Search

Abstract Objective The integration of the health insurance fund pool may threaten the sustainability of the fund by increasing its expenditures through the exacerbation of the moral hazard of participations. The purpose of this paper is to assess and predict the impact of the single pool reform of China’s Urban Employee Basic Medical Insurance (UEBMI) on the expenditure and sustainability of the health insurance fund. Methods In this paper, we consider the pilot implementation of the single pool reform in some provinces of China as a quasi-natural experiment, and develop a staggered DID model to assess the impact of the single pool reform on medical reimbursement expenditure. Based on the results, an actuarial model is developed to predict the impact on the accumulated balance of China’s health insurance fund if the single pool reform is continued. Results We found that the medical reimbursement expenditure would increase by 66.4% per insured person after the unified provincial-level pool reform. There is individual heterogeneity in the effects of the unified single pool reform on medical reimbursement expenditure, and the reimbursement expenditure of retired elderly has the largest increase. If the unified single pool reform is gradually promoted, the current and accumulated balance of the UEBMI pooling fund would have gaps in 2031 and 2042, respectively. Conclusion We verified that a larger fund pool will bring unreasonable growth of fund expenditures, which will threaten the sustainable development of health insurance. To minimize the impact of the unified single pool reform on the sustainability of the health insurance fund, we suggest strengthening the monitoring of moral hazard behavior, promoting the delayed retirement system, and encouraging childbearing.

Abstract Background While informal caregiving is crucial for improving and maintaining health of the elderly, there is limited evidence of its potential effect on caregivers’ wellbeing. Understanding this effect is important for policy makers to design effective long-term care policies. This longitudinal study aims to investigate the impact of informal caregiving on caregivers’ subjective wellbeing in China. Methods Three waves (2016, 2018, 2020) of data from the China Family Panel Studies (CFPS) are constructed for empirical analysis. Ordered logit model is first used to estimate the effect. Fixed effects ordered logit model and mixed effects ordered logit model are further employed to control for the possible bias from unobserved individual heterogeneity. Results Informal caregiving significantly reduces caregivers’ subjective wellbeing and the negative effect is stronger for high-frequency caregivers. Subgroup analysis reveals that informal caregiving imposed greater negative impacts on women, those living in rural areas, being married, working, and living separately from parents. Further analysis of mechanism indicates that decrease in wage income, leisure and sleep time were channels through which informal caregiving affects caregivers’ well-being. Conclusion When policy makers formulate sustainable long-term care policies and home support services, interventions to improve caregivers’ stress-coping skills and ensure their engagement in leisure and social activities could be adopted to mitigate the negative effects on caregivers’ subjective well-being.

Abstract Background Medical reimbursement in China is not for all diseases, and medical reimbursement expenses are not completely consistent with medical service demand, though the scope and proportion of medical reimbursement are gradually expanding. This study aimed to examine the effect of retirement on medical reimbursement expenses in urban China. Methods The effect of retirement on medical reimbursement expenses were estimated by using fuzzy regression discontinuity based on data from the China Health and Retirement Longitudinal Study (CHARLS) in 2011, 2013, 2015, and 2018. Its group heterogeneity by educational backgrounds and marital status, and underlying mechanisms were also explored. Results Retirement increased medical reimbursement expenses of outpatient significantly (P

Abstract Background Worker health is often influenced by their occupation type, and the accumulative effect of occupation has a significant impact on their health after retirement. Studies show that the type and level of occupation before retirement directly impact workers’ self-rated post-retirement health. However, there is little research on the self-rated post-retirement health of danwei leaders in China. This study seeks to examine the self-rated health level of Chinese danwei leaders after retirement. Furthermore, the differences between their self-rated health level and that of retirees from other occupations are explored by examining the accumulative effect of occupation and the mechanism underlying these differences. Methods Based on 5,910 samples’ data from the 2018 China Longitudinal Aging Social Survey, ordinary least squares, logit, and propensity score matching models are used to investigate the self-rated health level of Chinese danwei leaders after retirement, their differences with other occupations, and the corresponding mechanism. Results The results show that retired danwei leaders have higher self-rated health levels than retirees in other occupations. This was mainly found among female, non-eastern, married, not living with children, and highly educated respondents. The difference in self-rated health between retired danwei leaders and other retired groups was influenced by their post-retirement income and social status. Conclusions In China, retired danwei leaders rated their health higher than retirees from other occupations. Danwei leaders have high socioeconomic status due to their occupation. Compared with other groups, their advantages are significant and enjoyed for a long time. Additionally, most danwei leaders have high social influence even after retirement and their higher income and social status have a positive impact on their self-rated health compared with other employees. This study provides empirical evidence from China and extends current literature on the effects of occupational type and level on self-rated health after retirement.