What are people's attitudes toward medical insurance fraud whistleblowers? a study from China.

PURPOSE: Medical insurance fraud has caused huge losses to countries around the world, and public reporting has become an important means to combat medical insurance fraud. The attitude of medical insurance fraud whistleblowers affects people's reporting behavior, and understanding people's attitude toward medical insurance fraud whistleblowers provides a basis for further improving the system and policy of public participation in medical insurance fund supervision. METHODS: We adopted the questionnaire method to conduct a national cross-sectional survey of the Chinese public and analyzed the data using Chi-square tests, Fisher's exact tests, and binary logistic regression models. RESULTS: A total of 837 respondents were included, and 81.8% of the population had a supportive attitude toward medical insurance fraud whistleblowers, with gender, whether they had used medical insurance reimbursement, and present life satisfaction being statistically significant (P < 0.05). CONCLUSION: The public is generally supportive of medical insurance fraud whistleblowers, and women, those who have used medical insurance for reimbursement, and those who are satisfied with their lives are more likely to be supportive of medical insurance fraud whistleblowers.

What influences the public's willingness to report health insurance fraud in familiar or unfamiliar healthcare settings? a cross-sectional study of the young and middle-aged people in China.

INTRODUCTION: Young and middle-aged people are important participants in the fight against health insurance fraud. The study aims to investigate the differences in their willingness to report health insurance fraud and the factors influencing it when it occurs in familiar or unfamiliar healthcare settings. METHODS: Data were obtained from a validated questionnaire from 828 young and middle-aged people. McNemar's test was used to compare the public's willingness to report under the two scenarios. Chi-square tests and multiple logistic regression analysis were used to analyze the determinants of individuals' willingness to report health insurance fraud in different scenarios. RESULTS: Young and middle-aged people were more likely to report health insurance fraud in a familiar healthcare setting than in an unfamiliar one (McNemar's χ²=26.51, P < 0.05). Their sense of responsibility for maintaining the security of the health insurance fund, the government's openness about fraud cases, and the perception of their ability to report had significant positive effects on the public's willingness to report in both settings (P < 0.05). In a familiar healthcare setting, the more satisfied the public is with government measures to protect whistleblowers, the more likely they are to report (OR = 1.44, P = 0.025). Those who perceive the consequences of health insurance fraud to be serious are more likely to report than those who perceive the consequences to be less serious (OR = 1.61, P = 0.042). CONCLUSION: Individuals are more likely to report health insurance fraud in familiar healthcare settings than in unfamiliar ones, in which their awareness of the severity of the consequences of health insurance fraud and their perceived risk after reporting it play an important role. The government's publicizing of fraud cases and enhancing the public's sense of responsibility and ability to maintain the safety of the health insurance fund may be a way to increase their willingness to report, regardless of whether they are familiar with the healthcare setting or not.

Investigation on the Effectiveness of Augmented Reality Memory Training Game for Chinese Older Adults: A Randomized Controlled Trial.

Objective: To evaluate the effectiveness of augmented reality (AR) game based on n-back training paradigm as a training tool for working memory (WM) of Chinese healthy older adults. Materials and Methods: One hundred eighteen older adults self-assessed as healthy were included in this study. Individuals were randomly divided into an intervention group (n = 57) and a control group (n = 61). Interventions, consisting of a 30-minute AR game-based training and a 30-minute health science program, were administered three times per week for 4 weeks, whereas the control group was required to view a 60-minute health science program three times per week for 4 weeks. Tests, Digit Span, Corsi Block-Tapping Task (CBT), and Stroop Color and Word Test (SCWT), were conducted for all participants before and after the experiment, and the game accuracy rate of the intervention group before and after intervention was recorded. Results: There was a statistically significant difference in terms of both CBT indicators, CBT forward span (z = -2.835, P = 0.005) and CBT backward span (z = 3.285, P = 0.001), and the SCWT indicator of Stroop Words Test (SW) (z = -1.894, P = 0.048) in the two groups. The intervention group showed significant improvements in the game accuracy of both medium level (z = -3.535, P < 0.05) and of high level (z = -3.953, P < 0.05). In addition, differences were observed in subgroup analysis in the accuracy of medium level (H = 6.218, P < 0.05) and high level (H = 8.002, P < 0.05) among older people with different levels of education. Conclusion: AR game based on n-back training paradigm could improve WM of Chinese older adults, showing potential for wider promotion and adoption.

The Public's Self-Avoidance and Other-Reliance in the Reporting of Medical Insurance Fraud: A Cross-Sectional Survey in China.

Purpose: To understand the public's self-willingness to report medical insurance fraud and their expectations on others, to provide a reference for the government to do a good job in medical insurance anti-fraud. Methods: Data were obtained from a questionnaire survey of 846 respondents in China. Descriptive statistical analyses and multinomial logistic regression were used to analyze the different subjective attitudes of the public toward different subjects when faced with medical insurance fraud and the influencing factors. Results: 511 (60.40%) respondents were willing to report medical insurance fraud, while 739 (87.35%) respondents expected others to report it. 485 (57.33%) respondents were willing and expected others to report medical insurance fraud, followed by those who were not willing but expected others to report it (254, 30.02%). Compared to those who were unwilling to report themselves and did not want others to report, those who believe their reporting is useless (OR=3.13, 95% CI=1.15-8.33) and those who fear for their safety after reporting (OR=2.96, 95% CI=1.66-5.26) were more likely to expect others to report. Self-reporting willingness was stronger among the public who were satisfied with the government's protective measures for the safety of whistleblowers (OR=4.43, 95% CI=1.38-14.17). The public who believe that both themselves and others have responsibilities to report medical insurance fraud were willing to report and expect others to do the same. Conclusion: The public had a "self-avoidance" and "other-reliance" mentality in medical insurance anti-fraud. The free-rider mentality, lack of empathy, concerns about own risk after reporting, and the interference of decentralized responsibility were important factors contributing to this public mentality. At this stage, the government should prevent the public's "collective indifference" in medical insurance anti-fraud efforts. Improving the safety and protection of whistleblowers and making everyone feel more responsible and valued may be effective incentives to enhance the public's willingness to report.

Horizontal inequity trends of health care utilization in rural China after the medicine and healthcare system reform: based on longitudinal data from 2010 to 2018.

BACKGROUND: To assess the effectiveness of China's medicine and health care reform in promoting equity in health care utilization among rural residents, it is necessary to analyze temporal trends in equity in health care utilization among rural residents in China. This study is the first to assess horizontal inequity trends in health care utilization among rural Chinese residents from 2010 to 2018 and provides evidence for improving government health policies. METHODS: Longitudinal data obtained from China Family Panel Studies from 2010 to 2018 were used to determine trends in outpatient and inpatient utilization. Concentration index, concentration curve, and horizontal inequity index were calculated to measure inequalities. Decomposition analysis was applied to measure the contribution of need and non-need factors to the unfairness. RESULTS: From 2010 to 2018, outpatient utilization among rural residents increased by 35.10%, while inpatient utilization increased by 80.68%. Concentration indices for health care utilization were negative in all years. In 2012, there was an increase in the concentration index for outpatient utilization (CI = -0.0219). The concentration index for inpatient utilization decreased from -0.0478 in 2010 to -0.0888 in 2018. Except for outpatient utilization in 2012 (HI = 0.0214), horizontal inequity indices for outpatient utilization were negative in all years. The horizontal inequity index for inpatient utilization was highest in 2010 (HI = -0.0068) and lowest in 2018 (HI = -0.0303). The contribution of need factors to the inequity exceeded 50% in all years. CONCLUSIONS: Between 2010 and 2018, low-income groups in rural China used more health services. This seemingly pro-poor income-related inequality was due in large part to the greater health care need among low-income groups. Government policies aimed at increasing access to health services, particularly primary health care had helped to make health care utilization in rural China more equitable. It is necessary to design better health policies for disadvantaged groups to reduce future inequities in the use of health services by rural populations.

What has affected the governance effect of the whole population coverage of medical insurance in China in the past decade? Lessons for other countries.

Objective: This study aimed to explore the current state of governance of full population coverage of health insurance in China and its influencing factors to provide empirical references for countries with similar social backgrounds as China. Methods: A cross-sectional quantitative study was conducted nationwide between 22 January 2020 and 26 January 2020, with descriptive statistics, analysis of variance, and logistic regression models via SPSS 25.0 to analyze the effectiveness and influencing factors of the governance of full population coverage of health insurance in China. Results: The effectiveness of the governance relating to the total population coverage of health insurance was rated as good by 59% of the survey respondents. According to the statistical results, the governance of the public's ability to participate in insurance (OR = 1.516), the degree of information construction in the medical insurance sector (OR = 2.345), the government's governance capacity (OR = 4.284), and completeness of the government's governance tools (OR = 1.370) were all positively correlated (p < 0.05) on the governance effect of the whole population coverage of health insurance. Conclusions: The governance of Chinese health insurance relating to the total population coverage is effective. To effectively improve the effectiveness of the governance relating to the total population coverage of health insurance, health insurance information construction, governance capacity, and governance tools should be the focus of governance to further improve the accurate expansion of and increase the coverage of health insurance.

Rural residents' willingness to participate in basic medical insurance and influential factors: A survey of three provinces in China.

Background: Rural residents' participation in medical insurance has a significant relationship to the affordability of their medical care. This study aims to investigate the willingness of rural residents to participate in basic medical insurance for urban and rural residents and its determinants so as to enhance their willingness to participate in medical insurance. Methods: Data were obtained from 1,077 validated questionnaires from rural residents. Chi-square test and multiple logistic regression analysis were adopted to analyze determinants of rural residents' willingness to participate in basic medical insurance for urban and rural residents. Results: 94.3% of respondents were willing to participate in basic medical insurance for urban and rural residents and this was associated with the familiarity with the medical insurance policies [OR = 2.136, 95% CI (1.143, 3.989)], the reasonability of medical insurance premiums [OR = 2.326, 95% CI (0.998, 5.418)], the normality of doctors' treatment behavior [OR = 3.245, 95% CI (1.339, 7.867)] and the medical insurance's effectiveness in reducing the economic burden of disease [OR = 5.630, 95% CI (2.861, 11.079)]. Conclusion: Even though most respondents were willing to participate in basic medical insurance for urban and rural residents, some aspects need to be improved. The focus should be on promoting and regulating the behavior of medical staff. Financing policies and reimbursement of treatment costs need to be more scientifically developed. A comprehensive basic healthcare system needs to be optimized around the core function of "hedging financial risks".