Search

Ex post moral hazard, the additional healthcare utilization induced by health insurance, can be decomposed into an efficient portion generated by the income effect and an inefficient portion caused by the substitution effect, which has been discussed theoretically, but few studies have provided evidence of the efficient moral hazard. In 2016, the Chinese government launched the consolidation of urban and rural resident health insurance at the national level. After the consolidation, insurance benefits for nearly 800 million rural residents got improved. This paper uses a nationally-representative sample of 30,972 individuals from the China Health and Retirement Longitudinal Study (2011–2018) and adopts a 2-step empirical approach with the difference-in-differences method and the fuzzy regression discontinuity design to estimate the efficient moral hazard in the consolidation among rural residents. We find that the price shock contained in the consolidation increases inpatient care utilization, and the corresponding price elasticity is between −0.68 and −0.62. Further analysis shows that the efficient moral hazard resulting in welfare gains accounts for 43.33%–66.36% of the additional healthcare utilization. These findings highlight the necessity of evaluating the efficient moral hazard when analyzing the cost-benefit of health insurance reform. • We provide rare evidence of the efficient moral hazard effect in health insurance. • We focus on low-income groups from developing countries. • We use a 2-step empirical approach to estimate the efficient moral hazard effect. • The efficient moral hazard generated by income effect accounts for 43.33%–66.36%. [ABSTRACT FROM AUTHOR]

Informal payment for medical services is a common phenomenon in China. Patients make informal payments, in cash or in kind, to physicians in addition to official charges billed for medical services. This paper assesses the associations between patients' perceptions of the physician as an agent for the patient's interests (physician agency problem) and informal payment behavior. Using data of 24,000 and 6700 rural households respectively from the Health Development of Rural China Program database (collected in 2008) and Ningxia data source (collected in 2015), we find that patients' concern about physician agency problems is significantly associated with informal payments. The data shows that patients are more likely to make informal payments when they show low trust towards their physicians. For example, in the surgical cases, among patients who strongly distrusted the physicians, 17.9% (95% confidence interval [CI]:]: 13.5, 22.3) initiated informal payments, compared to 8.0% (95% CI: 5.1, 10.9) who expressed "strong trust" in their physicians. Poor communication was also significantly associated with an increase in the informal payment rate. For example, in the non-surgical setting, among the patients who rated the physicians' explaining skills as "poor," 5.9% (95% CI: 5.0, 6.9) of them made informal payments, significantly higher than the patients who rated "excellent" (of whom 1.8% made informal payments 95% CI, 0.9, 2.7). In this study, we provide an explanation for this finding: patients may initiate informal payments to physicians in order to mitigate the physician agency problem. It suggests that to mitigate informal payments, improving alignment between doctors' incentives and patients' interests would be essential. • Informal payments were directly related to patients' concerns about physicians' behavior. • Patients were more likely to make informal payments when they showed low trust towards their physicians. • Poor communication between patients and physicians was related to informal payment rate. • Informal payment might be viewed as an effort by the patients to align the physicians. [ABSTRACT FROM AUTHOR]

• Parental belief is associated with Child social-emotional development. • Parental investments mediate parental belief and child development. • The mediation effects vary across investments and developmental outcomes. • The varieties of play materials and activities are the strongest mediators. Parental investments are associated with early child outcomes, and some evidences outside China suggest that parental belief might affect parental investments. However, the interrelationships of parental belief, parental investments, and early child development has not been well documented in China. This paper aims to study the interrelationships between the caregiver's parental belief, the caregiver's parental investments, and the child's early developmental outcomes in rural China. A total of 1787 sample households in an undeveloped rural area of western China are enrolled in the cross-sectional study. A parental belief questionnaire, the Family Care Indicators (FCI), the Bayley Scales of Infant Development version III (BSID-III), and a socioeconomic questionnaire were used to measure the caregiver's parental belief on parenting practices, the caregiver's parental investments, the child's early developmental outcomes, and the socioeconomic characteristics of sample households, respectively. The mediation model was then applied to estimate the interrelationships. The results find that the caregiver's parental investments significantly mediate in the relationships between the caregiver's parental belief and the child's early developmental outcomes. Through parental investments, one standard deviation (SD) increase in the caregiver's parental belief is corresponding to 3% of one SD increase in the child's four developmental outcomes (cognition, language, motor, and social–emotion) respectively. For future studies aimed at designing targeted interventions on early child development in rural China, the key findings of this paper might be informative. Early interventions aimed at strengthening the caregiver's subjective belief on parenting practices and increasing the parental investments in the household might be effective to improve the development of rural children. [ABSTRACT FROM AUTHOR]

• Parental investment and skill mediate caregiver mental health and child development. • Caregiver depression are more harmful to parenting practices and child development. • The variety of play material has significant mediation effect on child development. • Coercive parenting mediate caregiver mental health and child development. Parenting practices are associated with early childhood development (ECD), and some evidences suggest that mental health might affect parenting practices. However, the interrelationships of mental health, parenting practices, and ECD outcomes have not yet been well documented in developing contexts like rural China. This paper aims to investigate the interrelationships between the caregiver's mental health, parenting practices, and the child's ECD outcomes in rural China. A total of 1787 sample households in an undeveloped rural area of western China are enrolled in the study. A socioeconomic questionnaire, the Depression, Anxiety and Stress Scale, the Family Care Indicators, the Parent and Family Adjustment Scales, and the Bayley Scales of Infant Development version III were used to measure the socioeconomic characteristics of sample households, the caregiver's mental health, parental investments and parenting skills, and the child's development outcomes, respectively. Mediation model was then applied to estimate the interrelationships. The results showed that parental practices significantly mediated between the caregiver's mental health and the child's cognition, language, motor, and social–emotion development. Through parental investments, one standard deviation increases in the caregiver's mental health test score was associated with the decline in the child's four development scores by 0.6% standard deviation, respectively. Through parenting skills, one standard deviation increases in the caregiver's mental health test score was associated with the decline in the child's language and social-emotional score by 2% and 5% standard deviation, respectively. Different dimensions of caregiver mental health, parental investments and skills played heterogeneous roles in the interrelationships. Early interventions aimed at improving the caregiver's mental health, parental investments and skills are important and might be effective to improve early childhood development in rural China. [ABSTRACT FROM AUTHOR]

• The gender disparities in DCM vary among different maltreatment subtypes. • DCM's negative effect was more severe for girls than for boys. • Gender heterogeneity is less evident than gender homogeneity in the risk factors. Currently, gender disparities in domestic child maltreatment (DCM) have become an important and highly controversial issue worldwide. This study aims to provide panoramic evidence from China on this issue. Data were derived from a survey of 4,308 children (M age = 12.13, 48.7% were boys) conducted in seven provinces in rural China from June to December 2019. This study used multistage cluster sampling to select respondents, and modified versions of the JVQ Scale and the DSM-5 Scale (11–17 years old) were adopted. This study reached three significant conclusions. First, the gender disparities in DCM vary among different maltreatment subtypes. Compared with girls, boys are more likely to experience physical abuse. A higher prevalence of neglect is observed among girls than among boys. Second, although DCM significantly increased the likelihood of posttraumatic depression for all children, its negative effect was more severe for girls than for boys. Third, gender heterogeneity is less evident than gender homogeneity in the risk factors for DCM. In rural China, children's problematic behaviours, family structure, parents' experiences of childhood violence and family relationships are common predictors of maltreatment for all children. This paper highlights gender differences in the risk of DCM among children in rural China, reveals the Confucian culture behind DCM and gender, and provides Chinese evidence for building an international dialogue. [ABSTRACT FROM AUTHOR]