In this article,we comment on the work put forth by Wu et al regarding the investigation of oesophageal cancer-specific mortality for a cohort of patients from Chongqing University Cancer Hospital.We specifically focu...In this article,we comment on the work put forth by Wu et al regarding the investigation of oesophageal cancer-specific mortality for a cohort of patients from Chongqing University Cancer Hospital.We specifically focused on the implications of public health plans such as Urban Employee Basic Medical Insurance(UEBMI)and Urban Resident Basic Medical Insurance as well as out-of-pocket ratios on patient treatment plans regarding whether they pursue surgical interventions or therapeutic treatments such as chemotherapy.While Wu et al put forth potential explanations for why patients with the UEBMI plan surprisingly had a 23.30%increased risk of oesophageal cancer-specific death,more analysis is needed to alleviate cancer burden within this group.Although it is likely that patients covered by Urban Resident Basic Medical Insurance and higher out-ofpocket ratios have stronger self-recovery awareness,more work must be done to improve outcomes for people with the UEBMI plan while simultaneously implementing international and domestic initiatives to better emphasize cancer prevention and early detection.Lastly,future research must explore the relationship between Serious Illness Medical Insurance as well as the New Rural Cooperative Medical System on the mortality rate of oesophageal cancer patients in rural China,where disease burden is significantly higher than urban areas.By unifying these public health insurance schemes,officials can significantly alleviate economic burden of treatment and better prognosis for patients with oesophageal cancer.展开更多
This article investigates the development process and current status of policy-based agricultural insurance in Chongqing.Based on recent data-including premium income,compensation amounts,the number of insured househo...This article investigates the development process and current status of policy-based agricultural insurance in Chongqing.Based on recent data-including premium income,compensation amounts,the number of insured households,and insurance penetration,the article analyzes the primary challenges faced in the system's operation and proposes recommendations from two dimensions:institutional optimization and practical interventions.These recommendations include establishing a differentiated participation incentive mechanism,optimizing the composition of insurance products,enhancing risk diversification and reinsurance systems,creating an agricultural disaster risk reserve fund,developing a dynamic fiscal subsidy distribution mechanism based on risk and performance,improving information-sharing platforms,strengthening the rural grassroots power grid infrastructure,and accelerating the adoption of modern technologies in underwriting and claims settlement processes.The findings suggest that the coordinated advancement of institutional optimization and technological empowerment can substantially enhance the inclusiveness,sustainability,and operational efficiency of policy-based agricultural insurance in Chongqing,thereby providing substantial support for agricultural modernization and the Rural Revitalization Strategy.展开更多
With the rapid development of China's insurance market,the high-quality development of the insurance market is faced with many different challenges and various problems.This paper aims to deeply analyze the actual...With the rapid development of China's insurance market,the high-quality development of the insurance market is faced with many different challenges and various problems.This paper aims to deeply analyze the actual problems in China's insurance market and put forward supporting countermeasures.First,by understanding the background of highquality insurance development,we can explain the research significance of this paper in combination with the existing national policies.Secondly,by summarizing the current situation of high-quality insurance development,the paper puts forward the shortage of insurance talents in the expansion of insurance scale,the continuous improvement of insurance density and depth,and the growth of insurance compensation in the development of high-quality insurance.Finally,from the perspective of differentiated customized insurance products,training professionals,and providing financial subsidies,we will put forward the corresponding suggestions for the problem and look forward to the future development prospects.展开更多
BACKGROUND Oesophageal cancer is a significant health concern worldwide,with high inci-dence and mortality rates.In China,the disease burden is particularly high,accounting for a substantial proportion of oesophageal ...BACKGROUND Oesophageal cancer is a significant health concern worldwide,with high inci-dence and mortality rates.In China,the disease burden is particularly high,accounting for a substantial proportion of oesophageal cancer cases and related deaths worldwide.AIM To explore the relationship between the mortality rate of oesophageal cancer patients and insurance type,out-of-pocket ratio,and the joint effects of insurance type and out-of-pocket ratio.METHODS The χ^(2) test was used to analyze patients’demographic and clinical characteristics.Multivariate logistic regression,the Cox proportional hazard model,and the competitive risk model were used to calculate the cumulative hazard ratios(HRs)of all-cause death and oesophageal cancer-specific death among patients with different types of insurance and out-of-pocket ratios.RESULTS Compared with patients covered by basic medical insurance for urban and rural residents,patients covered by urban employee basic medical insurance for urban workers(UEBMI)had a 23.30%increased risk of oesophageal cancer-specific death[HR=1.233,95%confidence interval(CI):1.093-1.391,P<0.005].Compared with patients in the low out-of-pocket ratio group,patients in the high out-of-pocket ratio group had a 25.80%reduction in the risk of oesophageal cancer-specific death(HR=0.742,95%CI:0.6555-0.84,P<0.005).With each 10%increase in the out-of-pocket ratio,the risk of oesophageal cancer-specific death decreased by 10.10%in patients covered by UEBMI.However,the risk of oesophageal cancer-specific death increased by 26.90%in patients in the high out-of-pocket ratio group.CONCLUSION This study reveals the relationships of the specific mortality rate of patients with oesophageal cancer with the out-of-pocket ratio and medical insurance types as well as their combined effects.This study provides practical suggestions and guidance for the formulation of relevant policies in this area.展开更多
The article by Wu et al highlights the growing incidence of esophageal tumor patients,particularly in China,where the high frequency and death rate are significant problems.The article also examined the impact of heal...The article by Wu et al highlights the growing incidence of esophageal tumor patients,particularly in China,where the high frequency and death rate are significant problems.The article also examined the impact of health insurance on treatment availability and patient outcomes,demonstrating that the type of insurance can affect the financial burden on patients.This study investigates the effects of different types of health care coverage,namely Urban Employee Basic Medical Insurance vs Urban-Rural Resident Basic Medical Insurance,and the personal spending ratio on treatment decisions and survival outcomes.The database used is derived from esophageal tumor patient continuation from Chongqing University Hospital in China.A total of 2543 patients were included in the study,allowing for the formation of research cohorts.Patient information included demographic characteristics.The study followed various processes to maintain consistency,including data sources,inclusion and exclusion criteria,follow-up duration,health insurance,and statistical analysis.The average age at diagnosis ranged from 57-74 years,and predominantly included men,married people,and those of Han ethnic background,comprising 2088 and 2519 individuals,respectively.Upon controlling for age,sex,relationship status,country of origin,pathological evaluation,tumor stage,and biochemical indicators,individuals who had Urban Employee Basic Medical Insurance exhibited a higher propensity to opt for radiotherapy,chemotherapy,immunotherapy,and targeted therapy compared to those covered by the Urban-Rural Resident Basic Medical Insurance.During the follow-up phase of the study,a total of 1438 deaths were documented,with 1106 ascribed to esophageal cancer.Additionally,individuals with Urban-Rural Resident Basic Medical Insurance had a significantly elevated risk of esophageal cancer,particularly mortality,compared to those without Urban-Rural Resident Basic Medical Insurance.展开更多
BACKGROUND Private insurance coverage is associated with higher rates of living donor kidney transplantation(LDKT)but whether this is attributable to confounding is not known.AIM To study the association between incre...BACKGROUND Private insurance coverage is associated with higher rates of living donor kidney transplantation(LDKT)but whether this is attributable to confounding is not known.AIM To study the association between increased access to private health insurance and LDKT.METHODS Retrospective cohort study using United States transplant registry data.We identified incident candidates aged 22-29 years who were waitlisted for a kidneyonly transplant from 2005-2014,excluding prior transplant recipients and those with missing data.We calculated the hazard of LDKT after waitlisting for those with private insurance vs other insurance pre-Affordable Care Act(ACA)vs post-ACA,using death and delisting as competing events,for candidates affected by the policy change(age 22-25 years)vs those who were not(age 26-29 years).RESULTS A total of 13817 candidates were included,of whom 46%were age 22-25 years and 54%were age 26-29 years.Among candidates aged 22-25 years at listing,those listed post-ACA were more likely to have private insurance compared to those listed pre-ACA(42%vs 35%),but there was no difference in private insurance coverage between eras among candidates aged 26-29 years at listing.In adjusted competing risk regression,privately insured patients age 22-25 years were less likely to receive a LDKT post-ACA compared to pre-ACA[hazard ratio(HR)=0.88,95%CI:0.78-1.00],as were those aged 22-25 years old with other insurance types(HR=0.80,95%CI:0.69-0.92).These associations were not seen among candidates age 26-29 years.CONCLUSION Candidates age 22-25 years were likelier to have private insurance post-ACA,without an increased rate in LDKT.Demonstrations of associations between insurance and LDKT are likely attributable to residual confounding.展开更多
Cancers remain a major health burden with a high mortality rate in China.Basic medical insurance,is the most important element in the financial support system of healthcare resources in both urban and rural areas,and ...Cancers remain a major health burden with a high mortality rate in China.Basic medical insurance,is the most important element in the financial support system of healthcare resources in both urban and rural areas,and requires further understanding to improve health policy.For instance,a single hospital-based prospective cohort study found that esophageal cancer survival outcomes were associated with different healthcare payment patterns and situations.Comparing the extracted literature-data between urban employee basic medical insurance and urban and rural resident basic medical insurance,the proportions of tumor-node-metastasis(TNM)stage I-II were 27.1%and 34.6%,while those of TNM stage IV were 35.0%and 26.1%,respectively.Additionally,high out-of-pocket rate(>60%)of hospitalization was associated with a higher proportion of TNM stage I-II(40.3%vs 26.9%)and a lower proportion of TNM stage IV(22.7%vs 32.8%).In addition,healthcare payment simultaneously influenced or was influenced by the proportions of early and advanced esophageal cancers.The critical difficulty in improving survival of esophageal cancer in populations should be a low proportion of early disease.A more comprehensive and robust public healthcare insurance system is desired to support cancer prevention and control in particular,in order to increase the proportion of early cancers and consequently improve patient survival.Additionally,commercial medical insurance and social charities hope to be fully introduced and encouraged to achieve these goals as active supplement.展开更多
BACKGROUND Hepatocellular carcinoma(HCC)remains a significant public health concern in South Korea even though the incidence rates are declining.While medical travel for cancer treatment is common,its patterns and inf...BACKGROUND Hepatocellular carcinoma(HCC)remains a significant public health concern in South Korea even though the incidence rates are declining.While medical travel for cancer treatment is common,its patterns and influencing factors for patients with HCC are unknown.AIM To assess medical travel patterns and determinants and their policy implications among patients with newly diagnosed HCC in South Korea.METHODS This retrospective cohort study used the National Health Insurance Service database to identify patients with newly diagnosed HCC from 2013 to 2021.Medical travel was defined as receiving initial treatment outside one’s residential region.Patient characteristics and regional trends were analyzed,and factors influencing medical travel were identified using logistic regression analysis.RESULTS Among 64808 patients 52.4%received treatment in the capital.This proportion increased to 67.4%when including the surrounding metropolitan area.Medical travel was significantly more common among younger and wealthier patients.Patients with greater comorbidity burden or liver cirrhosis were less likely to travel.While geographic distance influenced travel patterns,high-volume academic centers in the capital attracted patients nationwide regardless of proximity.CONCLUSION This nationwide study highlighted the centralization of HCC care in the capital.This observation indicates that regional cancer hubs should be strengthened and promoted for equitable healthcare access.展开更多
Since the resumption of diplomatic relations between China and Indonesia in the 1990s,the economic and trade cooperation between the two countries has developed rapidly and continuously.Since 2013,the scale of trade b...Since the resumption of diplomatic relations between China and Indonesia in the 1990s,the economic and trade cooperation between the two countries has developed rapidly and continuously.Since 2013,the scale of trade between the two countries has expanded year on year,and investment has broadened from traditional agriculture and industry to the digital economy and financial insurance,which has effectively promoted industrial development in both countries.More infrastructure cooperation has significantly improved the development environment in Indonesia,producing tangible benefits for the local people.Different types of special economic zones have facilitated breakthrough development for Indonesian industries while creating employment opportunities for local residents and driving local economic development.展开更多
Agricultural insurance plays a key role in promoting the coordinated development of green agriculture and farmers’income growth,which is crucial for China’s high-quality agricultural development.Using the coupling c...Agricultural insurance plays a key role in promoting the coordinated development of green agriculture and farmers’income growth,which is crucial for China’s high-quality agricultural development.Using the coupling coordination degree model,this study empirically demonstrates that the development of agricultural insurance significantly promotes the coordinated development of green agriculture and farmers’income growth once a certain threshold is exceeded.This effect is more pronounced in the major grain-producing regions and the central provinces.Expanding the scale of agricultural production and increasing investment in agricultural technology are the key mechanisms through which agricultural insurance supports the dual goals of green agriculture and income growth in China.In conclusion,this study proposes several policy recommendations,which include increasing investment in agricultural insurance infrastructure,strengthening the policy guidance for agricultural insurance,and designing differentiated agricultural insurance policies.展开更多
China’s healthcare system faces increasing challenges,including surging medical costs,resource allocation imbalances favoring large hospitals,and ineffective referral mechanisms.The lack of a unified strategy integra...China’s healthcare system faces increasing challenges,including surging medical costs,resource allocation imbalances favoring large hospitals,and ineffective referral mechanisms.The lack of a unified strategy integrating standardized coverage with personalized payment compounds these issues.To this end,this study proposes a risk-sharing reform strategy that combines equal coverage for the same disease(ECSD)with an individualized out-of-pocket(I-OOP)model.Specifically,the study employs a Markov model to capture patient transitions across health states and care levels.The findings show that ECSD and I-OOP enhance equity by standardizing disease coverage while tailoring costs to patient income and facility type.This approach alleviates demand on high-tier hospitals,promoting primary care utilization and enabling balanced resource distribution.The study’s findings provide a reference for policymakers and healthcare administrators by presenting a scalable framework that is aligned with China’s development goals with the aim of fostering an efficient,sustainable healthcare system that is adaptable to regional needs.展开更多
太平保险股份有限公司(The Tai Ping Insurance Co.,Ltd.)1929年11月20日创立于上海,由金城银行独资筹设,资本总额100万元,实收50万元。总公司在上海金城银行大楼(今江西中路212号)。初名太平水火保险公司,周作民任董事长兼总经理,丁雪...太平保险股份有限公司(The Tai Ping Insurance Co.,Ltd.)1929年11月20日创立于上海,由金城银行独资筹设,资本总额100万元,实收50万元。总公司在上海金城银行大楼(今江西中路212号)。初名太平水火保险公司,周作民任董事长兼总经理,丁雪农任协理兼止海分公司经理,经营水火保险业务。1933年改组为太平保险公司,黄奕住任董事长,周作民任总经理。公司除办理各种财产损失保险外.展开更多
Australian households are increasingly vulnerable to natural hazard-related disasters. To manage disaster risk, government commissioned inquiries have called for greater investment in mitigation. This article critical...Australian households are increasingly vulnerable to natural hazard-related disasters. To manage disaster risk, government commissioned inquiries have called for greater investment in mitigation. This article critically examines the call for a shift in funding priority towards pre-disaster mitigation measures, in the context of growing concerns around the ability of households to access and afford insurance. It examines mitigation measures in the context of three prominent Australian disasters: the Black Saturday bushfires(Victoria, 2009), the Queensland floods(2010–2011), and Cyclone Yasi(Queensland, 2011). We argue that as a mode of disaster security, mitigation operates as a complex assemblage of logics and practices of protection, preparedness, and resilience, which problematizes simplistic protection/resilience binaries. On the one hand, mitigation serves as a mode of protection, which underscores the dominant maladaptive rationality of insurance. It promises a collective solution to uninsurability that is limited by government fiscal constraints and growing employment of risk-reflective insurance pricing.On the other hand, there is evidence of an emergent rationality of household insurance as a path to resilience and preparedness—for example, in the development of insurance systems that price household retrofitting technologies and in the development of policyholder education campaigns. This resilience rationality holds the promise of securing individuals previously excluded from insurance.However, for householders lacking the necessary physical,cognitive, and financial capacities to make themselves and their properties resilient, the transition to a pre-disaster mitigation mode of security will likely do little to alleviate disadvantage and marginalization.展开更多
Some regions in China have already implemented capitation payment or capitation budget management for medical insurance funds.However,there remains a shortage of adequate tools and methodologies to accurately quantify...Some regions in China have already implemented capitation payment or capitation budget management for medical insurance funds.However,there remains a shortage of adequate tools and methodologies to accurately quantify differences in population health risks.Therefore,this paper constructs a health performance assessment model that comprises four steps.The first step is to categorize all participants into health risk groups based on whether they have contracted with a family doctor,their age,sex,and the type of consultation.The second step is to categorize health risk groups based on differences in healthcare resource utilization.The third step is to analyze health performance by examining healthcare resource utilization year over year.The fourth step is to apply the assessment results to assist local finance bureaus and medical insurance bureaus in developing incentive schemes.According to cost weights,the health risk groups are split into six classes:insured residents without health care visits,healthy insured person,slightly ill insured patients,ill insured patients,more seriously disease patients,and severely ill insured patients.We evaluate one compact medical community's health performance by examining changes in the proportion of resource usage group size and expense.From 2019 to 2021,both the proportion of patients with severe and ultra‐severe diseases and the proportion of costs in the sample increased,according to changes in resource utilization levels.This result indicates that the population's overall health has not improved and that the compact medical community is still primarily focused on treating diseases,with poor implementation of health maintenance measures and minimal improvement in health performance.展开更多
With the aging of the country’s population structure,the problem of social pensions is becoming more and more serious.As for the issue of social pension,the elderly with Alzheimer’s disease are a special group,and t...With the aging of the country’s population structure,the problem of social pensions is becoming more and more serious.As for the issue of social pension,the elderly with Alzheimer’s disease are a special group,and the issue of care services for these elderly has attracted widespread attention from society.However,judging from the current level of social security provided to the elderly with dementia in the country,there is a serious imbalance between supply and demand.Therefore,this problem needs to be solved urgently and is of great significance for further improving the country’s social pension security system.Routine care is limited to hospitals and mainly focuses on the patient’s condition.Patients fail to receive comprehensive care services and the effect is not ideal.Therefore,in order to improve patients’cognitive function and quality of life,and learn from international experience,a“community-institution-home”three-dimensional linkage care model based on long-term care insurance can be established.The application of this model can effectively solve and further improve the country’s elderly care and social security system.展开更多
Objective Antiretroviral drugs covered by medical insurance have been gradually used by people living with human immunodeficiency virus(PLWH)in recent years in China.This study aimed to analyze their willingness to pa...Objective Antiretroviral drugs covered by medical insurance have been gradually used by people living with human immunodeficiency virus(PLWH)in recent years in China.This study aimed to analyze their willingness to pay(WTP)for antiretroviral drugs.Methods A mixed-methods study design involving a cross-sectional survey and in-depth interviews was conducted.A cross-sectional survey was performed to collect data on the general characteristics,economic status,antiretroviral therapy(ART)status,and WTP of PLWH in 18 Chinese cities from August 2022 to February 2023.Multivariate logistic regression was used to analyze the factors associated with WTP.Representatives of PLWH were interviewed via in-depth interviews,and the data were thematically analyzed.Results Among the 941 PLWH,271(28.80%)were willing to pay for antiretroviral drugs covered by medical insurance.For basic medical insurance for urban and rural residents,PLWH with the following characteristics were more willing to pay:an educational level of senior high school or technical secondary school,having an undergraduate degree or higher,frequently working away from their hometowns,and homosexual transmission.Off-farm workers and recipients of government medical aid were more unwilling to pay.For basic medical insurance for urban employees,PLWH with the following characteristics were more willing to pay:frequently working away from their hometowns;homosexual transmission;personal annual income≥100,000 CNY;and adverse events of antiretroviral drugs.The main reasons for PLWH’s WTP for antiretroviral drugs covered by medical insurance were that the drugs had fewer adverse events and were easier to administer.The main reasons for PLWH’s unwillingness to pay were financial difficulties and privacy concerns.Conclusion Nearly one-third of PLWH are willing to pay for antiretroviral drugs covered by medical insurance.In the future,PLWH with a high WTP can be guided to use these drugs.展开更多
文摘In this article,we comment on the work put forth by Wu et al regarding the investigation of oesophageal cancer-specific mortality for a cohort of patients from Chongqing University Cancer Hospital.We specifically focused on the implications of public health plans such as Urban Employee Basic Medical Insurance(UEBMI)and Urban Resident Basic Medical Insurance as well as out-of-pocket ratios on patient treatment plans regarding whether they pursue surgical interventions or therapeutic treatments such as chemotherapy.While Wu et al put forth potential explanations for why patients with the UEBMI plan surprisingly had a 23.30%increased risk of oesophageal cancer-specific death,more analysis is needed to alleviate cancer burden within this group.Although it is likely that patients covered by Urban Resident Basic Medical Insurance and higher out-ofpocket ratios have stronger self-recovery awareness,more work must be done to improve outcomes for people with the UEBMI plan while simultaneously implementing international and domestic initiatives to better emphasize cancer prevention and early detection.Lastly,future research must explore the relationship between Serious Illness Medical Insurance as well as the New Rural Cooperative Medical System on the mortality rate of oesophageal cancer patients in rural China,where disease burden is significantly higher than urban areas.By unifying these public health insurance schemes,officials can significantly alleviate economic burden of treatment and better prognosis for patients with oesophageal cancer.
基金Supported by Chongqing Social Science Planning Project(Doctoral Project)"Research Support on the Impact of Policy-based Agricultural Insurance on the Production Behavior of Chinese Farmers"(2020BS39).
文摘This article investigates the development process and current status of policy-based agricultural insurance in Chongqing.Based on recent data-including premium income,compensation amounts,the number of insured households,and insurance penetration,the article analyzes the primary challenges faced in the system's operation and proposes recommendations from two dimensions:institutional optimization and practical interventions.These recommendations include establishing a differentiated participation incentive mechanism,optimizing the composition of insurance products,enhancing risk diversification and reinsurance systems,creating an agricultural disaster risk reserve fund,developing a dynamic fiscal subsidy distribution mechanism based on risk and performance,improving information-sharing platforms,strengthening the rural grassroots power grid infrastructure,and accelerating the adoption of modern technologies in underwriting and claims settlement processes.The findings suggest that the coordinated advancement of institutional optimization and technological empowerment can substantially enhance the inclusiveness,sustainability,and operational efficiency of policy-based agricultural insurance in Chongqing,thereby providing substantial support for agricultural modernization and the Rural Revitalization Strategy.
文摘With the rapid development of China's insurance market,the high-quality development of the insurance market is faced with many different challenges and various problems.This paper aims to deeply analyze the actual problems in China's insurance market and put forward supporting countermeasures.First,by understanding the background of highquality insurance development,we can explain the research significance of this paper in combination with the existing national policies.Secondly,by summarizing the current situation of high-quality insurance development,the paper puts forward the shortage of insurance talents in the expansion of insurance scale,the continuous improvement of insurance density and depth,and the growth of insurance compensation in the development of high-quality insurance.Finally,from the perspective of differentiated customized insurance products,training professionals,and providing financial subsidies,we will put forward the corresponding suggestions for the problem and look forward to the future development prospects.
基金Supported by the Chongqing Science and Health Joint Medical Research Project,No.2024MSXM065.
文摘BACKGROUND Oesophageal cancer is a significant health concern worldwide,with high inci-dence and mortality rates.In China,the disease burden is particularly high,accounting for a substantial proportion of oesophageal cancer cases and related deaths worldwide.AIM To explore the relationship between the mortality rate of oesophageal cancer patients and insurance type,out-of-pocket ratio,and the joint effects of insurance type and out-of-pocket ratio.METHODS The χ^(2) test was used to analyze patients’demographic and clinical characteristics.Multivariate logistic regression,the Cox proportional hazard model,and the competitive risk model were used to calculate the cumulative hazard ratios(HRs)of all-cause death and oesophageal cancer-specific death among patients with different types of insurance and out-of-pocket ratios.RESULTS Compared with patients covered by basic medical insurance for urban and rural residents,patients covered by urban employee basic medical insurance for urban workers(UEBMI)had a 23.30%increased risk of oesophageal cancer-specific death[HR=1.233,95%confidence interval(CI):1.093-1.391,P<0.005].Compared with patients in the low out-of-pocket ratio group,patients in the high out-of-pocket ratio group had a 25.80%reduction in the risk of oesophageal cancer-specific death(HR=0.742,95%CI:0.6555-0.84,P<0.005).With each 10%increase in the out-of-pocket ratio,the risk of oesophageal cancer-specific death decreased by 10.10%in patients covered by UEBMI.However,the risk of oesophageal cancer-specific death increased by 26.90%in patients in the high out-of-pocket ratio group.CONCLUSION This study reveals the relationships of the specific mortality rate of patients with oesophageal cancer with the out-of-pocket ratio and medical insurance types as well as their combined effects.This study provides practical suggestions and guidance for the formulation of relevant policies in this area.
文摘The article by Wu et al highlights the growing incidence of esophageal tumor patients,particularly in China,where the high frequency and death rate are significant problems.The article also examined the impact of health insurance on treatment availability and patient outcomes,demonstrating that the type of insurance can affect the financial burden on patients.This study investigates the effects of different types of health care coverage,namely Urban Employee Basic Medical Insurance vs Urban-Rural Resident Basic Medical Insurance,and the personal spending ratio on treatment decisions and survival outcomes.The database used is derived from esophageal tumor patient continuation from Chongqing University Hospital in China.A total of 2543 patients were included in the study,allowing for the formation of research cohorts.Patient information included demographic characteristics.The study followed various processes to maintain consistency,including data sources,inclusion and exclusion criteria,follow-up duration,health insurance,and statistical analysis.The average age at diagnosis ranged from 57-74 years,and predominantly included men,married people,and those of Han ethnic background,comprising 2088 and 2519 individuals,respectively.Upon controlling for age,sex,relationship status,country of origin,pathological evaluation,tumor stage,and biochemical indicators,individuals who had Urban Employee Basic Medical Insurance exhibited a higher propensity to opt for radiotherapy,chemotherapy,immunotherapy,and targeted therapy compared to those covered by the Urban-Rural Resident Basic Medical Insurance.During the follow-up phase of the study,a total of 1438 deaths were documented,with 1106 ascribed to esophageal cancer.Additionally,individuals with Urban-Rural Resident Basic Medical Insurance had a significantly elevated risk of esophageal cancer,particularly mortality,compared to those without Urban-Rural Resident Basic Medical Insurance.
基金Supported by National Institute of Diabetes and Digestive and Kidney Diseases,United States,No.K23DK133729。
文摘BACKGROUND Private insurance coverage is associated with higher rates of living donor kidney transplantation(LDKT)but whether this is attributable to confounding is not known.AIM To study the association between increased access to private health insurance and LDKT.METHODS Retrospective cohort study using United States transplant registry data.We identified incident candidates aged 22-29 years who were waitlisted for a kidneyonly transplant from 2005-2014,excluding prior transplant recipients and those with missing data.We calculated the hazard of LDKT after waitlisting for those with private insurance vs other insurance pre-Affordable Care Act(ACA)vs post-ACA,using death and delisting as competing events,for candidates affected by the policy change(age 22-25 years)vs those who were not(age 26-29 years).RESULTS A total of 13817 candidates were included,of whom 46%were age 22-25 years and 54%were age 26-29 years.Among candidates aged 22-25 years at listing,those listed post-ACA were more likely to have private insurance compared to those listed pre-ACA(42%vs 35%),but there was no difference in private insurance coverage between eras among candidates aged 26-29 years at listing.In adjusted competing risk regression,privately insured patients age 22-25 years were less likely to receive a LDKT post-ACA compared to pre-ACA[hazard ratio(HR)=0.88,95%CI:0.78-1.00],as were those aged 22-25 years old with other insurance types(HR=0.80,95%CI:0.69-0.92).These associations were not seen among candidates age 26-29 years.CONCLUSION Candidates age 22-25 years were likelier to have private insurance post-ACA,without an increased rate in LDKT.Demonstrations of associations between insurance and LDKT are likely attributable to residual confounding.
基金Supported by the Foundation of Science and Technology Department of Sichuan Province,China,No.23ZDYF0839Ya'an Science and Technology Plan of Economic and Social Development(Health Field),Ya’an,China,No.2024-1the Ya’an Philosophic and Social Science Research Plan,Ya’an,China,No.YAA20240035.
文摘Cancers remain a major health burden with a high mortality rate in China.Basic medical insurance,is the most important element in the financial support system of healthcare resources in both urban and rural areas,and requires further understanding to improve health policy.For instance,a single hospital-based prospective cohort study found that esophageal cancer survival outcomes were associated with different healthcare payment patterns and situations.Comparing the extracted literature-data between urban employee basic medical insurance and urban and rural resident basic medical insurance,the proportions of tumor-node-metastasis(TNM)stage I-II were 27.1%and 34.6%,while those of TNM stage IV were 35.0%and 26.1%,respectively.Additionally,high out-of-pocket rate(>60%)of hospitalization was associated with a higher proportion of TNM stage I-II(40.3%vs 26.9%)and a lower proportion of TNM stage IV(22.7%vs 32.8%).In addition,healthcare payment simultaneously influenced or was influenced by the proportions of early and advanced esophageal cancers.The critical difficulty in improving survival of esophageal cancer in populations should be a low proportion of early disease.A more comprehensive and robust public healthcare insurance system is desired to support cancer prevention and control in particular,in order to increase the proportion of early cancers and consequently improve patient survival.Additionally,commercial medical insurance and social charities hope to be fully introduced and encouraged to achieve these goals as active supplement.
基金Supported by Dong-A University Research Fund,No.20230598.
文摘BACKGROUND Hepatocellular carcinoma(HCC)remains a significant public health concern in South Korea even though the incidence rates are declining.While medical travel for cancer treatment is common,its patterns and influencing factors for patients with HCC are unknown.AIM To assess medical travel patterns and determinants and their policy implications among patients with newly diagnosed HCC in South Korea.METHODS This retrospective cohort study used the National Health Insurance Service database to identify patients with newly diagnosed HCC from 2013 to 2021.Medical travel was defined as receiving initial treatment outside one’s residential region.Patient characteristics and regional trends were analyzed,and factors influencing medical travel were identified using logistic regression analysis.RESULTS Among 64808 patients 52.4%received treatment in the capital.This proportion increased to 67.4%when including the surrounding metropolitan area.Medical travel was significantly more common among younger and wealthier patients.Patients with greater comorbidity burden or liver cirrhosis were less likely to travel.While geographic distance influenced travel patterns,high-volume academic centers in the capital attracted patients nationwide regardless of proximity.CONCLUSION This nationwide study highlighted the centralization of HCC care in the capital.This observation indicates that regional cancer hubs should be strengthened and promoted for equitable healthcare access.
文摘Since the resumption of diplomatic relations between China and Indonesia in the 1990s,the economic and trade cooperation between the two countries has developed rapidly and continuously.Since 2013,the scale of trade between the two countries has expanded year on year,and investment has broadened from traditional agriculture and industry to the digital economy and financial insurance,which has effectively promoted industrial development in both countries.More infrastructure cooperation has significantly improved the development environment in Indonesia,producing tangible benefits for the local people.Different types of special economic zones have facilitated breakthrough development for Indonesian industries while creating employment opportunities for local residents and driving local economic development.
基金This paper presents preliminary research findings from two projects:a major project funded by the National Social Science Fund of China,titled“Changes in the Nature of Rural Poverty in China in the New Era and Research on Post-2020 Anti-Poverty Policies”(Project No:19ZDA116)Doctoral Research Project under the Special Program for Talents in Shortage Areas Serving National Needs,Nanjing University of Finance and Economics,titled“The Impact of Policy-Based Agricultural Insurance on Farmers’Income and Welfare Levels”(Project No:BSZX2021-12).
文摘Agricultural insurance plays a key role in promoting the coordinated development of green agriculture and farmers’income growth,which is crucial for China’s high-quality agricultural development.Using the coupling coordination degree model,this study empirically demonstrates that the development of agricultural insurance significantly promotes the coordinated development of green agriculture and farmers’income growth once a certain threshold is exceeded.This effect is more pronounced in the major grain-producing regions and the central provinces.Expanding the scale of agricultural production and increasing investment in agricultural technology are the key mechanisms through which agricultural insurance supports the dual goals of green agriculture and income growth in China.In conclusion,this study proposes several policy recommendations,which include increasing investment in agricultural insurance infrastructure,strengthening the policy guidance for agricultural insurance,and designing differentiated agricultural insurance policies.
基金The National Natural Science Foundation of China(No.72071042)。
文摘China’s healthcare system faces increasing challenges,including surging medical costs,resource allocation imbalances favoring large hospitals,and ineffective referral mechanisms.The lack of a unified strategy integrating standardized coverage with personalized payment compounds these issues.To this end,this study proposes a risk-sharing reform strategy that combines equal coverage for the same disease(ECSD)with an individualized out-of-pocket(I-OOP)model.Specifically,the study employs a Markov model to capture patient transitions across health states and care levels.The findings show that ECSD and I-OOP enhance equity by standardizing disease coverage while tailoring costs to patient income and facility type.This approach alleviates demand on high-tier hospitals,promoting primary care utilization and enabling balanced resource distribution.The study’s findings provide a reference for policymakers and healthcare administrators by presenting a scalable framework that is aligned with China’s development goals with the aim of fostering an efficient,sustainable healthcare system that is adaptable to regional needs.
文摘太平保险股份有限公司(The Tai Ping Insurance Co.,Ltd.)1929年11月20日创立于上海,由金城银行独资筹设,资本总额100万元,实收50万元。总公司在上海金城银行大楼(今江西中路212号)。初名太平水火保险公司,周作民任董事长兼总经理,丁雪农任协理兼止海分公司经理,经营水火保险业务。1933年改组为太平保险公司,黄奕住任董事长,周作民任总经理。公司除办理各种财产损失保险外.
基金funded by the Australian Research Council (DP170100096)
文摘Australian households are increasingly vulnerable to natural hazard-related disasters. To manage disaster risk, government commissioned inquiries have called for greater investment in mitigation. This article critically examines the call for a shift in funding priority towards pre-disaster mitigation measures, in the context of growing concerns around the ability of households to access and afford insurance. It examines mitigation measures in the context of three prominent Australian disasters: the Black Saturday bushfires(Victoria, 2009), the Queensland floods(2010–2011), and Cyclone Yasi(Queensland, 2011). We argue that as a mode of disaster security, mitigation operates as a complex assemblage of logics and practices of protection, preparedness, and resilience, which problematizes simplistic protection/resilience binaries. On the one hand, mitigation serves as a mode of protection, which underscores the dominant maladaptive rationality of insurance. It promises a collective solution to uninsurability that is limited by government fiscal constraints and growing employment of risk-reflective insurance pricing.On the other hand, there is evidence of an emergent rationality of household insurance as a path to resilience and preparedness—for example, in the development of insurance systems that price household retrofitting technologies and in the development of policyholder education campaigns. This resilience rationality holds the promise of securing individuals previously excluded from insurance.However, for householders lacking the necessary physical,cognitive, and financial capacities to make themselves and their properties resilient, the transition to a pre-disaster mitigation mode of security will likely do little to alleviate disadvantage and marginalization.
基金Guangzhou Philosophy and Social Science Planning Project,Grant/Award Number:2023GZQN68Foshan Social Science Planning Project,Grant/Award Number:2023‐GJ117+1 种基金National Social Science Foundation Major Project“Research on Public Policies and Mechanisms for Achieving Positive Ageing”,Grant/Award Number:17ZDA121Tsinghua University Dushi Program,Grant/Award Number:2024Z11DSZ001。
文摘Some regions in China have already implemented capitation payment or capitation budget management for medical insurance funds.However,there remains a shortage of adequate tools and methodologies to accurately quantify differences in population health risks.Therefore,this paper constructs a health performance assessment model that comprises four steps.The first step is to categorize all participants into health risk groups based on whether they have contracted with a family doctor,their age,sex,and the type of consultation.The second step is to categorize health risk groups based on differences in healthcare resource utilization.The third step is to analyze health performance by examining healthcare resource utilization year over year.The fourth step is to apply the assessment results to assist local finance bureaus and medical insurance bureaus in developing incentive schemes.According to cost weights,the health risk groups are split into six classes:insured residents without health care visits,healthy insured person,slightly ill insured patients,ill insured patients,more seriously disease patients,and severely ill insured patients.We evaluate one compact medical community's health performance by examining changes in the proportion of resource usage group size and expense.From 2019 to 2021,both the proportion of patients with severe and ultra‐severe diseases and the proportion of costs in the sample increased,according to changes in resource utilization levels.This result indicates that the population's overall health has not improved and that the compact medical community is still primarily focused on treating diseases,with poor implementation of health maintenance measures and minimal improvement in health performance.
文摘With the aging of the country’s population structure,the problem of social pensions is becoming more and more serious.As for the issue of social pension,the elderly with Alzheimer’s disease are a special group,and the issue of care services for these elderly has attracted widespread attention from society.However,judging from the current level of social security provided to the elderly with dementia in the country,there is a serious imbalance between supply and demand.Therefore,this problem needs to be solved urgently and is of great significance for further improving the country’s social pension security system.Routine care is limited to hospitals and mainly focuses on the patient’s condition.Patients fail to receive comprehensive care services and the effect is not ideal.Therefore,in order to improve patients’cognitive function and quality of life,and learn from international experience,a“community-institution-home”three-dimensional linkage care model based on long-term care insurance can be established.The application of this model can effectively solve and further improve the country’s elderly care and social security system.
基金supported by the National Natural Science Foundation of China[Grant No.72374186]。
文摘Objective Antiretroviral drugs covered by medical insurance have been gradually used by people living with human immunodeficiency virus(PLWH)in recent years in China.This study aimed to analyze their willingness to pay(WTP)for antiretroviral drugs.Methods A mixed-methods study design involving a cross-sectional survey and in-depth interviews was conducted.A cross-sectional survey was performed to collect data on the general characteristics,economic status,antiretroviral therapy(ART)status,and WTP of PLWH in 18 Chinese cities from August 2022 to February 2023.Multivariate logistic regression was used to analyze the factors associated with WTP.Representatives of PLWH were interviewed via in-depth interviews,and the data were thematically analyzed.Results Among the 941 PLWH,271(28.80%)were willing to pay for antiretroviral drugs covered by medical insurance.For basic medical insurance for urban and rural residents,PLWH with the following characteristics were more willing to pay:an educational level of senior high school or technical secondary school,having an undergraduate degree or higher,frequently working away from their hometowns,and homosexual transmission.Off-farm workers and recipients of government medical aid were more unwilling to pay.For basic medical insurance for urban employees,PLWH with the following characteristics were more willing to pay:frequently working away from their hometowns;homosexual transmission;personal annual income≥100,000 CNY;and adverse events of antiretroviral drugs.The main reasons for PLWH’s WTP for antiretroviral drugs covered by medical insurance were that the drugs had fewer adverse events and were easier to administer.The main reasons for PLWH’s unwillingness to pay were financial difficulties and privacy concerns.Conclusion Nearly one-third of PLWH are willing to pay for antiretroviral drugs covered by medical insurance.In the future,PLWH with a high WTP can be guided to use these drugs.
