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Multilevel medical insurance mitigate health cost inequality due to air pollution: Evidence from China
Air pollution affects residents' health to varying extents according to differences in socioeconomic status. However, there has been a lack of research on whether air pollution contributes to unfair health costs. In this research, data from the China Labour Force Dynamics Survey are matched wit...
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| Published in: | International journal for equity in health 2024-08, Vol.23 (1), p.153-14, Article 153 |
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| creator | Wang, Ennan Zhu, Minglai Lin, Yisha Xi, Xiaoyu |
| description | Air pollution affects residents' health to varying extents according to differences in socioeconomic status. However, there has been a lack of research on whether air pollution contributes to unfair health costs.
In this research, data from the China Labour Force Dynamics Survey are matched with data on PM2.5 average concentration and precipitation, and the influence of air pollution on the health expenditures of residents is analysed with econometric methods involving a two-part model, instrument variables and moderating effects.
The findings reveal that air pollution significantly impacts Chinese residents' health costs and leads to low-income people face health inequality. Specifcally, the empirical evidence shows that air pollution has no significant influence on the probability of residents' health costs (β = 0.021, p = 0.770) but that it increases the amount of residents' total outpatient costs (β = 0.379, p |
| doi_str_mv | 10.1186/s12939-024-02238-9 |
| format | article |
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In this research, data from the China Labour Force Dynamics Survey are matched with data on PM2.5 average concentration and precipitation, and the influence of air pollution on the health expenditures of residents is analysed with econometric methods involving a two-part model, instrument variables and moderating effects.
The findings reveal that air pollution significantly impacts Chinese residents' health costs and leads to low-income people face health inequality. Specifcally, the empirical evidence shows that air pollution has no significant influence on the probability of residents' health costs (β = 0.021, p = 0.770) but that it increases the amount of residents' total outpatient costs (β = 0.379, p < 0.006), reimbursed outpatient cost (β = 0.453, p < 0.044) and out-of-pocket outpatient cost (β = 0.362, p < 0.048). The heterogeneity analysis of income indicates that low-income people face inequality due to health cost inflation caused by air pollution, their total and out-of-pocket outpatient cost significantly increase with PM2.5 (β = 0.417, p = 0.013; β = 0.491, p = 0.020). Further analysis reveals that social basic medical insurance does not have a remarkable positive moderating effect on the influence of air pollution on individual health inflation (β = 0.021, p = 0.292), but supplementary medical insurance for employees could reduce the effect of air pollution on low-income residents' reimbursed and out-of-pocket outpatient cost (β=-1.331, p = 0.096; β=-2.211, p = 0.014).
The study concludes that air pollution increases the amount of Chinese residents' outpatient cost and has no significant effect on the incidence of outpatient cost. However, air pollution has more significant impact on the low-income residents than the high-income residents, which indicates that air pollution leads to the inequity of medical cost. Additionally, the supplementary medical insurance reduces the inequity of medical cost caused by air pollution for the low-income employees.</description><identifier>ISSN: 1475-9276</identifier><identifier>EISSN: 1475-9276</identifier><identifier>DOI: 10.1186/s12939-024-02238-9</identifier><identifier>PMID: 39103862</identifier><language>eng</language><publisher>England: BioMed Central Ltd</publisher><subject>Adult ; Air pollution ; Air Pollution - adverse effects ; Air pollution effects ; Analysis ; China ; Chronic illnesses ; Cost analysis ; Costs ; Data analysis ; Demographic aspects ; Economic aspects ; Economic growth ; Environmental aspects ; Expenditures ; Female ; Health aspects ; Health Care Costs - statistics & numerical data ; Health care disparities ; Health care expenditures ; Health care policy ; Health disparities ; Health equity ; Health Expenditures - statistics & numerical data ; Health insurance ; Healthcare Disparities - economics ; Heterogeneity ; Household income ; Humans ; Income ; Income inequality ; Inflation ; Insurance ; Insurance, Health - economics ; Labor force ; Low income housing ; Male ; Medical care, Cost of ; Medical personnel ; Middle Aged ; Multilevel medical insurance systems ; Particulate matter ; Particulate Matter - adverse effects ; Poverty - statistics & numerical data ; Residents ; Social aspects ; Socioeconomic Factors ; Socioeconomic status ; Socioeconomics ; Surveys</subject><ispartof>International journal for equity in health, 2024-08, Vol.23 (1), p.153-14, Article 153</ispartof><rights>2024. The Author(s).</rights><rights>COPYRIGHT 2024 BioMed Central Ltd.</rights><rights>2024. This work is licensed under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>The Author(s) 2024 2024</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c479t-859c702208afd96e3ccb9c665100733ed6ba9a7078d80fcf311b39611dba30b63</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC11301995/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/3091293546?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,25752,27865,27923,27924,37011,37012,44589,53790,53792</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39103862$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Wang, Ennan</creatorcontrib><creatorcontrib>Zhu, Minglai</creatorcontrib><creatorcontrib>Lin, Yisha</creatorcontrib><creatorcontrib>Xi, Xiaoyu</creatorcontrib><title>Multilevel medical insurance mitigate health cost inequality due to air pollution: Evidence from China</title><title>International journal for equity in health</title><addtitle>Int J Equity Health</addtitle><description>Air pollution affects residents' health to varying extents according to differences in socioeconomic status. However, there has been a lack of research on whether air pollution contributes to unfair health costs.
In this research, data from the China Labour Force Dynamics Survey are matched with data on PM2.5 average concentration and precipitation, and the influence of air pollution on the health expenditures of residents is analysed with econometric methods involving a two-part model, instrument variables and moderating effects.
The findings reveal that air pollution significantly impacts Chinese residents' health costs and leads to low-income people face health inequality. Specifcally, the empirical evidence shows that air pollution has no significant influence on the probability of residents' health costs (β = 0.021, p = 0.770) but that it increases the amount of residents' total outpatient costs (β = 0.379, p < 0.006), reimbursed outpatient cost (β = 0.453, p < 0.044) and out-of-pocket outpatient cost (β = 0.362, p < 0.048). The heterogeneity analysis of income indicates that low-income people face inequality due to health cost inflation caused by air pollution, their total and out-of-pocket outpatient cost significantly increase with PM2.5 (β = 0.417, p = 0.013; β = 0.491, p = 0.020). Further analysis reveals that social basic medical insurance does not have a remarkable positive moderating effect on the influence of air pollution on individual health inflation (β = 0.021, p = 0.292), but supplementary medical insurance for employees could reduce the effect of air pollution on low-income residents' reimbursed and out-of-pocket outpatient cost (β=-1.331, p = 0.096; β=-2.211, p = 0.014).
The study concludes that air pollution increases the amount of Chinese residents' outpatient cost and has no significant effect on the incidence of outpatient cost. However, air pollution has more significant impact on the low-income residents than the high-income residents, which indicates that air pollution leads to the inequity of medical cost. Additionally, the supplementary medical insurance reduces the inequity of medical cost caused by air pollution for the low-income employees.</description><subject>Adult</subject><subject>Air pollution</subject><subject>Air Pollution - adverse effects</subject><subject>Air pollution effects</subject><subject>Analysis</subject><subject>China</subject><subject>Chronic illnesses</subject><subject>Cost analysis</subject><subject>Costs</subject><subject>Data analysis</subject><subject>Demographic aspects</subject><subject>Economic aspects</subject><subject>Economic growth</subject><subject>Environmental aspects</subject><subject>Expenditures</subject><subject>Female</subject><subject>Health aspects</subject><subject>Health Care Costs - statistics & numerical data</subject><subject>Health care disparities</subject><subject>Health care expenditures</subject><subject>Health care policy</subject><subject>Health disparities</subject><subject>Health equity</subject><subject>Health Expenditures - statistics & numerical data</subject><subject>Health insurance</subject><subject>Healthcare Disparities - economics</subject><subject>Heterogeneity</subject><subject>Household income</subject><subject>Humans</subject><subject>Income</subject><subject>Income inequality</subject><subject>Inflation</subject><subject>Insurance</subject><subject>Insurance, Health - economics</subject><subject>Labor force</subject><subject>Low income housing</subject><subject>Male</subject><subject>Medical care, Cost of</subject><subject>Medical personnel</subject><subject>Middle Aged</subject><subject>Multilevel medical insurance systems</subject><subject>Particulate matter</subject><subject>Particulate Matter - adverse effects</subject><subject>Poverty - statistics & numerical data</subject><subject>Residents</subject><subject>Social aspects</subject><subject>Socioeconomic Factors</subject><subject>Socioeconomic status</subject><subject>Socioeconomics</subject><subject>Surveys</subject><issn>1475-9276</issn><issn>1475-9276</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>7TQ</sourceid><sourceid>PIMPY</sourceid><sourceid>DOA</sourceid><recordid>eNptUl1vFCEUnRiNrdU_4IMh8UUfpsIww4AvptlU3aTGxI9nwsBllw0zbIHZ2H8v2621awwhEDjnwD33VNVLgs8J4exdIo2gosZNW2ZDeS0eVaek7btaND17_GB_Uj1LaYMx6Tnrn1YnVBBMOWtOK_tl9tl52IFHIxinlUduSnNUkwY0uuxWKgNag_J5jXRIuVzD9ay8yzfIzIByQMpFtA3ez9mF6T263DkDe7qNYUSLtZvU8-qJVT7Bi7v1rPr58fLH4nN99fXTcnFxVeu2F7nmndB9qQVzZY1gQLUehGasIxj3lIJhgxKqxz03HFttKSEDFYwQMyiKB0bPquVB1wS1kdvoRhVvZFBO3h6EuJIqZqc9SMutMl2R16ppuSWiG3rRDMxobpoW2qL14aC1nYdijYYpR-WPRI9vJreWq7CThFBMhOiKwps7hRiuZ0hZji5p8F5NEOYkKeaiIy3pmgJ9_Q90E-Y4Fa8KSuwb3bXsL2qlSgVusqE8rPei8oLj0lVO8f7j5_9BlWFgdDpMYEvDjwlvjwgFk-FXXqk5Jbn8_u0Y2xywOoaUIth7QwiW-1jKQyxliaW8jaUUhfTqoZX3lD85pL8B2xHciA</recordid><startdate>20240806</startdate><enddate>20240806</enddate><creator>Wang, Ennan</creator><creator>Zhu, Minglai</creator><creator>Lin, Yisha</creator><creator>Xi, Xiaoyu</creator><general>BioMed Central Ltd</general><general>BioMed Central</general><general>BMC</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>ISR</scope><scope>3V.</scope><scope>7TQ</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>ATCPS</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>CCPQU</scope><scope>DHY</scope><scope>DON</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PATMY</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PYCSY</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope></search><sort><creationdate>20240806</creationdate><title>Multilevel medical insurance mitigate health cost inequality due to air pollution: Evidence from China</title><author>Wang, Ennan ; Zhu, Minglai ; Lin, Yisha ; Xi, Xiaoyu</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c479t-859c702208afd96e3ccb9c665100733ed6ba9a7078d80fcf311b39611dba30b63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Adult</topic><topic>Air pollution</topic><topic>Air Pollution - adverse effects</topic><topic>Air pollution effects</topic><topic>Analysis</topic><topic>China</topic><topic>Chronic illnesses</topic><topic>Cost analysis</topic><topic>Costs</topic><topic>Data analysis</topic><topic>Demographic aspects</topic><topic>Economic aspects</topic><topic>Economic growth</topic><topic>Environmental aspects</topic><topic>Expenditures</topic><topic>Female</topic><topic>Health aspects</topic><topic>Health Care Costs - statistics & numerical data</topic><topic>Health care disparities</topic><topic>Health care expenditures</topic><topic>Health care policy</topic><topic>Health disparities</topic><topic>Health equity</topic><topic>Health Expenditures - statistics & numerical data</topic><topic>Health insurance</topic><topic>Healthcare Disparities - economics</topic><topic>Heterogeneity</topic><topic>Household income</topic><topic>Humans</topic><topic>Income</topic><topic>Income inequality</topic><topic>Inflation</topic><topic>Insurance</topic><topic>Insurance, Health - economics</topic><topic>Labor force</topic><topic>Low income housing</topic><topic>Male</topic><topic>Medical care, Cost of</topic><topic>Medical personnel</topic><topic>Middle Aged</topic><topic>Multilevel medical insurance systems</topic><topic>Particulate matter</topic><topic>Particulate Matter - adverse effects</topic><topic>Poverty - statistics & numerical data</topic><topic>Residents</topic><topic>Social aspects</topic><topic>Socioeconomic Factors</topic><topic>Socioeconomic status</topic><topic>Socioeconomics</topic><topic>Surveys</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Wang, Ennan</creatorcontrib><creatorcontrib>Zhu, Minglai</creatorcontrib><creatorcontrib>Lin, Yisha</creatorcontrib><creatorcontrib>Xi, Xiaoyu</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale In Context: Science</collection><collection>ProQuest Central (Corporate)</collection><collection>PAIS Index</collection><collection>Health & Medical Complete (ProQuest Database)</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest One Sustainability</collection><collection>ProQuest Central</collection><collection>Agricultural & Environmental Science Collection</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>ProQuest One Community College</collection><collection>PAIS International</collection><collection>PAIS International (Ovid)</collection><collection>ProQuest Central</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>Environmental Science Database</collection><collection>Publicly Available Content (ProQuest)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>Environmental Science Collection</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>Open Access: DOAJ - Directory of Open Access Journals</collection><jtitle>International journal for equity in health</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Wang, Ennan</au><au>Zhu, Minglai</au><au>Lin, Yisha</au><au>Xi, Xiaoyu</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Multilevel medical insurance mitigate health cost inequality due to air pollution: Evidence from China</atitle><jtitle>International journal for equity in health</jtitle><addtitle>Int J Equity Health</addtitle><date>2024-08-06</date><risdate>2024</risdate><volume>23</volume><issue>1</issue><spage>153</spage><epage>14</epage><pages>153-14</pages><artnum>153</artnum><issn>1475-9276</issn><eissn>1475-9276</eissn><abstract>Air pollution affects residents' health to varying extents according to differences in socioeconomic status. However, there has been a lack of research on whether air pollution contributes to unfair health costs.
In this research, data from the China Labour Force Dynamics Survey are matched with data on PM2.5 average concentration and precipitation, and the influence of air pollution on the health expenditures of residents is analysed with econometric methods involving a two-part model, instrument variables and moderating effects.
The findings reveal that air pollution significantly impacts Chinese residents' health costs and leads to low-income people face health inequality. Specifcally, the empirical evidence shows that air pollution has no significant influence on the probability of residents' health costs (β = 0.021, p = 0.770) but that it increases the amount of residents' total outpatient costs (β = 0.379, p < 0.006), reimbursed outpatient cost (β = 0.453, p < 0.044) and out-of-pocket outpatient cost (β = 0.362, p < 0.048). The heterogeneity analysis of income indicates that low-income people face inequality due to health cost inflation caused by air pollution, their total and out-of-pocket outpatient cost significantly increase with PM2.5 (β = 0.417, p = 0.013; β = 0.491, p = 0.020). Further analysis reveals that social basic medical insurance does not have a remarkable positive moderating effect on the influence of air pollution on individual health inflation (β = 0.021, p = 0.292), but supplementary medical insurance for employees could reduce the effect of air pollution on low-income residents' reimbursed and out-of-pocket outpatient cost (β=-1.331, p = 0.096; β=-2.211, p = 0.014).
The study concludes that air pollution increases the amount of Chinese residents' outpatient cost and has no significant effect on the incidence of outpatient cost. However, air pollution has more significant impact on the low-income residents than the high-income residents, which indicates that air pollution leads to the inequity of medical cost. Additionally, the supplementary medical insurance reduces the inequity of medical cost caused by air pollution for the low-income employees.</abstract><cop>England</cop><pub>BioMed Central Ltd</pub><pmid>39103862</pmid><doi>10.1186/s12939-024-02238-9</doi><tpages>14</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | International journal for equity in health, 2024-08, Vol.23 (1), p.153-14, Article 153 |
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| subjects | Adult Air pollution Air Pollution - adverse effects Air pollution effects Analysis China Chronic illnesses Cost analysis Costs Data analysis Demographic aspects Economic aspects Economic growth Environmental aspects Expenditures Female Health aspects Health Care Costs - statistics & numerical data Health care disparities Health care expenditures Health care policy Health disparities Health equity Health Expenditures - statistics & numerical data Health insurance Healthcare Disparities - economics Heterogeneity Household income Humans Income Income inequality Inflation Insurance Insurance, Health - economics Labor force Low income housing Male Medical care, Cost of Medical personnel Middle Aged Multilevel medical insurance systems Particulate matter Particulate Matter - adverse effects Poverty - statistics & numerical data Residents Social aspects Socioeconomic Factors Socioeconomic status Socioeconomics Surveys |
| title | Multilevel medical insurance mitigate health cost inequality due to air pollution: Evidence from China |
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