Search

Background The phenomenon of medical migration is common in China. Due to the limited capacity and substantial geographical variation in medical practice, patients with chronic kidney disease (CKD) travel more frequently to seek medical care. We aimed to assess the cost-effectiveness of medical migration for CKD patients in China and provide real-world evidence for the allocation of CKD resources. Methods Records of patients with CKD between January 2014 and December 2018 were extracted from a large national database. A patient is defined as a medical migrant if she travelled across the provincial border to a non-residential province to be admitted for inpatient care. The propensity score matching method is used to estimate the effect of medical migration on medical expenditure, length of hospital stay, and in-hospital mortality. The cost-effectiveness is evaluated by comparing the estimated cost per life saved with contemporaneous estimates of the value of a statistical life. Results Among 4,392,650 hospitalizations with CKD, medical migrants accounted for 4.9% in 2018. Migrant patients were estimated to incur a 26.35% increase in total medical expenditure, experience a 0.24-percentage-points reduction in in-hospital mortality rates, and a 0.49-days reduction in length of hospital stay compared to non-migrant patients. Overall, medical migration among CKD patients incurred an average of 1 million yuan per life saved, which accounted for 20–40% of contemporaneous estimates of the value of a statistical life. Compared with migrant patients with self-payment and commercial insurance, migrant patients with public health insurance (urban basic medical insurance and new rural co-operative medical care) incurred lower cost per life saved. Cost per life saved for CKD patients was similar between female and male, lower among older population, and varied substantially across regions. Conclusions The medical care seeking behaviors of CKD patients was prominent and medical resources of kidney care were unevenly allocated across regions. Medical migration led to a reduction in mortality, but was associated with higher medical expenditure. It is imperative to reduce the regional disparity of medical resources and improve the clinical capacity. Our study shows that it is imperative to prioritize resource allocation toward improving kidney health and regional health care planning.

Recent research documents increasing unhappiness (even depression) among Chinese adults despite the rapid economic growth in China. This paper explains this discrepancy by exploring the relationship between relative economic status and mental health (measured by Center for Epidemiologic Studies Depression Scale score) among the middle‐aged and elderly in China. In measuring relative economic status, we use five reference groups for comparison (i.e., relatives, colleagues, schoolmates, neighbors or villagers, and people in the same city or county). Using data from 2013 China Health and Retirement Longitudinal Study, we find that individuals with relatively lower economic status are more likely to be mentally depressed. The relationship differs across reference groups for comparisons, with the larger impacts seen from the comparison against acquaintances, while the impact of comparison to regional average is the smallest despite its frequent use in the literature. The relative economic status–mental health gradient is asymmetric; that is, the negative impact of worse relative economic status is comparatively larger and more significant than the positive impact of better relative economic status. Our results imply that reducing wealth gaps within groups of similar backgrounds can be more effective in improving people’s mental health than a general reduction of wealth inequality within the population.

Background/aimTo quantify the impact of baseline presenting visual acuity (VA), refractive error and spectacles wear on subsequent academic performance among Chinese middle school children.MethodsA prospective, longitudinal, school-based study on grade 7 Chinese children (age, mean±SD, 12.7±0.5 years, range=11.1–15.9) at four randomly selected middle schools in Anyang, China. Comprehensive eye examinations including cycloplegic autorefraction were performed at baseline, and information on demographic characteristics, known risk factors for myopia and spectacle wear was collected. Academic test scores for all subjects in the curriculum were obtained from the local Bureau of Education. Main outcome measure was total test scores for five subjects at the end of grade 9, adjusted for total scored at the beginning of grade 7.ResultsAmong 2363 eligible children, 73.1% (1728/2363) had seventh grade test scores available. 93.9% (1623/1728) completed eye examinations, and 98.5% (1599/1623) of these had ninth grade test scores. Adjusting only for baseline test score, the following were significantly associated with higher ninth grade scores: younger age, male sex, less time outdoors, better baseline presenting VA, higher parental education and income and parental myopia, but refractive error and spectacle wear were not. In the full multivariate model, baseline test score (pConclusionsIn this longitudinal study, better presenting VA, but not cycloplegic refractive error or spectacle wear, was significantly associated with subsequent academic performance.

Mental health conditions such as depression is a rapidly rising epidemic and a major contributor to the overall global burden of disease. In addition to the direct medical costs and indirect economic costs that falls into the traditional boundary of disease burden estimation, many social costs associated with depression are hidden yet important. This paper provides empirical evidence on the existence of two hidden costs associated with depression: negative impact on social trust and life satisfaction. Based on the data obtained from 2012 China Family Panel Studies, our estimated results indicate that individuals who have a high tendency for depression or depressive symptoms are less likely to trust other people, and they also have significantly lower life satisfaction than their counterparts who are relatively mentally healthy. Given that trust is an important component of social capital, which in turn is an important input to foster economic growth in general and innovation in particular, the reduction in trust induced by the increasing prevalence of depression imposes a significant cost to the society in terms of poor economic performance. Similarly, as life satisfaction has been widely recognized as an important measure of well-being, our study also highlights that the increase in the prevalence of depression leads to a reduction in the well-being that individual can enjoy. All these costs are real, but did not receive sufficient attention in the previous research. The contribution of our research is to shed light on the existence of these hidden costs and to quantify the magnitude of such costs in the context of China.

China's fast economic growth in the past decades is accompanied by a rapid epidemiological transition from communicable to non-communicable diseases (NCDs). An important yet often neglected NCD is mental disorder, which accounts for 14% of global disease burden but has been paid relatively little research attention in China. This paper uses a nationally representative dataset to investigate the prevalence and correlates of depression and depressive symptoms among the adult population in China. Our results indicate that the prevalence rate of depression, estimated with the Center for Epidemiologic Studies Depression Scale (CES-D), is high (37.9% for depressive symptoms and 4.1% for depression) and unevenly distributed across regions and subpopulations. Specifically, women, older people and those who live in the central/western and rural areas are more likely to be depressed. We also find significant socioeconomic gradients in mental health: higher education and income levels are associated with lower likelihood of depression, especially among the lower socioeconomic groups. Our results indicate the urgent need for depression prevention and treatment in China (particularly in the economically less developed regions) through the expansion of primary mental health care resources and a reduction of socioeconomic inequalities.

This paper constructs a multidimensional Theil Index to estimate and decompose the inequality of nutrition intake among the adult population in China. Using 1991–2009 China Health and Nutri...

This paper is the first to examine the causal relationship between China's One-Child Policy (OCP) and the long-term accumulation of human capital by a regression discontinuity design. Based on the 2005 China Inter-census Survey data, we observe a strong policy shock upon the probability of being a single child among people born around the starting point of OCP, which in turn significantly increases their educational attainment in adulthood. The results strongly suggest that there exists a quantity-quality trade-off as renewed by Becker, and the trade-off is more pronounced in the economically less developed regions and among families with the same-sex children. The results shed light on the re-understanding of China's family planning initiative as well as the application of regression discontinuity designs.

Introduction The Asia-Pacific is home to 30% of the world’s smokers. Additional efforts are needed to reduce negative health impacts of tobacco, including e-cigarettes. The study objectives were to 1. Investigate Asian-Pacific students’ knowledge, attitudes, and use of tobacco products; 2. Determine the level of student support for tobacco control policies; and 3. Examine differences in students’ attitudes by the strength of national tobacco control policies based on implementation of WHO’s MPOWER package, and e-cigarette regulation in their countries. Methods A total of 1953 students from members of the Association of Pacific Rim Universities in 13 countries completed the online survey. We compared the results by the Fisher-Freeman-Halton test. Results While about 83% of students had heard of e-cigarettes; only 14.1% had tried them. Students in countries with e-cigarette bans were the least likely to report having experimented with e-cigarettes (8.1%). While the vast majority of students (87.9%) reported having seen health campaigns targeting combustible cigarettes, far fewer (42.5%) had seen any health campaigns targeting e-cigarettes. About 80% of students supported smoke-free campuses, with the most support coming from those in countries with the weakest adoption of MPOWER policies (88.7%) and no e-cigarette regulations (80.4%). Students in countries with the weakest MPOWER policies were also the most likely to support campus bans and government regulation of e-cigarettes. Conclusions The adoption of tobacco control polices by government may have an impact on e-cigarette smoking behavior among students, and student support for tobacco control, including noncombustible products, is high. Universities should take action by adopting comprehensive tobacco control measures that include e-cigarette regulations.

A major goal of China’s healthcare reform is to control the increasing healthcare spending, much of which can be attributed to the overuse of diagnostic tests and has been relatively less studied in the literature. This article analyzes the correlation between medical equipment expansion and the increase in diagnostic test expenditure in China, using Sichuan Province as an example. County-level data aggregated from hospitals’ annual reports in Sichuan Province from 2008 to 2012 were used. The results show a positive correlation between the expansion of medical equipment and the increase in diagnostic test expenditure. Our study provides implications on reforming China’s healthcare delivery system and medical equipment regulation policies.

The new round of health care reforms in China achieved significant initial results. New and emerging problems coinciding with the deepening of the reforms, however, require further institutional changes to strengthen the competition mechanism and promote public hospital efficiency. This paper provides a conceptual framework and preliminary assessment of public hospital competition in China. Specifically, we distinguish between two closely related concepts – competition and privatization, and identify several critical conditions under which hospital competition can be used as a policy instrument to improve health care delivery in China. We also investigate the current performance and identify several unintended consequences of public hospital competition – mainly, medical arms race, drug over-prescription and the erosion of a trusting relationship between patients and physicians. Finally, we discuss the policy options for enhancing the internal competition in China’s hospital market, and conclude that public investment on information provision is key to reaping the positive outcomes of pro-competition policies.

This paper analyzes theoretically and empirically the impact of intergenerational transmission of human capital on the income mobility in China. We use a three-period overlapping-generations (OLG) model to show that the human capital transfer plays a remarkable role in determining the parent-to-offspring investment in human capital and the intergenerational elasticity of income. We then estimate a simultaneous equations model (SEM) using the 1989–2009 China Health and Nutrition Survey (CHNS) data to verify our theoretical predictions. The results show that (i) human capital, measured by health and education, is directly transmitted from one generation to the next, reflecting the parent-induced inequality of development opportunities among offspring in China; (ii) the estimated intergenerational income elasticity increases from 0.429 to 0.481 when the direct transfer of human capital is accounted for, suggesting that omitting this mechanism would overestimate China's income mobility. Our findings provide policy implications on strengthening human capital investments among the disadvantaged groups, reinforcing reforms that promote equality of opportunity, and improving the efficiency of labor markets in China.

How parenting style influences human capital accumulation is an important yet under-researched topic in the economics literature. Based on the two-wave longitudinal dataset of Chinese Education Panel Survey (CEPS), this study explores the impact of parenting style on adolescents' human capital formation, including cognitive and non-cognitive skills in China. Following the mainstream approach in development psychology, the measurement of parenting style is constructed from two dimensions – demandingness and responsiveness, and further classified into four types: authoritative, authoritarian, permissive and neglectful. We find that both demandingness and responsiveness of parents have positive effects on children's academic performance, while parents' responsiveness play a substantial role in the formation of children's cognitive skills (measured by the standardized cognitive skill tests) as well as socio-emotional skills (measured by mental health, self-confidence, motivation and extraversion). Putting together, the authoritative parenting style characterized by high demandingness and high responsiveness is associated with the best outcome measures among the four parenting types in cultivating children's human capital formation. Moreover, we find that student time-allocation, extracurricular activities and parent-teacher interactions may serve as important channels of the parenting influences, and that there exist moderate interactive effects between fathers' and mothers' influences and between the demandingness and responsiveness of parenting styles.

With its rapid economic growth and fast changing lifestyle, China witnessed expansionary prevalence of obesity and overweight during the recent decades. This paper provides the first nationally representative estimate of the medical cost attributable to obesity and overweight in China. We improve upon the traditional estimation methodology (two-part model) by jointly adopting the instrumental variable approach and the panel data methods in order to correct for the potential endogeneity of body size and the individual heterogeneity in medical expenditure. Using longitudinal data from 2000-2009 China Health and Nutrition Surveys, we find that body size has a significant impact on the individual expected medical expenditure and the per capita medical cost attributable to obesity and overweight in a single medical event is estimated to be 6.18 Yuan, or 5.29% of the total personal medical expenditure. This translates to 24.35 billion Yuan annual cost on the national scale, accounting for 2.46% of China's national health care expenditure. The subsample analyses also show that such cost is higher for the urban, women, and better educated people and increases over time. Our results contribute to the literature on the economic impact of obesity in developing countries and bear policy implications on controlling the rising health care costs in China. Copyright © 2015 John Wiley & Sons, Ltd.

This paper analyzes whether hospital competition is associated with improved health care delivery in China, particularly in the dimensions of health care quality and cost. We explore the differences in competition over time and across regions to examine the relationship in an environment wherein the hospital industry is largely state owned, the price of medical care is partially regulated, and hospitals can compete on both quality and cost. Using provincial- and individual-level data, along with a set of outcome indicators, we find that hospital competition is significantly correlated with lower observation room mortality, shorter outpatient waiting time, and fewer outpatient costs, while we do not find evidence that would suggest negative influences of competition on the other measures of hospital performance. Our results offer new evidence in support of competition-based reforms in China's health care sector and provide implications for other developing countries facing similar health care challenges.

The geographic maldistribution of health care resources is one of the most persistent characteristics of health care systems around the world. Based on China’s provincial-level panel data in 1949-2010, this paper empirically investigates whether the geographic distribution of health care resources is convergent or divergent in the long run and whether the rapid economic growth contributes to reducing the regional disparity in health care resources in China. Using a dynamic convergence model that controls unobserved provincial heterogeneity and spatial dependence, the empirical results provide much support for β-convergence in that the provinces with lower initial values of health care resources, including the densities of physicians and hospital beds, are seen to grow faster and to catch up with the provinces with higher initial stocks. In addition, we find that GDP per capita has a significant and non-linear impact on the convergence rate of health care resources, providing support for a Kuznets curve in China’s health sector. That is, the inequality in the distribution of health care resources follows an inverted “U” shape as income increases over time. An important implication of our study is that economic growth per se provides a built-in stabilizer to mitigate health inequality through the convergence of health care resources across regions in the long run.

This paper estimates the intergenerational health transmission in China using the 1991–2009 China Health and Nutrition Survey (CHNS) data. Three decades of persistent economic growth in China has been accompanied by high income inequality, which may in turn be caused by the inequality of opportunity in education and health. In this paper, we find that there is a strong correlation of health status between parent and their offspring in both the urban and rural sectors, suggesting the existence of intergenerational health inequality in China. The correlation is robust to various model specifications, including the control of unobserved household heterogeneity using instrumental variables. We also find that parents' socio-economic characteristics and environmental choices are strongly correlated with their own and their children's health, supporting the “nature–nurture interaction” hypothesis. The Blinder–Oaxaca decomposition further indicates that 15% to 27% of the rural–urban inequality of child health is attributable to the endowed inequality from their parents' health. An important policy implication of our study is that the increasing inequality of income and opportunity in China can be ameliorated through the improvement of the current generation's health status and living standards.

This paper examines whether participating in the New Rural Cooperative Medical Scheme (NRCMS), a publicly subsidised health insurance programme in rural China, encourages individuals to engage in risky health behaviours. Despite its rapidly increasing coverage rate, relatively little attention has been paid to the impact of NRCMS on the lifestyle choices of its enrollees. On the basis of the 2000–2009 longitudinal data from the China Health and Nutrition Survey (CHNS), we find that NRCMS participation has a statistically significant (although quantitatively small) impact on people’s tendency towards smoking, heavy drinking (among males), spending time in sedentary activities, consuming high-calorie food and being overweight. The increase in these unhealthy lifestyles in turn leads to elevated disease risks, indicating that insurance-induced, “ex ante moral hazard” is present in rural China. The findings are robust to the variation in model specification and sample selection, as well as to the introduction of an instrumental variable that controls the endogeneity of insurance participation. Our results provide implications on reforming the pricing and administration practice of China’s largest health insurance campaign and on evaluating public insurance schemes in other developing countries.

Rural-to-urban migrant workers are an under-represented group in China's health insurance system, and the status of their health and healthcare draws increasing attention. This paper uses the 2007–2010 State Council URBMI Household Survey data to evaluate the efficacy of major health insurance programs in improving the accessibility, affordability and appropriateness of healthcare among migrant workers. Based on the instrumental variable (IV) estimation that accounts for the endogeneity of insurance participation, we find that the Urban Employee Basic Medical Insurance (UEBMI) is most effective in promoting physical exams and improving self-rated health status for migrant workers, while the New Rural Cooperative Medical Scheme (NRCMS), the Urban Resident Basic Medical Insurance (URBMI) and commercial insurance show significant benefits in boosting preventive care utilization. However, the current programs are not effective in alleviating the financial burden of healthcare and promoting formal medical utilization among migrant workers, possibly due to the lack of systematic financing scheme for outpatient treatment and the segmentation between insurance platforms. Our study provides implications on reforming China's medical insurance system and migrant health policies.

This paper examines whether participating in the New Rural Cooperative Medical Scheme (NRCMS), a publicly subsidised health insurance programme in rural China, encourages individuals to engage in risky health behaviours. Despite its rapidly increasing coverage rate, relatively little attention has been paid to the impact of NRCMS on the lifestyle choices of its enrollees. On the basis of the 2000–2009 longitudinal data from the China Health and Nutrition Survey (CHNS), we find that NRCMS participation has a statistically significant (although quantitatively small) impact on people’s tendency towards smoking, heavy drinking (among males), spending time in sedentary activities, consuming high-calorie food and being overweight. The increase in these unhealthy lifestyles in turn leads to elevated disease risks, indicating that insurance-induced, “ex ante moral hazard” is present in rural China. The findings are robust to the variation in model specification and sample selection, as well as to the introduction of an instrumental variable that controls the endogeneity of insurance participation. Our results provide implications on reforming the pricing and administration practice of China’s largest health insurance campaign and on evaluating public insurance schemes in other developing countries.

This paper tests whether body size affects employment status in the Chinese urban labor market. Based on Urban Resident Basic Medical Insurance (URBMI) survey data, we find that body size has an inverted U-shaped effect on the probability of being employed when human capital and other factors are controlled, indicating the existence of “body size discrimination”. Based on our results, the optimal BMI for employment is estimated to be 22.7 for female and 24.3 for male. Further studies show that the “health channel” and the “esthetic channel” play an important role in forming the body size discrimination among both male and female. Furthermore, we find that the employment type (formal employment vs. informal employment) is also affected by body size. Our paper provides new evidence on the impact of body size on employment, and reveals new characteristics of the Chinese urban labor market.

This article estimates the impacts of health information technology (HIT) on health-care delivery in the Wenchuan County of China, where the devastation of the 2008 Great Wenchuan Earthquake and the subsequent large-scale HIT implementation (the Healthy Wenchuan Program) offers a 'natural experiment' opportunity, enabling us to conduct a difference-in-difference evaluation of the potential benefits of HIT on accessibility, affordability and appropriateness of health-care services in the underdeveloped rural area. Based on data collected from two field surveys in township hospitals, we find that for both the inpatient and outpatient samples, the HIT system promotes access to medical care by increasing doctor referrals and encouraging within-county medical utilization, reduces patient financial burden in certain expenditure categories, and contributes to higher patient satisfaction on medical care quality. On the other hand, we also find that HIT leads to increased patient waiting time for hospital registration, reflecting the unique challenges in implementing HIT in the underdeveloped areas. Our study contributes to the growing body of literature on evaluating the impacts of HIT application in the developing regions, and provides implications on the potential role of HIT in China's national health system reforms.

PurposeThe purpose of this paper is to estimate the value of a statistical life (VSL) in China using the hedonic wage model, and to explore the regional difference in VSL within the country.Design/methodology/approachUsing the hedonic wage regression, this paper estimates the compensating wage differential for incremental job mortality risk among Chinese workers. The implied VSL is derived for China and its different regions. The data is from the 2005 China inter‐census population survey, consisting of 1.3 million urban and rural workers. The authors also made important improvement in the model specification to explicitly address the missing variable issue in the previous studies.FindingsThe paper results indicate that the industry mortality risk has a significant impact on the wage rate. The implied VSL is 1.81 million RMB, a value substantially higher than previous estimates. The results also suggest a sizable urban‐rural difference, with the urban VSL being 4.3 times higher than the rural estimate. The strong urban‐rural inequality of income could be attributed to the segregation between the urban and rural labor markets.Practical implicationsThe paper findings indicate the importance of reforming the current workers' compensation standard and improving the institutional environment, as well as enhancing the labor protection in the rural labor market.Originality/valueThis paper is the first attempt to estimate the value of life in China using the census based data. The paper results contribute to the growing literature in obtaining comparable VSL estimates in the developing countries.

This paper estimates the labor supply functions for health care professionals in China using Census-based data in 2005. The rapid economic growth and population aging in China led to a substantial increase in the demand for health care services and the derived demand for health care professionals in recent years. However, the increase in the supply of doctors and nurses lags behind the growth in demand, raising the question of whether the excess demand should be met by expanding the health care manpower or by inducing the existing personnel to work more hours through wage increase. Our findings indicate that wage rate adjustment has a significant impact on the length of working time among the self-employed practitioners (with an estimated short-run elasticity of 0.575), while the labor supply of hospital employees is inelastic due to their fixed payment scheme. Instead, hours worked in the employee group are related to non-wage factors such as asset holdings and the hospital ownership type. An important policy implication of our study is that adjustments of labor compensation methods and hospital ownership structure are potentially effective approaches for coping with the excess demand for health care professionals and improving the quality of health care in China.

The large and growing uninsured population poses an alarming threat to the US health care system, and is a major target of the Obama health reform. This paper investigates analytically and empirically the degree to which the absence of health insurance in the US reflects the availability of the health care safety net, such as the guaranteed or charitable care provided by emergency rooms, community health centers and physicians. Our theoretical model demonstrates that the safety net can be a real alternative to health insurance, thus discouraging private insurance purchase in the market setting. In particular, when the community premium rate fails to reflect the value of such resources, not purchasing insurance becomes a rational decision for a sizeable portion of the population. The calibrated simulation based on US statistics indicates about 15.75 % of the uninsured population, or 7.2 million people in US, are attributable to the existing safety net system. Further empirical analysis using nationally representative data shows consistently that the presence of local safety net resources may reduce the probability of individual insurance purchase by as much as 45.9 %.

With its rapid economic growth and fast changing lifestyle, China witnessed expansionary prevalence of obesity and overweight during the recent decades. This paper provides the first nationally representative estimate of the medical cost attributable to obesity and overweight in China. We improve upon the traditional estimation methodology (two-part model) by jointly adopting the instrumental variable approach and the panel data methods in order to correct for the potential endogeneity of body size and the individual heterogeneity in medical expenditure. Using longitudinal data from 2000-2009 China Health and Nutrition Surveys, we find that body size has a significant impact on the individual expected medical expenditure and the per capita medical cost attributable to obesity and overweight in a single medical event is estimated to be 6.18 Yuan, or 5.29% of the total personal medical expenditure. This translates to 24.35 billion Yuan annual cost on the national scale, accounting for 2.46% of China's national health care expenditure. The subsample analyses also show that such cost is higher for the urban, women, and better educated people and increases over time. Our results contribute to the literature on the economic impact of obesity in developing countries and bear policy implications on controlling the rising health care costs in China. Copyright © 2015 John WileySons, Ltd.