Is Chinese National Health Insurance Effective in the Face of Severe Illness? A Perspective from Health Service Utilization and Economic Burden

Over the past decade, health insurance coverage has expanded dramatically in China. Health insurance benefits, however, remain shallow or ambiguous. This study examines the effect of Chinese national health insurance policy on health service utilization and economic burden in urban settings using the Urban Resident Basic Medical Insurance Household Survey. We employ the Heckman selection model to correct for selection bias among hospital inpatients, and find that compared to individuals without health insurance, those with health insurance are more likely to be admitted to the hospital when their physicians recommended them to enter the hospital as inpatients. Health insurance is also associated with about 45.6 % decrease in out-of-pocket inpatient expenditures. Individuals with urban employee basic medical insurance see the largest decrease in economic burden, followed by individuals with urban resident basic medical Insurance, and those with new rural cooperative medical insurance.     

Life Satisfaction,Self-Esteem,and Loneliness Among LGB Adults and Heterosexual Adults in China

ABSTRACT

Low levels of life satisfaction have been linked to low self-esteem and loneliness, but this association has never been tested directly in LGB (lesbian/gay/bisexual) populations. We compared 275 Chinese LGB adults to 275 demographic-matched Chinese heterosexual controls on life satisfaction, self-esteem, and loneliness. LGB adults reported lower levels of self-esteem and higher levels of loneliness than heterosexuals, but similar levels of overall life satisfaction. Self-esteem partially mediated (but did not moderate) the relationship between loneliness and life satisfaction in both groups. Hierarchical regressions indicated that demographic variables, loneliness, and self-esteem can predict life satisfaction in both LGB and heterosexual adults, but explained more variance of life satisfaction in the LGB group. Thus self-esteem and loneliness play a more important role in life satisfaction for LGB rather than heterosexual Chinese adults.     

Health and Other Aspects of the Quality of Life of Older People

Celebrating the United Nations' International Year of Older Persons, in September 1999 a survey research project was undertaken throughout the Northern Interior Health Region (NIHR) of British Columbia. A total of 875 people completed 23-page questionnaires, the average age of the respondents was 69 and the range ran from 55 to 95 years. Responses to the SF-36 questionnaire indicated that for male respondents aged 55–64, the mean score for the 8 dimensions was 74.4. This mean was practically identical to that of the United States norm for such people (74.5) and lower than that for the United Kingdom (77.4). For male respondents aged 65 and older, the mean was 68.3. This was numerically higher but again practically the same as that of the norm for the United States (68.1). For females aged 55–64, the mean score for 8 dimensions was 73. This was superior to that of the United States norm of (70.6) for such people and lower than that for the United Kingdom (74.6). For female respondents aged 65 and older, the mean score was 65.4. This was practically identical to that of the United States (65.5).Comparing 18 average figures for our respondents on satisfaction with specific domains of life (e.g., financial security, health, friendships) and life as a whole with those of average adults in Prince George in November 1999, we found that in all but two cases the older people's scores were higher. Only in the cases of satisfaction with health and overall happiness were older people's scores lower, and the differences were not statistically significant.Eleven percent of our respondents reported that they had been a victim of a crime in the last year, compared to 38% in our 1997 adult victimization survey. Older people had a more benign view than ordinary adults of the growth of crime in their neighbourhood and city, although exactly 64% of both groups thought that crime had increased in Canada. Although older people had a more optimistic view than other adults of the increase in crime in their neighbourhoods, fewer of the former than the latter felt safe out at night. Nevertheless, compared to adults surveyed in 1997, the behaviour of respondents in our survey of older people was not as constrained by concerns of criminal victimization.Two or three of the 8 SF-36 health dimensions explained 37% of the variation in life satisfaction scores, 34% of variation in happiness scores, 34% in satisfaction with the overall quality of life scores and 22% in satisfaction with one's overall standard of living. In every case, Mental Health was the dimension that had the greatest impact on our four dependent variables.When all of our potential predictors were entered into a regression equation simultaneously, we found that they could explain 60% of the variance in life satisfaction scores, 44% in happiness scores, 58% in satisfaction with the overall quality of life scores and 59% in satisfaction with one's overall standard of living scores.     

Age,Health and Life Satisfaction Among Older Europeans

In this paper we investigate how age affects the self-reported level of life satisfaction among the elderly in Europe. By using a vignette approach, we find evidence that age influences life satisfaction through two counterbalancing channels. On the one hand, controlling for the effects of all other variables, the own perceived level of life satisfaction increases with age. On the other hand, given the same true level of life satisfaction, older respondents are more likely to rank themselves as “dissatisfied” with their life than younger individuals. Detrimental health conditions and physical limitations play a crucial role in explaining scale biases in the reporting style of older individuals.     

Life Satisfaction of Older Adults in Hong Kong: The Role of Social Support from Grandchildren

This study explores the relationship between the life satisfaction of older adults and the social support from grandchildren in Hong Kong. Two hundred and fifteen older people (from the ages of 64 to 101, mean age 79.3), whose youngest grandchild was aged 12 or older, were recruited from elderly service agencies to participate in the study. Face-to-face interviews were conducted by trained interviewers using a standardized questionnaire, which included the Life Satisfaction Scale for Chinese, the Lubben Social Network Scale, the Chinese Tradition Scale, grandchildren social support measures, self-rated health, self-rated financial adequacy, and demographic variables. Hierarchical regression showed that the life satisfaction of older adults benefitted significantly from the social support from grandchildren (R ² change = .05, F _change = 7.15, p < .001); while controlling demographic characteristics, general social support, attitude towards Chinese tradition, self-rated health, and self-rated financial adequacy. The total explained variance was 51%. Emotional support and appraisal support from grandchildren were identified as significant contributing factors. The policy and practice implications for active aging policies are discussed in a Chinese context.     

Is the Pro-Poor Premium Exemption Policy of Ghana’s NHIS Reducing Disparities Among the Elderly?

Under the act that established the National Health Insurance Scheme (NHIS), persons 70 years of age or above are automatically enrolled in the scheme and therefore can access health services free at the point of use. This suggests that the elderly who are unable to afford the premiums of private health insurance can enrol in the NHIS thereby eliminating the possibility of disparities in health insurance coverage. Notwithstanding, few studies have examined health insurance coverage among the elderly in Ghana. The lack of studies on the elderly in Ghana may be due to limited data on this important demographic group. Using data from the Study on Global Ageing and Health and applying logit models, this paper investigates whether the pro-poor exemption policy is eliminating disparities among the elderly aged 70 years and older. The results show that disparities in insurance coverage among the elderly are based on respondents’ socio-economic circumstances, mainly their wealth status. The study underscores the need for eliminating health access disparities among the elderly and suggests that the current premium exemptions alone may not be the solution to eliminating disparities in health insurance coverage among the elderly.     

The Relative Contribution of Health Status and Quality of Life Domains in Subjective Health in Old Age

To analyze the influence of different health status dimensions and quality of life (QoL) domains on older adults’ subjective health, and to assess the role that residential satisfaction plays in these relationships. A QoL survey was conducted on a representative sample of the community-dwelling older adult population in Madrid province (Spain). Logistic regression models were applied to studying: the health status dimensions associated with satisfaction with health; the relationship between satisfaction with health and other QoL domains; and, the influence of these domains on satisfaction with life. Sociodemographic and residential characteristics were included in all the models. The determinants of satisfaction with health in the first model were: mobility, usual activities, morbidity, and satisfaction with neighborhood. QoL domains associated with health were: leisure activities, neighborhood, and finances. Satisfaction with life was explained by these three domains, along with age, family and health. In sum, leisure, neighborhood, and finances showed a positive effect on satisfaction with health and with life.     

Health Care Service Needs and Correlates of Quality of Life: A Case Study of Elderly Chinese Immigrants in Canada

This study explored the health care service needs and the major correlates of quality of life among 127 community-dwelling elderly Chinese immigrants in a western Canadian city. Participants were interviewed in their homes by trained, bilingual interviewers employing a structured questionnaire that covered a wide range of topics including health care service needs, living arrangements, health status, social network, life satisfaction, and socio-demographic information. Results demonstrated that ethnic nursing homes, senior centres that provide programs and services, and homemaker services were respondents’ major service needs. Multiple ordinary least-squares regression analysis revealed that respondents who emigrated from Mainland China and those who exhibited greater psychological well-being, reported being physically more mobile, perceived fewer service needs, and expressed satisfaction with the quality of their neighbourhood demonstrated higher levels of life satisfaction.     

基于医疗保险视角的老年人医疗费用研究

在"全国老年人口健康状况调查"2008年数据集基础上,应用Tobit多元嵌套模型考察不同类型医疗保险身份对老年人医疗费用的作用。结果表明,老年人的经济状况以及健康状况等因素(而不是医疗保险身份因素)对其医疗费用存在显著作用,当前医疗保险尚且不能满足我国老年人群医疗健康需求,老年人医疗费用主要还是以子女支付为主,其医疗保险身份呈现出典型"不足论"的特征。老年人医疗健康需求处于被压抑状态,医疗保险的覆盖率和保险额度都有待进一步提高,以增强老年人的医疗费用支付能力。     

Assets and Life Satisfaction Patterns Among Korean Older Adults: Latent Class Analysis

This study aims to examine the association of assets with life satisfaction patterns among Korean older adults aged 50 and above. This study used the first two panel data sets (2005 and 2007) from the Korean Retirement and Income Study, which collected information from a nationally representative sample. Key independent variables include financial assets, real assets, and debts. This study classifies overall patterns of life satisfaction using seven multi-dimensional items via Latent Class Analysis. Multinomial regression models were used to determine factors related to estimated life satisfaction patterns after the data were adjusted by weighting and multiple imputation. This study found three classes of life satisfaction at both waves: low, moderate, and high. During the 2-year study period, significant portions of older adults moved upward (23%) and downward (22%) in their life satisfaction patterns. Consistent with the asset effect theory, this study found that assets and debts are significantly associated with life satisfaction patterns and longitudinal changes in these patterns. The study findings suggest that older adults’ life satisfaction can be maintained or promoted through economic security. Financial planning programs combined with asset accumulation may help older adults to achieve economic security and associated life satisfaction.     

Health,Quality of Care and Quality of Life: A Case of Frail Older Adults

This study explores the relationship between health, quality of care of geriatric case management and quality of life for the purpose of furthering the understanding of the relationship between quality of life and geriatric case management. Using survey data from a group of frail older adults, this study assesses the relative merit of two mediation hypotheses: one considering health as a mediator for quality of care of geriatric case management and quality of life, and the other considering quality of care of geriatric case management as a mediator for health and quality of life. The study findings show that quality of care of geriatric case management, measured by client satisfaction, was not a mediator between health and quality of life (measured by life satisfaction). There was a significant positive association between quality of care of geriatric case management and quality of life. Although the significant association between quality of care of geriatric case management and quality of life could not be mediated by either self-rated health or self-reported physical activity levels, it was completely mediated by health satisfaction. These findings provided preliminary empirical evidence to support a significant relationship between quality of care of geriatric case management and quality of life.     

Marital Disruption and Health Insurance

Despite the high levels of marital disruption in the United States and the fact that a significant portion of health insurance coverage for those less than age 65 is based on family membership, surprisingly little research is available on the consequences of marital disruption for the health insurance coverage of men, women, and children. We address this shortfall by examining patterns of coverage surrounding marital disruption for men, women, and children, further subset by educational level. Using the 1996, 2001, and 2004 panels of the Survey of Income and Program Participation (SIPP), we find large differences in health insurance coverage across marital status groups in the cross-section. In longitudinal analyses that focus on within-person change, we find small overall coverage changes but large changes in type of coverage following marital disruption. Both men and women show increases in private coverage in their own names, but offsetting decreases in dependent coverage tend to be larger. One surprising result is that dependent coverage for children also declines after marital dissolution, even though children are still likely to be eligible for that coverage. Children and (to a lesser extent) women show increases in public coverage around the time of divorce or separation. We also find that these patterns differ by education. The most vulnerable group appears to be lower-educated women with children because the increases in private, own-name, and public insurance are not large enough to offset the large decrease in dependent coverage. As the United States implements federal health reform, it is critical that we understand the ways in which life course events—specifically, marital disruption—shape the dynamic patterns of coverage.     

An Exploratory Study on the Quality of Life of older Chinese People Living alone in Hong Kong

This study successfully interviewed 109 randomly selected Chinese people aged 60 and over living alone in two public housing estates in an urban area of Hong Kong. The results show that mental health status, number of days staying in hospital, life satisfaction, age, and self-esteem are significant factors in predicting the life quality of older Chinese respondents living alone. The explanatory power of this model is 56.4. The results of this study are consistent with previous findings reported in the west and in Hong Kong. A subgroup analysis of those older Chinese respondents living alone who have offspring also living in Hong Kong shows that belief in childrens support in old age, good walking ability, and better self-reported health status via life satisfaction as the mediating variable, better self-reported health status and satisfactory self-reported financial status via self-esteem as the mediating variable, are crucial predictors of quality of life. This model explains 64.2% of the variance in quality of life from a subset of the predictor variables.     

An Exploratory Study on the Quality of Life of older Chinese People Living alone in Hong Kong

This study successfully interviewed 109 randomly selected Chinese people aged 60 and over living alone in two public housing estates in an urban area of Hong Kong. The results show that mental health status, number of days staying in hospital, life satisfaction, age, and self-esteem are significant factors in predicting the life quality of older Chinese respondents living alone. The explanatory power of this model is 56.4. The results of this study are consistent with previous findings reported in the west and in Hong Kong. A subgroup analysis of those older Chinese respondents living alone who have offspring also living in Hong Kong shows that belief in childrens’ support in old age, good walking ability, and better self-reported health status via life satisfaction as the mediating variable, better self-reported health status and satisfactory self-reported financial status via self-esteem as the mediating variable, are crucial predictors of quality of life. This model explains 64.2% of the variance in quality of life from a subset of the predictor variables.     

Comparing Self-Rated Health, Satisfaction and Quality of Life Scores Between Diabetics and Others Living in The Bella Coola Valley

Objective: To investigate the relative effect that diabetes has on self-rated health, satisfaction with various specific domains of life, and satisfaction with quality of life operationalized as happiness, satisfaction with life as a whole, and satisfaction with overall quality of life. Design: Mixed methods – mailed survey and chart review. Study Population: All people aged 17 years or older, residing in the Bella Coola Valley in September 2001 and having a chart at the Bella Coola Medical Clinic. Main outcome measures: Self-rated health, self-rated stress, rating of self-care received, global life satisfaction (Life as whole; Overall standard of living; Overall quality of life; and Overall happiness); and satisfaction with various domains of life. Results: A total of 968 useable surveys were returned for a response rate of 56 (968/1734). Age was negatively related to General Health, but positively related to Life Satisfaction. Not being of Aboriginal descent was positively related to all of the four global health indicators and to Subjective Well-Being. After accounting for age, race, and weight, we found that diabetics report significantly poorer self-rated health, and lower satisfaction with health scores compared to people without diabetes. Participants with diabetes who were the least compliant with their treatment regimens rated their current health significantly lower than those who were the most compliant. People with diabetes were, however, no more likely to be unhappy or dissatisfied with their lives as a whole or with the overall quality of their lives compared to people without diabetes. Among people with diabetes, however, those who used insulin did report significantly less satisfaction with the overall quality of their lives than those who didn’t use insulin. Conclusion: Diabetics understand they have poorer health than others, but they do not have poorer global life satisfaction scores. This may explain why it is difficult to get diabetics to adopt behaviours which may lower their quality of life – e.g., diet plans, lose weight, engage in exercise programs, or take medications.     

Determinants of Health and the Quality of Life in the Bella Coola Valley

The aim of this investigation is to obtain some baseline self-reported data on the health status and overall quality of life of all residents of the Bella Coola Valley of British Columbia aged 17 years or older, and to measure the impact of a set of designated health determinants on their health and quality of life. In the period from August to November 2001, a variety of procedures were used to ensure that all eligible residents of the Valley received a copy of our questionnaire, and 687 useable questionnaires were obtained for our working dataset. Health status was measured by SF-36 and the U.S. Centers for Disease Control healthy days items. Thirty-one items were used to measure the Provincial Health Officer’s designated determinants of health in four clusters, namely, biological, social and economic, health behaviours and health services determinants. Quality of life was measured by satisfaction levels in 13 specific domains of life (e.g., family, financial security), four global items (e.g., happiness, life satisfaction) and one global Subjective Well-Being Index. Besides obtaining baseline figures on all our measures for the Valley, we made some comparisons among our figures and those from other areas, e.g., Prince George, BC. Most of the measures indicated that the health status and quality of life of Bella Coola Valley residents were lower than those of Prince George residents. For the sample as a whole, SF-36 scores on the eight dimensions ran from 82.3 (physical functioning) to 50.0 (social functioning), with a mean of 62.7. Residents in the Valley averaged 6.5 days in the past 30 in which their health was physically not good, 5.5 days when it was mentally not good and 4.1 days when their health limited their usual daily activities. Eleven percent of respondents described their general health as “excellent” and another 27% said it was “very good”. On a 7-point scale from 1=very dissatisfied to 7=very satisfied, respondents had average life satisfaction and satisfaction with the overall quality of life scores of 5.5. For specific domains of life, the lowest mean level of satisfaction was reported for federal and provincial government officials (3.3) and the highest was reported for living partners and personal safety around home (5.8). Regarding bivariate relations, each of the eight dimensions of SF-36 was significantly correlated with a single item measure of general health, and five of the eight were significantly correlated with the number of good health days. Happiness and the Subjective Well-Being Index were positively but moderately correlated with six of the eight dimensions, and life satisfaction was positively correlated with five. Age was negatively related to general health, but positively related to life satisfaction. Not being of aboriginal descent was positively related to all of the four global health indicators and to the Subjective Well-Being Index. Education was positively related to the four global health measures but not to the three global quality of life measures. The Social Support and Good Family Indexes were positively related to all seven global measures. There was a positive correlation between six of the seven global measures and the frequency with which respondents participated in activities sponsored by voluntary organizations. Frequency of smoking was negatively associated with every global dependent variable except the Physical Health Index. Frequency of skipping meals was negatively associated and average hours of sleep per night was positively associated with all seven global measures. Turning to multivariate relationships, the four clusters of health determinants explained from 12% (SF-36 Mental Health Index) to 24% (general health) of the variance in the dependent global health variables, and from 20% (happiness) to 26% (Subjective Well-Being Index) of the variance in the dependent global quality of life variables. Adding domain satisfaction scores to the total set of predictors allowed us to explain from 20% (SF-36 Mental health Index) to 29% (general health) of the variance in the dependent global health variables, and from 39% (happiness) to 62% (life satisfaction) in the dependent global quality of life variables. By including measures of social support and good family relationships in our set of health determinants, we practically guaranteed that the latter would be relatively strongly predictive of global quality of life.     

Social Integration and Health Insurance Status Among African American Men and Women

Using 2010 national data, we investigate the relationship between social integration and health insurance for African American adults. During the previous year 21.6% of men and 19.8% of women lacked continuous health insurance. The effect of marital status, income, and employment on insurance coverage differed by age and gender. Additionally, frequency of church attendance was positively associated with continuous health insurance for women aged 51–64. Spiritual/religious identity was marginally associated with insurance status for men aged 36–50. As provisions of the Affordable Care Act take effect, implementation programs should expand enrollment efforts to include the conjugal unit and the church.     

Religion and Mental Health Among Israeli Jews: Findings from the SHARE-Israel Study

This study investigates the impact of religiousness on mental health indicators in a population sample of Israeli Jews aged 50 or older. Data are from the Israel sample of the Survey of Health, Ageing and Retirement in Europe (SHARE-Israel), collected from 2005 to 2006. Of the 1,287 Jewish respondents, 473 (36.8 %) were native-born Israelis and 814 (63.2 %) were diaspora-born. Religious measures included past-month synagogue activities, current prayer, and having received a religious education. Mental health outcomes included single-item measures of lifetime depression and life satisfaction, along with the CES-D and EURO-D depression scales, the CASP-12 quality of life scale, and the LOT-R optimism scale. Participation in synagogue activities was found to be significantly associated with less depression, better quality of life, and more optimism, even after adjusting for effects of the other religious measures, for sociodemographic covariates, for the possibly confounding effect of age-related activity limitation, and for nativity. Findings for prayer were less consistent, including inverse associations with mental health, perhaps reflecting prayer’s use as a coping response. Finally, religious education was associated with greater optimism. These results underscore a modest contribution of religious participation to well-being among middle-aged and older adults, extending this research to the Israeli and Jewish populations.     

Health Condition and Quality of Life in Older Adults: Adaptation of Qolie-89

This study aimed at adapting the Questionnaire Quality of Life in Epilepsy (QOLIE-89 version 1.0: Vickrey et al., 1993), Quality of Life in Epilepsy QoLIE-89 RAND (Santa Monica, CA)] so that it may be used to measure quality of life (QoL) of older adults, healthy or suffering from various chronic illnesses. The participants were 202 older adults recruited from the Pathology Clinic of a general hospital in Thessaloniki, Greece, and from Community Centers for Older adults. The mean age was 71 years. Of them, 51 suffered from diabetes, 50 from cardiovascular disease, 52 suffered from arthritis/myoskeletal diseases, and 49 were healthy. The QOLIE-89 inventory comprises 89 items that measure 17 topics. Exploratory factor analysis revealed 3 factors, namely, health (i.e., physical health and functioning), cognition, and social behavior. Cronbach’s α for the various topics in each group of participants ranged from 0.60 to 0.90 with a number of exceptions with very low α. Concurrent validity was tested through correlations with measures of subjective well being, affect, life satisfaction, and adaptation to old age. A series of ANOVAs showed differences between the healthy and the chronic illness groups of participants but no clearcut differences between the three chronic illness groups. Further study on the adaptation of QOLIE-89 is needed so that its potential as a general measure of QoL in older adults is determined.     

Asset Impacts on Life Satisfaction in an Asset-Rich Country: Focusing on Older Adults in Singapore

Using a representative sample, this study examined the extent to which assets matter for life satisfaction among older adults in Singapore. Singapore is a particularly useful context to explore the relationship between life satisfaction and assets because almost all Singaporeans own their own house, regardless of income level. First, this study used a latent profile analysis to assess patterns of life satisfaction. Then, asset impacts on this pattern of life satisfaction were examined, while controlling for contextual and health factors. The study found that financial assets matter for life satisfaction of older adults in Singapore. In particular, older adults in both the moderate life satisfaction class (LSC) and the High LSC were likely to have higher financial assets. Comparatively, other economic indicators such as real assets, total debts, and monthly household income were not significantly related to life satisfaction of older adults in the Moderate and High LSC compared to the Low LSC. However, real assets and monthly household income were significant predictors distinguishing the Moderate LSC and the High LSC. Throughout the models, total debts were not considered as a significant predictor of life satisfaction differences. This paper concludes by providing several policy and practice implications.