, Nuffield Trust, W1G 7LP London, UK
| | - Nina Hemmings
- Policy Department, Nuffield Trust, W1G 7LP London, UK
| | - Piotr Bandosz
- Department of Prevention and Medical Education, Medical University of Gdansk, Gdansk, 80-210 Poland
| | - Wing Kit Chan
- School of Government, Sun Yat-sen University, Guangzhou, 510275 P.R. China
| | - Jing Liao
- Department of Medical Statistics & Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510275 P.R. China
- Sun Yat-sen Global Health Institute, School of Public Health, Institute of State Governance, Sun Yat-sen University, Guangzhou, 510275 P.R. China
| | - Eric John Brunner
- Department of Epidemiology & Public Health, University College London, London, WC1E 7HB UK
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Cao N, Shi T, Pan C. Does long-term care insurance reduce the disability among middle-aged and older adults? Evidence from China. BMC Public Health 2023; 23:1138. [PMID: 37312092 DOI: 10.1186/s12889-023-16057-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 06/06/2023] [Indexed: 06/15/2023] Open
Abstract
This study aimed to examine whether the implementation of Long-Term Care Insurance (LTCI) policy could reduce the disability among middle-aged and older adults in China, and to test the heterogeneity of the effects. Data came from four waves of the China Health and Retirement Longitudinal Study (CHARLS, 2011 to 2018). The Difference-In-Differences (DID) method and the panel data fixed effect model were used to estimate the effect of implementation of LTCI policy on disability among individuals aged 45 years and above. The LTCI policy had a positive impact on reducing disability among middle-aged and older people. Females, younger adults, city dwellers, and individuals living alone benefited the most from LTCI policy. The results provided empirical evidence for the implementation of LTCI policy in China and other similar countries as China. The implementation of LTCI policy should also pay more attention to inequity of the effects on reducing disability among different demographic groups.
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Affiliation(s)
- Na Cao
- School of Public Health and Management, Wenzhou Medical University, Wenzhou Medical University Chashan Campus, Wenzhou City, 325035, Zhejiang Province, China
- School of Public Health, Wuhan University, Wuhan City, Hubei Province, China
| | - Tong Shi
- School of Public Health, Wuhan University, Wuhan City, Hubei Province, China
| | - Chaoping Pan
- School of Public Health and Management, Wenzhou Medical University, Wenzhou Medical University Chashan Campus, Wenzhou City, 325035, Zhejiang Province, China.
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Putri NK, Laksono AD, Rohmah N. Predictors of national health insurance membership among the poor with different education levels in Indonesia. BMC Public Health 2023; 23:373. [PMID: 36810024 PMCID: PMC9945403 DOI: 10.1186/s12889-023-15292-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 02/20/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Indonesia has made significant progress in expanding universal health coverage (UHC) through its National Health Insurance (NHI) mechanism. However, in the context of NHI implementation in Indonesia, socioeconomic disparities caused its subpopulations to have different literacy of NHI concepts and procedures, increasing the risk of healthcare access inequities. Hence, the study aimed to analyse the predictors of NHI membership among the poor with different education levels in Indonesia. METHODS This study used the secondary dataset of the nationwide survey "Abilities and Willingness to Pay, Fee, and Participant Satisfaction in implementing National Health Insurance in Indonesia in 2019" by The Ministry of Health of the Republic of Indonesia. The study population was the poor population in Indonesia and included a weighted sample of 18,514 poor people. The study used NHI membership as a dependent variable. Meanwhile, the study analysed seven independent variables: wealth, residence, age, gender, education, employment, and marital status. In the final step of the analysis, the study used binary logistic regression. RESULTS The results show that the NHI membership among the poor population tends to be higher among those who have higher education, live in urban areas, are older than 17 years old, are married and are wealthier. The poor population with higher education levels is more likely to become NHI members than those with lower education. Their residence, age, gender, employment, marital status, and wealth also predicted their NHI membership. Poor people with primary education are 1.454 times more likely to be NHI members than those without education (AOR 1.454; 95% CI 1.331-1.588). Meanwhile, those with secondary education are 1.478 times more likely to be NHI members than those with no education (AOR 1.478; 95% CI 1.309-1.668). Moreover, higher education is 1.724 times more likely to result in being an NHI member than no education (AOR 1.724; 95% CI 1.356-2.192). CONCLUSION Education level, residence, age, gender, employment, marital status, and wealth predict NHI membership among the poor population. Since significant differences exist in all of those predictors among the poor population with different education levels, our findings highlighted the importance of government investment in NHI, which must be supported with investment in the poor population's education.
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Affiliation(s)
- Nuzulul Kusuma Putri
- Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia. .,The Airlangga Centre for Health Policy (ACeHAP), Surabaya, Indonesia.
| | - Agung Dwi Laksono
- The Airlangga Centre for Health Policy (ACeHAP), Surabaya, Indonesia ,National Research and Innovation Agency, Republic of Indonesia, Jakarta, Indonesia
| | - Nikmatur Rohmah
- grid.443502.40000 0001 2368 5645Faculty of Health Science, Muhammadiyah University of Jember, Jember, Indonesia
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Ma H, Jia E, Ma H, Pan Y, Jiang S, Xiong J. Preferences for public long-term care insurance among middle-aged and elderly residents: A discrete choice experiment in Hubei Province, China. Front Public Health 2023; 11:1050407. [PMID: 36778541 PMCID: PMC9909219 DOI: 10.3389/fpubh.2023.1050407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 01/09/2023] [Indexed: 01/27/2023] Open
Abstract
Objective It is critical to incorporate residents' preferences into the design of long-term care insurance (LTCI). However, little is known about middle-aged and elderly residents' preferences for personalized need-related attributes of LTCI in China. Through a discrete choice experiment (DCE), we aimed to focus on the direct beneficiaries of LTCI and then elicit their preferences for LTCI under a hypothetical scenario of dysfunction. Methods Attributes and levels were defined through a literature review and two rounds of expert consultations (n = 8). A D-optimal fractional factorial design was used to generate the DCE questionnaire. Face-to-face interviews with middle-aged and elderly residents were conducted in two cities in Hubei Province, China, between November and December 2020. A mixed logit model was utilized for estimation. Results Five attributes were identified and incorporated into the DCE questionnaire. A total of 390 participants completed DCE questionnaires. Care facilities, care content, reimbursement rate, caregivers, and annual premium per person all had a significant impact on residents' preferences. Residents had significantly higher preferences for the LTCI scheme with home and community-based care centers (β = 1.40, p < 0.01), multi-level services (β = 0.44, p < 0.01), 90% reimbursement rate (β = 0.37, p < 0.01), and sufficiently trained caregivers (β = 0.26, p < 0.01). Individual characteristics, such as gender, employment, and education level were the factors that drove heterogeneity in preferences for LTCI. Conclusion This study provides new evidence on the preferences of middle-aged and elderly residents for personalized need-related public LTCI features. The design of the LTCI scheme in China needs to take these findings into account to maximize the utility for direct beneficiaries of LTCI and enhance their enrollment.
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Affiliation(s)
- He Ma
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Erping Jia
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Huimin Ma
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yanzhi Pan
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Shan Jiang
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Juyang Xiong
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China,*Correspondence: Juyang Xiong ✉
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11
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Different impact on health outcomes of long-term care insurance between urban and rural older residents in China. Sci Rep 2023; 13:253. [PMID: 36604590 PMCID: PMC9815686 DOI: 10.1038/s41598-023-27576-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 01/04/2023] [Indexed: 01/07/2023] Open
Abstract
Long-term care insurance (LTCI) is garnering attention internationally and is being considered a public policy in a growing number of countries. Previous research has focused on the effects of LTCI in developed countries, ignoring the health outcomes of developing countries, especially in rural regions. Therefore, this study investigates whether different impact on health outcomes is present in the effects of LTCI between urban and rural residents in China. We employed a quasi-experimental design with data from the China Health and Retirement Longitudinal Survey. The specific implementation time of each pilot city was sorted according to the LTCI policy texts, dividing these pilot cities into the treatment group and control group. Finally, difference-in-differences analyses were utilized to evaluate the health effects of LTCI between urban and rural residents, and the health effect in urban areas was further tested. The implementation of LTCI has effectively enhanced the self-rating health (SRH) of the entire group of residents; however, this effect may only be significant for the urban group. In particular, LTCI can increase the SRH of urban residents by 0.377 units compared to the urban residents without LTCI (P < 0.01). The result of the placebo effect test further verifies that LTCI could improve the health of residents to some extent. In China, LTCI may have triggered different impacts on health outcomes between urban and rural residents, and may not improve the SRH of rural residents and only prove efficacious for urban residents. Government and policy-makers should give more attention to the rural group as it needs long-term care the most.
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12
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Chen Y, Zhao H. Long-term care insurance, mental health of the elderly and its spillovers. Front Public Health 2023; 11:982656. [PMID: 36935677 PMCID: PMC10020345 DOI: 10.3389/fpubh.2023.982656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 02/16/2023] [Indexed: 03/06/2023] Open
Abstract
The paper studies the effects of the long-term care insurance (LTCI) program in China on the mental health of older adults and the wellbeing of their families. We employ the staggered difference-in-differences approach based on the LTCI pilots from 2015 to 2017. First, we find the LTCI program improves older adults' happiness and reduces depression symptoms significantly. The effects on the improvement in memory and cognition are associated with the elderly with activities of daily living-related need for care. Second, the effects of LTCI are partially mediated through providing community services, relieving care burdens, and reducing the incidence of diseases. More importantly, LTCI coverage improves caregivers' physical health and social activities, reflecting its welfare spillover effects. Furthermore, the relationship between LTCI and mental health differs due to the difference in LTCI designs and older adults' demographic characteristics. This presents a need to consider mental health in the services and evaluation criteria of LTCI.
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Affiliation(s)
- Yunfei Chen
- School of Economics, Shanghai University, Shanghai, China
| | - Hong Zhao
- School of Economics, Qingdao University, Qingdao, China
- *Correspondence: Hong Zhao
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13
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Wickramasinghe A, Gamage M, Torabi MR, Perera B. Impact of perceived social support and physical fitness on quality of life of institutionalized and non-institutionalized older adults in Sri Lanka. DIALOGUES IN HEALTH 2022; 1:100079. [PMID: 38515873 PMCID: PMC10953875 DOI: 10.1016/j.dialog.2022.100079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 11/09/2022] [Accepted: 11/10/2022] [Indexed: 03/23/2024]
Abstract
Background and aim Quality of life (QoL) in old age contributes to enhance active aging. This study aimed to assess and compare QoL and associated factors of institutionalized and non-institutionalized older adults (aged 60+ years) in Southern Sri Lanka. Methods A total of 160 older adults (80 institutionalized and 80 non-institutionalized) were surveyed. Physical and cognitive skills were measured using Barthel index, and Mini Mental State Examination scales. Nutritional status and perceived social support were measured using Mini Nutritional Assessment and Multidimensional Scale of Perceived Social Support. Descriptive statistics and multiple regression techniques were used in the analysis. Results The mean age of the institutionalized older adults was higher than that of non-institutionalized older adults (74.9 years versus 72.1 years, p < 0.01). About half of the sample consisted of older men (48.8%). Economically under privileged older adults who were unmarried were more likely to become institutionalized. The mean value of the QoL score was higher in non-institutionalized older adults compared to that of institutionalized older adults (63.1 (SD = 21.9) versus 49.1 (SD = 25.6), p < 0.05). Activities of daily living (ẞ=-0.46, p < 0.01) and perceived social support (ẞ=-0.20, p < 0.05) were found to be significant determinants of QoL of institutionalized older adults while activities of daily living (ẞ=-0.28, p < 0.05) and nutritional status (ẞ=-0.27, p < 0.05) were found to be significant determinants of QoL of non-institutionalized older adults. Cognitive impairments was not a significant determinant of QoL in both institutionalized and non-institutionalized older adults. Conclusions Promotion of physically active life style especially among young older adults to maintain their independence as they age and improvements of social support and social connectedness among older adults would be practical and cost-effective strategies to promote active aging in Sri Lankan older adults.
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Affiliation(s)
- Anuradha Wickramasinghe
- Department of Nursing, Faculty of Allied Health Sciences, University of Ruhuna, Galle, Sri Lanka
| | - Madushika Gamage
- Department of Nursing, Faculty of Allied Health Sciences, University of Ruhuna, Galle, Sri Lanka
| | - Mohammad R. Torabi
- School of Public Health – Bloomington, Indiana University, IN 47405, USA
| | - Bilesha Perera
- Department of Community Medicine, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
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14
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Roland D, Allan S, Chambers E, Smith D, Gousia K. Personal assistants in England and the factors associated with absenteeism. Front Public Health 2022; 10:970370. [PMID: 36299742 PMCID: PMC9589044 DOI: 10.3389/fpubh.2022.970370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 09/15/2022] [Indexed: 01/25/2023] Open
Abstract
Personal assistants (PAs) have become an increasingly important element of long-term care (LTC) in England since the introduction of Direct Payments in 1996 and the Care Act 2014 legislation. The PAs, who are directly employed by social care users, can perform a number of support tasks including vital assistance in activities of daily living (ADL). Internationally these roles would be classed as domestic care work, including the employment of migrant care workers, e.g. in Germany and Austria. High turnover rates and work absenteeism in this market can cause disruption of these important daily activities, causing LTC users to potentially suffer neglect and poorer quality of life. Although there is research on turnover and absenteeism in nursing workforce in hospitals and LTC workers in nursing homes, little attention has been given to reasons for turnover of PAs and even less for absenteeism, which often precedes turnover, in a workforce of over 100,000 people in England. This research aims to fill this gap in knowledge by analyzing the reasons behind the absenteeism of PAs using quantitative methods. We used survey data of PAs in England, exploring the factors associated to one form of absenteeism-sick leave from work. After controlling for a number of factors ranging from job characteristics such as number of hours worked and type of contract, socio-economic characteristics from the PA and their employer, and supply and demand factors at local government region, the findings suggest a number of factors that significantly influenced sick leave, including distances traveled to work and number of PAs employed. Following the analysis, two people with life experience of LTC discuss the findings of the study and how they compare to their experiences of the market for PAs, providing a unique perspective from the people who could benefit the most from improving PA retention and reducing absenteeism.
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Affiliation(s)
- Daniel Roland
- Personal Social Services Research Unit, School of Social Policy, Sociology and Social Research, University of Kent, Canterbury, United Kingdom,*Correspondence: Daniel Roland
| | - Stephen Allan
- Personal Social Services Research Unit, School of Social Policy, Sociology and Social Research, University of Kent, Canterbury, United Kingdom
| | - Eleni Chambers
- Patient and Public Involvement Research Advisor, Division of Nursing & Midwifery, Health Sciences School, University of Sheffield, Sheffield, United Kingdom,Patient and Public Involvement Research Advisor, Public Involvement Research Advisor Network, Personal Social Services Research Unit, University of Kent, Canterbury, United Kingdom
| | - Debs Smith
- Patient and Public Involvement Research Advisor, Division of Nursing & Midwifery, Health Sciences School, University of Sheffield, Sheffield, United Kingdom,Patient and Public Involvement Research Advisor, Public Involvement Research Advisor Network, Personal Social Services Research Unit, University of Kent, Canterbury, United Kingdom
| | - Katerina Gousia
- Personal Social Services Research Unit, School of Social Policy, Sociology and Social Research, University of Kent, Canterbury, United Kingdom
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15
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Amilon A, Kjær AA, Ladenburg J, Siren A. Trust in the publicly financed care system and willingness to pay for long-term care: A discrete choice experiment in Denmark. Soc Sci Med 2022; 311:115332. [PMID: 36084519 DOI: 10.1016/j.socscimed.2022.115332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 08/23/2022] [Accepted: 08/26/2022] [Indexed: 10/14/2022]
Abstract
Aging populations put pressure on the provision and financing of long-term care (LTC) services in many countries. The projected increase in LTC expenditures may in particular constitute a threat to the future sustainability of public budgets in welfare states, where LTC is financed through taxes. To accommodate the increasing number of 80+ year-olds in society, policy-makers and service administrators need a better understanding of care preferences among future older adults: What types of services do older citizens prefer most, and which factors shape their LTC preferences? A discrete choice experiment (DCE) was administered to a representative sample of the Danish population aged 54-64 from May to July 2019 (n = 1154), investigating which factors shape individuals' preferences and willingness-to-pay (WTP) for their future LTC. Our results reveal that respondents are willing to make additional out-of-pocket payments to supplement the care provided for free by the municipality. The WTP was highest for services such as receiving help from a regular care team ($129 per month) and an extra shower a week ($116 per month). Moreover, we find heterogeneous care preferences, with three user characteristics associated with higher WTP for services: higher education, high wealth, and a low trust in the publicly financed care system. Our results raise concerns that inequalities between relatively more- and less-resourceful older adults may increase in Scandinavian-type welfare states in the future. Such increasing inequality in service provision may undermine citizens' trust in and support of the publicly financed care system.
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Affiliation(s)
- Anna Amilon
- The Danish Center for Social Science Research, Herluf Trolles Gade 11, 1052, Copenhagen, Denmark.
| | - Agnete Aslaug Kjær
- The Danish Center for Social Science Research, Herluf Trolles Gade 11, 1052, Copenhagen, Denmark; Den Tværgående Analyseenhed, Københavns Kommune, Rådhuspladsen 1, 1599, Copenhagen, Denmark.
| | - Jacob Ladenburg
- The Rockwool Foundation, Ny Kongensgade 6, 1472, Copenhagen, Denmark; Technical University of Denmark, Produktionstorvet 424, 024, 2800, Kgs. Lyngby, Denmark.
| | - Anu Siren
- The Danish Center for Social Science Research, Herluf Trolles Gade 11, 1052, Copenhagen, Denmark; Tampere University, Arvo Ylpön katu 34, 33,520, Tampere, Finland.
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16
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Deng X, Liao J, Peng R, Chen J. The Impact of Long-Term Care Insurance on Medical Utilization and Expenditures: Evidence from Jingmen, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12275. [PMID: 36231574 PMCID: PMC9564761 DOI: 10.3390/ijerph191912275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/27/2022] [Accepted: 09/23/2022] [Indexed: 06/16/2023]
Abstract
The purpose of this study was to evaluate the impact of long-term care insurance (LTCI) on medical utilization and expenditures in Jingmen, a pilot city of China. The propensity score matching-difference in difference (PSM-DID) approach was employed to examine the expenses and frequency of inpatient and outpatient services before and after the implementation of the LTCI based on the 2015-2018 panel data from the China Health and Retirement Longitudinal Study (CHARLS). The results showed that the annual expenditure and frequency of the inpatient services of Jingmen residents were reduced by 1923 Yuan (287.0 USD) and 0.24 times, respectively. The impact of the LTCI varied between urban and rural areas. The annual expenditure and frequency of inpatient services in rural areas were reduced by 1600 Yuan (238.8 USD) and 0.30 times, which were lower than those (3400 Yuan (507.5 USD) and 0.20 times) in urban areas. The monthly outpatient expenses and frequency in rural areas were reduced by 300 Yuan (44.8 USD) and 0.14 times, but increased by 555 Yuan (82.8 USD) and 0.07 times in urban area. The findings indicated that the implementation of the LTCI can reduce the medical utilization and expenses, and it had a greater effect in rural areas than in urban areas. It is suggested to promote the LTCI nationwide, and more policy preference should be given to the development of the LTCI in rural areas.
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17
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Zhang L, Fu S, Wang Y, Fang Y. Research on the optimization of financing scheme of long-term care insurance in China based on system dynamics simulation. Front Public Health 2022; 10:908864. [PMID: 36211654 PMCID: PMC9538358 DOI: 10.3389/fpubh.2022.908864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 08/17/2022] [Indexed: 01/22/2023] Open
Abstract
Objective The aging population in China highlights the significance of long-term care insurance (LTCI). This study provides policy suggestions for China to establish a sustainable LTCI financing mechanism by predicting the trend of funds balance and screening the appropriate financing scheme. Method A system dynamics model (SDM) of LTCI funds was constructed by clarifying the current situation and its main influencing factors of revenue and expenditure of LTCI funds in China. Also, through literature research and expert consultation, we found the intervention goals and predicted the changing trend of LTCI fund balance from 2020 to 2050 under different intervention schemes. Results The SDM of LTCI financing passes the dimensional consistency test, structural test, and historical test. Therefore, it can objectively reflect the structure and behavior of the financing system. It is found that the factors affecting the revenue and expenditure system of LTCI funds mainly include economic factors, demographic factors, and other factors. By adjusting three intervention indicators, namely, individual payment rate, reimbursement proportion, and severe disability rate, this study produces 45 financing combination schemes. By comparing the changing trend of LTCI fund balance under different intervention schemes, according to the screening principle, five better financing schemes are finally selected. These five financing schemes have no deficit and excessive balance in the forecast period, which is in line with the principle of sustainability. It can provide a reference for the selection of financing schemes in pilot areas. Discussion This study has optimized the policy of the LTCI financing mechanism, determined the suitable LTCI participants, financing channels and levels, and screened out the suitable LTCI financing policy optimization scheme for China. By appropriately increasing the individual payment rate, strengthening the disability intervention of the elderly, formulating scientific and objective disability evaluation standards, and finally establishing a dynamic financing adjustment mechanism of LTCI. This study can provide a basis for the scientific formulation of the LTCI financing mechanism in China and provide a reference for developing countries to establish a sustainable LTCI.
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Affiliation(s)
- Liangwen Zhang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China,Key Laboratory of Health Technology Assessment of Fujian Province University, School of Public Health, Xiamen University, Xiamen, China
| | - Sijia Fu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China,Key Laboratory of Health Technology Assessment of Fujian Province University, School of Public Health, Xiamen University, Xiamen, China
| | - Yifan Wang
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR, China
| | - Ya Fang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China,Key Laboratory of Health Technology Assessment of Fujian Province University, School of Public Health, Xiamen University, Xiamen, China,*Correspondence: Ya Fang
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18
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Laksono AD, Nugraheni WP, Rohmah N, Wulandari RD. Health insurance ownership among female workers in Indonesia: does socioeconomic status matter? BMC Public Health 2022; 22:1798. [PMID: 36138387 PMCID: PMC9494853 DOI: 10.1186/s12889-022-14189-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 09/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Female workers are vulnerable groups in the Indonesian context, and female workers must be responsible for domestic problems and earn a living. The study aimed to analyze the role of socioeconomic on health insurance ownership among female workers in Indonesia. METHODS The study population was all female workers in Indonesia. This cross-sectional study involved 7,943 respondents. The study analyzed health insurance ownership as an outcome variable and socioeconomic status as an exposure variable. The study also involved five control variables: residence, age, marital, education, and occupation. The research used multinomial logistic regression in the final step. RESULTS The results show the poorest female workers have a possibility of 0.735 times more than the richest to have NHI (AOR 0.733; 95% CI 0.733-0.737). The poorer female workers have 0.939 times less likely than the richest to have NHI (AOR 0.939; 95% CI 0.937-0.942). Female workers with middle socioeconomic status are possibly 0.833 times less than the richest to have NHI (AOR 0.833; 95% 0.831-0.835). Moreover, the richer female workers have 1.028 times more likely than the richest to have NHI (AOR 1.028; 95% CI 1.025-1.030). Moreover, all socioeconomic statuses have a lower possibility than the richest of having other health insurance. CONCLUSIONS The study concluded that socioeconomic has a role in health insurance ownership among female workers in Indonesia.
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Affiliation(s)
- Agung Dwi Laksono
- National Research and Innovation Agency Republic of Indonesia, Jakarta, Indonesia
| | | | - Nikmatur Rohmah
- Faculty of Health Science, Muhammadiyah University of Jember, East Java, Indonesia
| | - Ratna Dwi Wulandari
- Department of Administration and Health Policy, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia.
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19
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Chen N, Bai J, Nicholas S, Maitland E, Tan J, Wang J. Preferences for private health insurance in China: A discrete choice experiment. Front Public Health 2022; 10:985582. [PMID: 36148354 PMCID: PMC9486459 DOI: 10.3389/fpubh.2022.985582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 08/08/2022] [Indexed: 01/25/2023] Open
Abstract
Introduction There is limited evidence on the sustainability and optimal design of China's private health insurance market, especially from the demand-side. With the increasing medical cost burden on both patients and the social security system, policy makers need data on potential clients' demand for private health insurance. Methods A discrete choice experiment was conducted to explore potential clients' preferences for a type of government-involved private supplementary health insurance, Huimin Insurance, in China. A mixed logit model was used to evaluated participants' preferences for six attributes. Willingness to pay, subgroup analysis and interaction effects were estimated based on the initial model. Results Among the 947 participants, 883 (93.2%) were aged 18 to 59 years and 578 (61.0%) were female. Participants had a strong preference for government involvement, extensive benefit packages, high reimbursement ratio and compensation for pre-existing conditions. With respect to the attribute of deductible, participants were indifferent between the level of CNY15,000 and CNY18,000 but had strong and significant preference for the level of CNY15,000 than CNY20,000. The premium was significantly correlated with a decline in the utility of PHI. Conclusions All attributes had a significant impact on participants' preference for Huimin Insurance. Providing a reference point for the development of private health insurance in China, our results inform the optimal design of PHI, especially Huimin Insurance's products.
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Affiliation(s)
- Nuo Chen
- Dong Fureng Institute of Economic and Social Development, Wuhan University, Beijing, China
| | - Jing Bai
- Dong Fureng Institute of Economic and Social Development, Wuhan University, Beijing, China
| | - Stephen Nicholas
- Australian National Institute of Management and Commerce, Sydney, NSW, Australia,Newcastle Business School, University of Newcastle, Newcastle, NSW, Australia
| | - Elizabeth Maitland
- School of Management, University of Liverpool, Liverpool, United Kingdom
| | - Jialong Tan
- School of Public Health, Wuhan University, Wuhan, China,*Correspondence: Jialong Tan
| | - Jian Wang
- Dong Fureng Institute of Economic and Social Development, Wuhan University, Beijing, China,Center for Health Economics and Management at the School of Economics and Management, Wuhan University, Wuhan, China,Jian Wang
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20
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Hess S, Lancsar E, Mariel P, Meyerhoff J, Song F, van den Broek-Altenburg E, Alaba OA, Amaris G, Arellana J, Basso LJ, Benson J, Bravo-Moncayo L, Chanel O, Choi S, Crastes Dit Sourd R, Cybis HB, Dorner Z, Falco P, Garzón-Pérez L, Glass K, Guzman LA, Huang Z, Huynh E, Kim B, Konstantinus A, Konstantinus I, Larranaga AM, Longo A, Loo BPY, Oehlmann M, O'Neill V, de Dios Ortúzar J, Sanz MJ, Sarmiento OL, Moyo HT, Tucker S, Wang Y, Wang Y, Webb EJD, Zhang J, Zuidgeest MHP. The path towards herd immunity: Predicting COVID-19 vaccination uptake through results from a stated choice study across six continents. Soc Sci Med 2022; 298:114800. [PMID: 35287066 PMCID: PMC8848547 DOI: 10.1016/j.socscimed.2022.114800] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 01/18/2022] [Accepted: 02/07/2022] [Indexed: 11/27/2022]
Abstract
Despite unprecedented progress in developing COVID-19 vaccines, global vaccination levels needed to reach herd immunity remain a distant target, while new variants keep emerging. Obtaining near universal vaccine uptake relies on understanding and addressing vaccine resistance. Simple questions about vaccine acceptance however ignore that the vaccines being offered vary across countries and even population subgroups, and differ in terms of efficacy and side effects. By using advanced discrete choice models estimated on stated choice data collected in 18 countries/territories across six continents, we show a substantial influence of vaccine characteristics. Uptake increases if more efficacious vaccines (95% vs 60%) are offered (mean across study areas = 3.9%, range of 0.6%-8.1%) or if vaccines offer at least 12 months of protection (mean across study areas = 2.4%, range of 0.2%-5.8%), while an increase in severe side effects (from 0.001% to 0.01%) leads to reduced uptake (mean = -1.3%, range of -0.2% to -3.9%). Additionally, a large share of individuals (mean = 55.2%, range of 28%-75.8%) would delay vaccination by 3 months to obtain a more efficacious (95% vs 60%) vaccine, where this increases further if the low efficacy vaccine has a higher risk (0.01% instead of 0.001%) of severe side effects (mean = 65.9%, range of 41.4%-86.5%). Our work highlights that careful consideration of which vaccines to offer can be beneficial. In support of this, we provide an interactive tool to predict uptake in a country as a function of the vaccines being deployed, and also depending on the levels of infectiousness and severity of circulating variants of COVID-19.
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Affiliation(s)
| | | | | | | | - Fangqing Song
- University of Leeds, United Kingdom; University College London, United Kingdom.
| | | | | | - Gloria Amaris
- University of Leeds, United Kingdom; Norwegian University of Science and Technology, Trondheim, Norway
| | | | | | | | - Luis Bravo-Moncayo
- Universidad de Las Américas, Ecuador; Universidad Técnica del Norte, Ecuador
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Malte Oehlmann
- Chair of Marketing and Consumer Research, TUM School of Management, Technical University of Munich, Germany
| | | | | | - María José Sanz
- BC3 Basque Centre for Climate Change, Spain; Ikerbasque Foundation, Spain
| | | | | | | | | | - Yu Wang
- Beijing Jiaotong University, China
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21
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Legal Aspects of Social Infrastructure for Housing and Care for the Elderly—The Case of Slovenia. LAWS 2022. [DOI: 10.3390/laws11020016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
On 17 June 2021, the Government of the Republic of Slovenia adopted a Bill on Long-term Care. This legislative activity also raised the question of the existence and effectiveness of a legal environment to promote social infrastructure development for housing and care of older adults. Social infrastructures include the facilities in which long-term care services are provided. Therefore, the new legislative proposal also raised the issue of the regulation of this social infrastructure and the housing and care solutions as a part of the social infrastructure since they benefit individuals and communities. Furthermore, in line with the growing trend towards deinstitutionalisation, the legal environments should enhance alternative housing solutions for the elderly. The purpose of this article is to describe the foundations of the social infrastructure for older adults and examine the legal basis for its provision. The research belongs to legal geography studies, which means that the substance of laws and materialisation in space are considered. We identified two primary spatial–legal barriers to overcome, which are (a) the separate treatment of the housing and health aspects and (b) the absence of the guarantee schemes for the construction of housing-with-care solutions. The results would be helpful for the optimal organisation of integrated care, which individual research groups in Slovenia are studying.
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22
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Liu H, Hu T. Evaluating the long-term care insurance policy from medical expenses and health security equity perspective: evidence from China. Arch Public Health 2022; 80:3. [PMID: 34983634 PMCID: PMC8725500 DOI: 10.1186/s13690-021-00761-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/11/2021] [Indexed: 11/10/2022] Open
Abstract
Background Since the national long-term care (LTCI) policy pilot in 2016 of China, the LTCI policy has had significant impact on the residents in the pilot area. Methods From the perspective of medical expenses and health security equity, this study selects tracking survey data from the CHARLS database in 2013, 2015, and 2018 and empirically investigates the effect of LTCI policy pilot by using differences-in-differences method (DID). Moreover, this study measures the economic distribution and health equity of the treated and untreated groups using the concentration and Theil indices. Results The results showed that group heterogeneity of medical expenses and health level of elderly in the treatment group were narrowing. Moreover, the policy results showed that the LTCI policy pilot significantly affects the outpatient, hospital expenses, and length of stay of elders. Residence registration, income level, and basic medical insurance play a significant regulatory role. Additionally, LTCI policy pilot significantly improved the overall health of the elderly. Conclusions The measurement results of inequality show that the policy increases the income of low-income people, lowers the inequality level of outpatient and inpatient reimbursement, and reduces the concentration index of ADL disability and serious diseases. However, the inequality of serious diseases is becoming higher. Based on this, this paper provides several suggestions on optimizing the pilot policy of LTCI.
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Affiliation(s)
- Huan Liu
- Zhejiang University of Finance & Economics, Hang Zhou, China.
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Laksono AD, Nantabah ZK, Wulandari RD, Khoiri A, Tahangnacca M. Barriers to Expanding the National Health Insurance Membership in Indonesia: Who Should the Target? J Prim Care Community Health 2022; 13:21501319221111112. [PMID: 35818670 PMCID: PMC9280783 DOI: 10.1177/21501319221111112] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: The Indonesian government initiated National Health Insurance (NHI) to reduce health service barriers. The study aimed to analyze specific targets for expanding the NHI’s membership in Indonesia. Methods: The study population was all populations in Indonesia. Meanwhile, the study involved a 47 644 weighted sample. The analyzed variables included NHI’s membership, residence, age, gender, education, employment, marital status, and wealth. The study employed binary logistic regression in the final step. Results: The urban population was 0.608 times less likely than the rural population to become a non-member of NHI. Aging younger was one of the barriers to becoming an NHI member, and the male gender is one of the barriers to becoming an NHI member. Meanwhile, the lower the education level, the greater the obstacles to becoming an NHI member in Indonesia. Besides, the unemployed population was 1.002 more likely than the employed population to become a non-member of NHI. The result shows that never married or married have a higher chance of becoming a non-member of NHI. Finally, all wealth status categories are more likely to become barriers to the most prosperous population becoming an NHI member. Conclusions: The study concluded that 7 population characteristics become specific targets for expanding NHI membership in Indonesia. The 7 characteristics are the population who live in rural areas, are young, male, poor education, unemployed, never married or married, and poor.
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Affiliation(s)
- Agung Dwi Laksono
- National Research and Innovation Agency, Republic of Indonesia, Jakarta, Indonesia.,The Airlangga Centre for Health Policy (ACeHAP), Surabaya, Indonesia
| | | | - Ratna Dwi Wulandari
- The Airlangga Centre for Health Policy (ACeHAP), Surabaya, Indonesia.,Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
| | - Abu Khoiri
- Faculty of Public Health, Universitas Jember, Jember, Indonesia
| | - Minsarnawati Tahangnacca
- Faculty of Health Science, Syarif Hidayatullah Jakarta State Islamic University, Jakarta, Indonesia
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