Does the Development of the Insurance Industry Promote the Purchase of Rural Commercial Health Insurance?

Factors associated with the enrollment of commercial medical insurance in China: Results from China General Social Survey

BACKGROUND

The Chinese government has been promoting commercial medical insurance (CMI) in recent decades as it plays an increasingly important role in addressing disease burden, health inequities, and other healthcare challenges. However, compared with developed countries, the CMI is still less fledged with low coverage.

OBJECTIVE

This study aims to explore the factors associated with enrollment in CMI, with regards to explicit characteristics (including sociodemographic characteristics and family economic status), latent characteristics (including social security status), and the global incentive compatibility index (including health status), to inform the design of CMI to improve its coverage in China.

METHODS

Based on the principal-agent model, we summarized and classified the factors associated with the enrollment in CMI, and then analyzed the data generated from the Chinese General Social Survey in 2015,2018 and 2021 respectively. A comparison of factors regarding sociodemographic characteristics, family economic status, social security status, and health status was conducted between individuals enrolled and unenrolled in CMI using Mann-Whitney U test and Chi-square test. Binary logistic regression analysis was used to explore factors influencing the enrollment status of CMI.

RESULTS

Of all individuals, the proportion of enrolled individuals shows an increasing trend year by year, with 8.7%,11.8% and 14.1% enrolled in CMI in 2015,2018 and 2021, respectively. The binary regression analysis further suggested that the factors associated with the enrollment in CMI were consistent in 2015,2018 and 2021.We found that individuals divorced, obese, who had a higher level of education, had non-agricultural household registration, perceived themselves as the upper social status, conducted daily exercise, had more family houses, had a car, had investment activities, or did not have basic health insurance were more likely to be enrolled in CMI.

CONCLUSIONS

We identified multidimensional factors associated with the enrollment of CMI, which help inform the government and insurance industry to improve the coverage of CMI.

A firm-level analysis of Chinese commercial health insurance surrender

Based on the unbalanced panel data of Chinese professional health insurance companies from 2011 to 2021, the paper constructs "PW+PCSE" model to empirically investigate the main factors affecting the commercial health insurance surrender in China from the company level. The results show that asset-liability ratio has a significant positive effect on health insurance surrender rate. The value preservation and appreciation rate of capital and R&D expenditure rate both have significant negative effects on health insurance surrender rate. These studies bring important enlightenment for domestic health insurance companies to avoid surrender risk.

Study on the Dynamic Relationship between Chinese Residents' Individual Characteristics and Commercial Health Insurance Demand

Based on the time series data of age characteristics, household registration characteristics, gender characteristics, education characteristics, marriage characteristics and commercial health insurance density of Chinese residents from 1997 to 2020, this paper aims to explore the dynamic relationship between the individual characteristics of Chinese residents and the demand for commercial health insurance by means of impulse response and variance decomposition analysis using an SVAR model. The results show that the age characteristics, household registration characteristics, gender characteristics, education characteristics and marriage characteristics of Chinese residents have a significant impact on the demand for commercial health insurance, but there is a time lag. There is a long-term equilibrium relationship between them: In terms of age characteristics and gender characteristics, the former has a positive effect in the short term and a significant inhibition on commercial health insurance demand in the long term, while the latter has the opposite. In terms of household registration characteristics, education characteristics and marriage characteristics, there are positive effects on the whole and negative effects in a particular period.

Influence of Internet Use on Commercial Health Insurance of Chinese Residents

As a necessary supplement to social medical insurance, commercial health insurance is an important part of the Healthy China strategy. This study, based on the Chinese General Social Survey (CGSS) data in 2017, uses the probit model to analyze and study the internal relationship between Internet use and commercial health insurance purchase of urban and rural residents. The research results show that the use of the Internet significantly promoted commercial health insurance purchases of residents, and the promotion effect for rural residents is apparently better than that among urban residents. In addition, the social level of residents is improved through the use of Internet, which can promote commercial health insurance purchases. It provides a significant reference value for the effective integration of Internet use and commercial health insurance, and the high-quality development of the modern insurance industry.

Influence of Commercial Insurance Purchase on the Health Status of Chinese Residents

Under the context of rapid economic and social development, and growing demands for a better life, Chinese residents have been increasingly concerned with their health status and issues. In this study, the internal relations between the purchase of commercial insurance by residents and their health status are analyzed and studied with a polytomous logit model based on the data of Chinese General Social Survey (CGSS) in 2015. According to the research result, purchase of commercial insurance significantly improved the health status of residents, with an improving effect for rural residents apparently better than that among urban residents. In addition, purchase of commercial insurance can promote the health status of residents by increasing their household income. This research will provide an effective reference for the innovative development and medical reform of the commercial insurance of China in the future, which is theoretically and practically significant to the implementation of the Healthy China Strategy.

Temporal trend of comorbidity and increasing impacts on mortality, length of stay, and hospital costs of first stroke in Tianjin, North of China

BACKGROUND

Stroke patients have a high incidence of comorbidity. Previous studies have shown that comorbidity can impact on the short-term and long-term mortality after stroke.

METHODS

Our study aimed to explore the trend of comorbidity among patients with first stroke from 2010 to 2020, and the influence of comorbidity on admission mortality, length of stay and hospitalization costs. 5988 eligible patients were enrolled in our study, and divided into 4 comorbidity burden groups according to Charlson comorbidity index (CCI): none, moderate, severe, very severe. Survival analysis was expressed by Kaplan-Meier curve. Cox regression model was used to analyze the effect of comorbidity on 7-day and in-hospital mortality. Generalized linear model (GLM) was used to analyze the association between comorbidity and hospitalization days and cost.

RESULTS

Compared to patients without comorbidity, those with very severe comorbidity were more likely to be male (342, 57.7%), suffer from ischemic stroke (565, 95.3%), afford higher expense (Midian, 19339.3RMB, IQR13020.7-27485.9RMB), and have a higher in-hospital mortality (60, 10.1%). From 2010 to 2020, proportion of patients with severe and very severe comorbidity increased 12.9%. The heaviest comorbidity burden increased the risk of 7-day mortality (adjusted hazard ratio, 3.51, 95% CI 2.22-5.53) and in-hospital mortality (adjusted hazard ratio, 3.83, 95% CI 2.70-5.45). Patients with very severe comorbidity had a 12% longer LOS and extra 27% expense than those without comorbidity.

CONCLUSIONS

Comorbidity burden showed an increasing trend year in past eleven years. The heavy comorbidity burden increased in-hospital mortality, LOS, and hospitalization cost, especially in patients aged 55 years or more. The findings also provide some reference on improvement of health care reform policies and allocation of resources.