Relationships between the Physical Activity Intensity and the Medical Expenditure of Middle-Aged and Elderly People: Parsing from the CHARLS Database.

There are many studies on the impact of physical activity on health but few studies on the relationship between physical activity and medical expenditure among the elderly. Based on the China Health and Retirement Longitudinal Survey (CHARLS) database and selected 4456 valid samples, this paper used a two-part model to analyze the effects of high, moderate, and low physical activity intensity on medical expenditure. It is found that the intensity of physical activity was negatively correlated with medical expenditure, and the medical expenditure of the high physical activity intensity group was significantly lower than that of the low physical activity intensity group. For example, compared to people with no physical activity, the total medical expenditure decreased by 22.4%, 40.4%, and 62.5% per week in those with low, moderate, and high physical activity intensity. Thus, the government should provide more places for the elderly to exercise, planning special exercise areas for the elderly in community playgrounds, such as a dancing square, which will also help the elderly to increase their amount of exercise per week and develop a daily exercise habit.

Poverty Reduction Effects of Medical Insurance on Middle-Aged and Elderly Families under the Goal of Common Prosperity in China.

Eliminating poverty due to illness is an important way for China to pursue common prosperity. The high medical expenditure caused by the aging population has brought severe challenges to governments and families of all countries, especially in China, where the entire population has just been lifted out of poverty in 2020 and then hit by COVID-19. How to prevent the possible return of poor boundary families to poverty in China has become a difficult research topic. Based on the latest data from the China Health and Retirement Longitudinal Survey, this paper discusses the poverty reduction effect of medical insurance on middle-aged and elderly families from the absolute index and relative index. Medical insurance had a poverty reduction effect on middle-aged and elderly families, especially the poor boundary families. For example, people who participated in medical insurance reduced their financial burden by 2.36% for middle-aged and older families compared to people who did not participate in medical insurance. Furthermore, the poverty reduction effect had heterogeneity in gender and age. This research brings some policy implications. For example, the government should give more protection to vulnerable groups such as the elderly and low-income families and improve the fairness and effectiveness of the medical insurance system.

Risk Characteristics of Catastrophic Health Expenditure in Multidimensional Borderline Poor Households in China.

Background: Ending poverty and realizing common prosperity are the essential requirements for the localization of Marxism in China. The ongoing COVID-19 pandemic in the post-poverty era further aggravates the risk of catastrophic health expenditure for borderline poor households and increases the uncertainty of returning to poverty due to illness, potentially undermining decades of hard-won efforts to eradicate poverty in China. Methods: Based on the latest data released by China Health and Retirement Longitudinal Survey (CHARLS) database, this paper uses the Logit model to empirically explore the risk characteristics of catastrophic health expenditure of multidimensional borderline poor households based on identifying multidimensional borderline poor households. Results: The results show that factors such as family income level, child support, and medical insurance have different impacts on catastrophic health expenditure, and the risk of catastrophic health expenditure of multidimensional borderline poor households is much higher than that of non- multidimensional borderline poor households, and there is a certain difference between urban and rural areas. Discussion: The government should strengthen and improve the social security system and health service system, such as medical insurance, and more resources should be allocated to multidimensional borderline poor households, especially in rural areas.

Configurations of the driving factors promoting China's commercial health insurance: A comparative qualitative analysis based on the technology-organization-environment framework.

With the nation's remarkable improvement in living standards, China's health insurance system cannot satisfy people's higher demands; therefore, it is necessary to promote the supply of commercial health insurance (CHI) in China. Based on the technology-organization-environment (TOE) framework, this study constructs a novel analysis framework to investigate the driving path of China's CHI. Employing the data of 31 provincial regions of China in 2018, a fuzzy-set qualitative comparative analysis is conducted to analyze configurations. We also adopt a necessary condition analysis in the robustness check to examine the necessary conditions, determining that no necessary relationship exists between possible conditions and the performance of CHI. More particularly, three sufficient configurations, TOE strategy, government attention (GA)-environment adaptability (EA)-citizen demand (CD) strategy, and dual EA-CD strategy are demonstrated to achieve high performance, and the other three configurations of technological management capability (TMC)-EA-CD strategy, technological infrastructure (TI)-EA strategy, and combined TI-TMC-EA strategy do not result in high performance. In addition, technological conditions (TI and TMC) and EA are relatively more important than the other configurations. Notably, government departments' financial expenditure is found to have a negative effect on CHI promotion.

Does Elderly Chronic Disease Hinder the Sustainability of Borderline Poor Families' Wellbeing: An Investigation From Catastrophic Health Expenditure in China.

Objectives: Health and health expenditure caused by elderly chronic diseases are a global problem. As China has just lifted itself out of poverty in 2020, the sustainable development of Borderline Poor Families' Wellbeing faces severe challenges. Therefore, it is of great practical significance to explore the impact of elderly chronic diseases on the catastrophic health expenditure of Borderline Poor Families. Methods: Based on screening 8086 effective samples from China Health and Retirement Longitudinal Study (CHARLS) database and calculating catastrophic health expenditure, this paper uses two-part model and logit regression to discuss the impact of elderly chronic diseases on the sustainable development of Borderline Poor Families' Wellbeing. Results: The results showed that stroke, cancer, and liver disease caused the most catastrophic health expenditures and had the greatest impact on the Borderline Poor Families' Wellbeing. Conclusion: Therefore, in order to ensure the sustainable development of Borderline Poor Families' Wellbeing, the government should strengthen the publicity of pre-prevention and post-healthcare of chronic diseases such as stroke, and combine pre-prevention policy with post-guarantee policy.

The Impact of Dependency Burden on Urban Household Health Expenditure and Its Regional Heterogeneity in China: Based on Quantile Regression Method.

Background: The aging population has led to a growing health expenditure burden. According to the National Bureau of Statistics of China, the old-age dependency ratio rose from 10.7% in 2003 to 17.8% in 2019, and health expenditure increased from 658.410 billion yuan in 2003 to 5812.191 billion yuan in 2019 in China. Methods: This paper utilizes the quantile regression method to discuss the influencing factors of health expenditure in urban China based on the China Household Finance Survey (CHFS), especially dependency burden. Moreover, its regional heterogeneity is also compared. Results: The old-age dependency ratio, age, family size, self-rated health status, and income significantly impact the health expenditure of urban families in the quantile regression of the national sample. Dependency burden and other variables on urban household health expenditure have great regional heterogeneity. The relationship between urban health expenditure and residential areas in western China is more stable than that in eastern and central China. Discussion: Government should improve the healthcare system suitable for the older adult population as soon as possible. The government of western China should pay more attention to the introduction of professional medical talents and the configuration of precision medical equipment to improve the health system in western China.

Theoretical Model and Actual Characteristics of Air Pollution Affecting Health Cost: A Review.

BACKGROUND: The impact of environmental pollution (such as air pollution) on health costs has received a great deal of global attention in the last 20 years. METHODS: This review aims to summarize the theoretical analysis model of air pollution affecting health costs, and further explore the actual characteristics of the impact of air pollution on health costs. The following main databases were taken into account: Web of Science Core Collection, Medline, SCOPUS, PubMed, and CNKI (China). As of 30 March 2021, we retrieved a total of 445 papers and ended up with 52 articles. RESULTS: This review mainly expounds clarification of the concept of air pollution and health costs, the theoretical model and the actual characteristics of air pollution affecting health costs. In addition, it also discusses other related factors affecting health costs. CONCLUSION: Our conclusion is that, while academic research on the relationship between air pollution and health costs has made some progress, there are still some shortcomings, such as insufficient consideration of individual avoidance behavior and rural-urban and international mobility. Therefore, the simple use of the original data obtained in the statistical yearbook of the health cost caused by air pollution is also the reason for the errors in the empirical results. In addition, the choice of proxy variables of environmental pollution by scholars is relatively simple, mainly focusing on air pollutants, while the impact of water quality or soil pollution safety on health costs is becoming increasingly prominent, and will become the focus of future research.

Spatial-temporal evolution of the relationship between agricultural material inputs and agricultural greenhouse gas emissions: experience from China 2003-2018.

Agricultural materials input (fertilizer and pesticide, etc.), together with straw burning, rice planting, and livestock breeding, constitute the sources of agricultural greenhouse gas (GHG) emissions. However, most related studies have discussed the total amount of agricultural GHG emissions or the role of straw burning and rice planting in agricultural GHG emissions and few studies on agricultural GHG emissions from Agricultural materials. Based on the data of 31 provinces in China from 2003 to 2018, this paper explored the evolution process of agricultural GHG emissions from Agricultural materials. Our research turned up some interesting findings. For example, firstly, Agricultural materials play an increasingly important role in agricultural GHG emissions. Agricultural GHG emissions due to Agricultural materials account for an increasing proportion of the total agricultural GHG emissions. Secondly, there are regional differences in the evolution trend of agricultural GHG emissions caused by agricultural materials. Especially after the urbanization rate broke through the critical line of 50% around 2010 in China.

Recent Advances in Consumer Behavior Theory: Shocks from the COVID-19 Pandemic.

Background: The COVID-19 pneumonia epidemic has had an enormous impact on people's lives, particularly aspects of life such as consumption, and has therefore brought new elements to the expansion of Consumer behavior theory. Methods: This paper searches the literature on consumption research conducted from 1981 to 2021, including sources such as CNKI, Wanfang, Google Scholar, and Web of Science. Through the exploration of the existing relevant literature, this article found that the COVID-19 pneumonia epidemic has had a profound impact on consumption willingness, consumption patterns, and consumption objects, and, as such, has newly expanded the theoretical model of consumer behavior. Results: Through reviewing the literature, this paper found some results. For example with regard to consumption patterns, early studies and the impact of COVID-19 was focused on online consumption, however in the context of COVID-19, scholars proposed paying attention to the combination of online and offline development. Conclusion: The COVID-19 pneumonia epidemic has had a profound effect on consumer behavior worldwide. Under the current economic depression, the government should take adequate measures in order to respond to the new changes in consumer behavior and therefore promote economic growth. For example, the government should encourage the combination of online and offline business operation modes to break the boundaries of customer groups and supply chains, so that consumers can buy anytime and anywhere.

The threshold effect of agricultural energy consumption on agricultural carbon emissions: a comparison between relative poverty regions and other regions.

Environmental pollution, such as agricultural carbon emissions (ACE), is one of the main causes of health problems in the relative poverty (RP) regions in China. Therefore, it is of great significance to study ACE in RP regions, not only to accelerate the green upgrading of agriculture, but also to alleviate the high health burden brought by it. However, most studies on ACE were based on the classification of carbon emission sources, and few studies were based on agricultural energy consumption. Moreover, the threshold regression model is rarely used in the limited relevant literatures. This paper used 2001-2017 panel data of 30 provinces to explore the relationship between agricultural carbon emission (ACE) and agricultural energy consumption intensity (AECI) to sudden development in different regions based on the threshold regression model. Some meaningful results were discovered. For example, energy intensity has a significant threshold effect on the growth of ACE, but only a single threshold effect in the RP regions, while a double threshold effect in the high income (HI)regions. Compared with the HI regions, the requirements of environmental protection quality in RP regions are increasing. Therefore, it is necessary to formulate regional carbon emission reduction policies suitable for the characteristics of RP regions. Among them, how to balance the health or health expenditure caused by economic growth and environmental pollution should be put in the first place.

Difference in carbon footprint between single- and double-cropping rice production in China, 2003-2016.

Agricultural greenhouse gas (GHG) emissions account for 14% of the total greenhouse gas (GHG) emissions from human activities, and the carbon footprint (CF) of agricultural production, which can help to propose positive measures to mitigate greenhouse gas (GHG) emissions, is a general method for assessing the impact of agricultural practices on the external environment. This article calculated the carbon footprint (CF) of rice production and compared the differences between the double-and single-cropping rice regions, which is rarely mentioned in previous literature. Some interesting information was shown. For example, the internal structure of rice production carbon footprint (CF) is prominent. (a) In terms of time evolution, CF of agricultural materials showed an increasing trend year by year, while CF of rice planting remained basically stable. (b) In terms of regional differences, whether single-cropping rice regions or double-cropping rice regions, CF of agricultural materials did not show the previous increasing trend after 2011, especially after 2015. This may be greatly affected by the policy such as the abolishing of the China agricultural tax in 2006. These studies can help us to reveal how agricultural policies and different rice cropping patterns affect each region.

The effect of trade openness on the relationship between agricultural technology inputs and carbon emissions: evidence from a panel threshold model.

The development of low-carbon agriculture systems has been a global consensus to reduce carbon emissions in the agricultural sector for addressing climate change challenges. This fact brings the need to study the agricultural carbon emissions (ACEs). Studies focusing on calculating the spatiotemporal changes of ACEs and analyzing the main factors for ACE changes have been conducted. The agricultural technology inputs (ATIs) as an important factor to influence ACEs have been identified. The traditional linear model was the commonly used method to study the relationship between ATIs and ACEs, whereas the impact of ATIs on ACEs in different areas might be complex and nonlinear due to the differences in trade openness causing different development levels of agricultural technologies. Therefore, this study aims to investigate the effect of trade openness on the relationship between ATIs and ACEs using a panel threshold model and put forward policy implications for the low-carbon agriculture development. The analysis was based on data from a panel of 31 provinces of China during 2003-2018. The results show that ATIs and ACEs increased from 2003 to 2018 and the spatial distribution of ATIs was similar to that of ACEs. The ATIs had a positive effect on ACEs with a significant single-threshold effect from trade openness. When the trade openness was below the threshold (0.1425), the positive effect of ATIs on ACEs was significant (coefficient, 0.117), whereas, when the trade openness was above the threshold (0.1425), the positive effect of ATIs on ACEs significantly decreased (coefficient, 0.062). Furthermore, industrial structure and agricultural economic development were the positive drivers of ACEs, while trade openness, education level of rural workers, R&D funding, and natural disasters had negative relationships with ACEs. The results provide valuable references for understanding ACE drivers and developing low-carbon agriculture with the consideration of ATIs and trade openness.

Review of evolution of the public long-term care insurance (LTCI) system in different countries: influence and challenge.

BACKGROUND: The growing demand for LTC (Long-term care) services for disabled elderly has become a daunting task for countries worldwide, especially China, where population aging is particularly severe. According to CSY (China Statistical Yearbook,2019), the elderly aged 65 or above has reached 167 million in 2018, and the number of disabled elderly is as high as 54%. Germany and other countries have alleviated the crisis by promoting the public LTCI (Long-Term Care Insurance) system since the 1990s, while China's public LTCI system formal pilot only started in 2016. Therefore, the development of the public LTCI system has gradually become a hot topic for scholars in various countries, including China. METHODS: This review has been systematically sorted the existing related literature to discuss the development of public LTCI (Long-Term Care Insurance)system form four aspects, namely, the comparison of public LTCI systems in different countries, the influence of public LTCI, challenge of public LTCI, and the relationship between public LTCI and private LTCI. We searched some databases including Web of Science Core Collection, Medline, SCOPUS, EBSCO, EMBASE, ProQuest and PubMed from January 2008 to September 2020. The quality of 38 quantitative and 21 qualitative articles was evaluated using the CASP(Critical Appraisal Skills Programme) critical evaluation checklist. RESULTS: The review systematically examines the development of public LTCI system from four aspects, namely, the comparison of public LTCI systems in different countries, the influence of public LTCI, the challenge of public LTCI, and the relationship between public LTCI and private LTCI. For example, LTCI has a positive effect on the health and life quality of the disabled elderly. However, the role of LTCI in alleviating the financial burden on families with the disabled elderly may be limited. CONCLUSION: Some policy implications on the future development of China's LTCI system can be obtained. For example, the government should fully consider the constraints such as price rise, the elderly disability rate, and the substantial economic burden. It also can strengthen the effective combination of public LTCI and private LTCI. It does not only help to expand the space for its theoretical research but also to learn the experiences in the practice of the LTCI system in various countries around the world. It will significantly help the smooth development and further promote the in-depth reform of the LTCI system in China.

Effect Evaluation of the Long-Term Care Insurance (LTCI) System on the Health Care of the Elderly: A Review.

BACKGROUND: How to cope with the rapid growth of LTC (long-term care) needs for the old people without activities of daily living (ADL), which is also a serious hazard caused by public health emergencies such as COVID-2019 and SARS (2003), has become an urgent task in China, Germany, Japan, and other aging countries. As a response, the LTCI (long-term care insurance) system has been executed among European countries and piloted in 15 cities of China in 2016. Subsequently, the influence and dilemma of LTCI system have become a hot academic topic in the past 20 years. METHODS: The review was carried out to reveal the effects of the LTCI system on different economic entities by reviewing relevant literature published from January 2008 to September 2019. The quality of 25 quantitative and 24 qualitative articles was evaluated using the JBI and CASP critical evaluation checklist, respectively. RESULTS: The review systematically examines the effects of the LTCI system on different microeconomic entities such as caretakers or their families and macroeconomic entities such as government spending. The results show that the LTCI system has a great impact on social welfare. For example, LTCI has a positive effect on the health and life quality of the disabled elderly. However, the role of LTCI in alleviating the financial burden on families with the disabled elderly may be limited. CONCLUSION: Implementation of LTCI system not only in reducing the physical and mental health problems of health care recipients and providers, and the economic burden of their families, but also promote the development of health care service industry and further improvement of the health care system. However, the dilemma and sustainable development of the LTCI system is the government needs to focus on in the future due to the sustainability of its funding sources.

Comparison of the Measurement of Long-Term Care Costs between China and Other Countries: A Systematic Review of the Last Decade.

BACKGROUND: The rapid aging of populations in some countries has led to a growing number of the disabled elderly, creating a huge need for Long-Term Care (LTC) and meeting its costs, which is a heavy economic burden on the families of the disabled elderly and governments. Therefore, the measurement of Long-Term Care (LTC) costs has become an important basis for the government to formulate Long-Term Care (LTC) policies, and academic research on Long-Term Care (LTC) costs is also in the process of continuous development and deepening. METHODS: This is a systematic review that aims to examine the evidence published in the last decade (2010-2019) regarding the comparison of the measurement of Long-Term Care (LTC) costs between China and other countries. RESULTS: Eighteen Chinese studies and 17 other countries' studies were included in this review. Most Chinese scholars estimated long-term care costs based on the degree of disability among the disabled elderly. However, the studies of European and American countries are more and more in-depth and comprehensive, and more detailed regarding the post-care cost of specific diseases, such as Parkinson's disease, Alzheimer's disease, and epilepsy. CONCLUSION: In future academic research, we should fully consider the human value of long-term care providers and further study the differences in the long-term care costs of different chronic diseases. In China's future policymaking, according to the experience of Germany, Sweden, and other countries, it may be an effective way to develop private long-term care insurance and realize the effective complementarity between private long-term care insurance and public long-term care insurance (LTCI).

Does COVID-2019 have an Impact on the Purchase Intention of Commercial Long-Term Care Insurance among the Elderly in China?

PURPOSE: As an important measure to alleviate long-term care (LTC) costs for the disabled due to the aging of the population, long-term care insurance (LTCI) system has been paid more attention in China. In addition to the government-led public LTCI system that has been piloted in cities such as Qingdao, Chongqing and Shanghai, health insurers such as the China Life Insurance Company are also experimenting with various types of commercial LTCI in the private market. However, the commercial LTCI market is developing very slowly due to public awareness and other reasons. On the other hand, COVID-2019 has had an impact on the cognition of the importance of long-term care for the elderly due to the fact that the death cases of COVID-2019 have been mainly concentrated in the elderly population with chronic diseases such as hypertension. Therefore, the purpose of this study is to explore the differences in the purchase intention of commercial LTCI among the elderly in two different periods: before and after the outbreak of COVID-2019. METHODS: By using the Andersen behavioral model and two investigations in two different periods before and after the outbreak of COVID-2019, this study explores the impacts of COVID-2019 on the purchase intention of commercial LTCI. RESULTS: Some significant discoveries were found. For example, 25.8% of interviewees showed purchase intention in LTCI in the time before the COVID-2019 outbreak, while this proportion increased to 37.6% after the COVID-2019 outbreak. People who were younger (OR = 2.128, before COVID-2019; OR = 1.875, after COVID-2019) or who had more education (OR = 1.502, before COVID-2019; OR = 2.218, after COVID-2019) were more interested in commercial LTCI. CONCLUSION: This study shows that COVID-2019 has had an obvious impact on the purchase intention of commercial LTCI, which provides some enlightenment for China to improve the LTCI system in the future, especially to accelerate the development of commercial LTCI. For example, it is essential to promote the importance of long-term care among the elderly in a focused and targeted way. In terms of the key target audience, it can be developed gradually from the groups with higher education levels and the middle elderly aged 45-64 years old.

Health Insurance and Long-Term Care Services for the Disabled Elderly in China: Based on CHARLS Data.

PURPOSE: This paper aimed to explore the relationship between the different factors, especially health insurance, and the availability of long-term care (LTC) services, among the disabled elderly. METHODS: Based on the data of China Health and Retirement Longitudinal Study (CHARLS), the logistic regression model was utilized to evaluate the influence of the different factors, especially health insurance, on the availability of long-term care services. RESULTS: Our findings show some interesting results. Firstly, the findings suggest that informal long-term care (LTC) services for elderly persons with disabilities heavily depend on a family member from different health insurance groups. About 80.733% of the disabled elderly depend on a family member as their primary caregivers. Secondly, other influence factors such as income and area of residence were also significantly related to the availability of long-term rental services. Thirdly, Health insurance is a very important factor influencing the availability of Long-term care services both in urban and rural areas (p<0.001) but Income is the most interesting variable. CONCLUSION: Based on our results, the growth and integration of formal long-term care (LTC) services should be facilitated. Firstly, policymakers can encourage formal long-term care (LTC) services from a variety of sources to work together to increase overall supply capability. Secondly, the long-term living security needs of people who do not have health insurance should be regulated through subsidies according to the economic status.

An assessment of the economic burden of senile chronic diseases in China based on China Health and Retirement Longitudinal Survey.

OBJECTIVE: This study assessed the economic burden of senile chronic diseases (SCD) in China. METHODS: Based on China Health and Retirement Longitudinal Survey data, we used propensity score matching to compare the economic burden of SCD for families with and without members with SCD. RESULTS: We examined three aspects of economic burden: health service utilization, including health care utilization and expenditure, family daily consumption spending, and workforce participation of family members in labor markets. SCD-families showed a higher hospitalization rate and number of outpatient visits than the control group. SCD-families also consumed less per capita. Additionally, the negative influence of SCD on total family income may be partially offset by increasing the labor force participation rate of healthy family members. Finally, we also discussed the burden of SCD  in different educational status. CONCLUSIONS: Relevant results may provide insight into formulating health and labor policies by the Chinese government. The study significance consists of the selection of matching variables and robustness, whereas study limitations include the omission of other important variables.

Factors Influencing Long-Term Care Service Needs among the Elderly Based on the Latest Anderson Model: A Case Study from the Middle and Upper Reaches of the Yangtze River.

The rapid growth of population aging makes providing adequate long-term care (LTC) services for the elderly a serious social dilemma in China. Thus, it is necessary to carry out a theoretical discussion on the LTC service needs of the elderly and find out their influencing factors. With four regions of the middle and upper reaches of the Yangtze River as the sample case, this study aims to explore the factors that affect LTC service needs of the elderly in the frame of the latest Anderson Model, which added psychosocial factors to predisposing characteristics, enabling factors, and need factors in the old version. Some interesting results have been found, for example, self-image evaluation is composed of several factors such as general physical health, attitude towards life, or psychosocial states. Finally, sub-analyses-namely, by age, by gender, and by educational level-were carried out since the choice of different long-term care service patterns is related to different age/gender/education groups.

Is Carbon Dioxide (CO2) Emission an Important Factor Affecting Healthcare Expenditure? Evidence from China, 2005-2016.

As a result of China's economic growth, air pollution, including carbon dioxide (CO2) emission, has caused serious health problems and accompanying heavy economic burdens on healthcare. Therefore, the effect of carbon dioxide emission on healthcare expenditure (HCE) has attracted the interest of many researchers, most of which have adopted traditional empirical methods, such as ordinary least squares (OLS) or quantile regression (QR), to analyze the issue. This paper, however, attempts to introduce Bayesian quantile regression (BQR) to discuss the relationship between carbon dioxide emission and HCE, based on the longitudinal data of 30 provinces in China (2005-2016). It was found that carbon dioxide emission is, indeed, an important factor affecting healthcare expenditure in China, although its influence is not as great as the income variable. It was also revealed that the effect of carbon dioxide emission on HCE at a higher quantile was much smaller, which indicates that most people are not paying sufficient attention to the correlation between air pollution and healthcare. This study also proves the applicability of Bayesian quantile regression and its ability to offer more valuable information, as compared to traditional empirical tools, thus expanding and deepening research capabilities on the topic.