Background Many informal caregivers at working age and face the dual burden of providing care and working. This study examines how China's long-term care insurance (LTCI) pilot programs affect the labor-force participation of adult children who may provide informal care to parents.Methods We analyze four waves (2011, 2013, 2015, and 2018) of micro panel data from the China Health and Retirement Longitudinal Study and exploit the staggered rollout of LTCI pilots across cities from 2012 to 2017. A difference-in-differences design estimates the causal impact of LTCI implementation on labor-force participation of adult children, with robustness checks and subgroup analyses by gender, age, cohabitation status, and skill level.Results Implementation of LTCI significantly increases the likelihood of adult children remaining in the labor force. Mechanism analysis indicates this effect is driven by both reduced caregiving time (substitution effect) and improved expectations of future support (anticipation effect). The positive impact is particularly strong among men, individuals under 45 years old, cohabitation without parents, and lower-skilled workers.Conclusion Expanding LTCI can effectively alleviate the caregiving-employment conflict and enhance labor participation of adult children. To maximize workforce and social welfare benefits, policymakers should expand LTCI coverage, strengthen community care services, and focus support on high-burden caregiver groups.

Objectives:To investigate type 2 diabetes self-management behaviors and glycemic control under the impacts of COVID-19 legacy and Diabetes Prevention and Control Action, and explore the heterogeneous impacts of five self-management activities on glycemic control and how these impacts differ across key groups. Methods:A cross-sectional survey was conducted between April and September 2023 in hospitals and communities in China. Overall, 1817 adults with type 2 diabetes and normal cognitive and behavioral capacities completed a questionnaire regarding diabetes self-management behaviors and glycemic control. Ordinary least squares regression analyses were conducted. Results:Mean score of overall self-management behaviors was 5.89. About 26.86% reported good glycemic control. Among five self-management activities, medication adherence was the best (mean = 6.77) but glucose-monitoring adherence was the worst (mean = 5.18). Overall self-management behaviors and the five activities (coefficient = 0.031-0.146, all p < 0.001) all exerted positive impacts on glycemic control, with dietary control showing the greatest impact while medication adherence the least. Younger persons, rural persons, and persons with financial difficulties were key groups benefiting less from self-management. Conclusion:Diabetes self-management behaviors and glycemic control were suboptimal. Customized health promotions should focus on key groups and addressing the deficiencies in self-management activities especially dietary control.

Objectives:This study has two primary objectives: (a) to conduct a comparative cost-effectiveness analysis of four commonly used oral iron supplements for treating iron-deficiency anemia during pregnancy in China, including ferrous succinate sustained-release tablets, polysaccharide-iron complex capsules, iron protein succinylate oral solution, and iron dextran oral solution; and (b) to assess the budget impact of including ferrous succinate sustained-release tablets in the National Reimbursement Drug List (NRDL) on national medical insurance expenditures. Methods:A decision tree model was developed to analyze the cost-effectiveness based on treatment efficacy derived from a network meta-analysis. A sensitivity analysis was conducted to address uncertainties in the parameters. Subsequently, a budget impact analysis model was utilized to calculate the effect of including ferrous succinate sustained-release tablets in the NRDL on the expenditures of employee medical insurance funds, resident medical insurance funds, and the total medical insurance fund expenditures. Results:The cost-effectiveness analysis showed that ferrous succinate sustained-release tablets are a cost-effective treatment option. When compared to polysaccharide-iron complex capsules, the additional cost per effect of the ferrous succinate sustained-release tablets is $3.23. If these tablets are included in the NRDL, the total medical insurance expenditure on oral iron preparations for treating iron-deficiency anemia in pregnant women is expected to decrease from $160.14 million to $156.82 million between 2025 and 2027. Conclusion:Ferrous succinate sustained-release tablets are a cost-effective treatment option for iron-deficiency anemia during pregnancy in China.

Rapid population ageing and insufficient formal care have led over 80% of Chinese older adults to rely on informal care. Yet, research on caregivers' health costs in developing countries remains scarce and inconclusive. This study aims to assess the relationship between informal caregiving and caregivers' multidimensional health and identify the vulnerable groups. Utilizing data from the Harmonized CHARLS, which includes 16 287 participants from 28 Chinese provinces, we assessed psychological health via the CES-D10 scale and physical health by chronic disease count. Ordinary least squares evaluated the association between informal caregiving and psychological health, and Zero-inflated Poisson regression examined the relationship with physical health. We also applied propensity score matching and placebo tests to mitigate potential endogeneity. Our findings reveal that informal caregivers have significantly higher CES-D10 scores [b = 0.859, SE = 0.339, P = 0.011, confidence interval (CI) (0.194, 1.525)] and a greater likelihood of chronic diseases [odds ratio (OR) = 1.213, SE = 0.039, P < 0.001, CI (1.117, 1.269)] compared with non-caregivers. The negative health effects are especially pronounced among women, rural hukou holders, and the employed. Our study argues that policies should prioritize the health deterioration of informal caregivers over their cost-effectiveness, particularly among vulnerable groups. It calls for adequate support for informal caregivers, including gender-sensitive subsidies for female caregivers, improved primary healthcare for rural caregivers, and flexible working arrangements for employed caregivers to reduce their burdens.

RationaleResearch on how social mobility impacts health has primarily focused on developed countries or regions, with a notable absence of in-depth examination into the underlying mechanisms responsible for these influences.ObjectiveThis paper utilizes data from the 2021 Chinese General Social Survey to focus on the health effects of social mobility in China and the underlying mechanisms behind these effects.MethodsWe employed an ordered logistic regression model as the baseline to test the health effects of social mobility. To address endogeneity issues, we used placebo tests, instrumental variable methods, and the Karlson-Holm-Breen mediation analysis to explore the pathways through which social mobility affects health.ResultsOur findings indicate that upward social mobility is associated with better self-rated health, and this conclusion holds in China. The health benefits of upward social mobility are more pronounced for males and individuals with lower initial socioeconomic status. Upward social mobility primarily influences individuals’ health through material conditions, psychological support, and social capital.ConclusionOur research findings support the rising from rags hypothesis, expanding the research context of social mobility theory, which provides a new perspective on promoting health equity and improving health within the life course context.

Background To estimate the long-term cost-effectiveness of once-weekly semaglutide versus sitagliptin as an add-on therapy for type 2 diabetes patients inadequately controlled on metformin in China, to better inform healthcare decision making.Methods The Cardiff diabetes model which is a Monte Carlo micro-simulation model was used to project short-term effects of once-weekly semaglutide versus sitagliptin into long-term outcomes. Short-term data of patient profiles and treatment effects were derived from the 30-week SUSTAIN China trial, in which 868 type 2 diabetes patients with a mean age of 53.1 years inadequately controlled on metformin were randomized to receive once-weekly semaglutide 0.5 mg, once-weekly semaglutide 1 mg, or sitagliptin 100 mg. Costs and quality-adjusted life years (QALYs) were estimated from a healthcare system perspective at a discount rate of 5%. Univariate sensitivity analysis, scenario analysis, and probabilistic sensitivity analysis were conducted to test the uncertainty.Results Over patients' lifetime projections, patients in both once-weekly semaglutide 0.5 mg and 1 mg arms predicted less incidences of most vascular complications, mortality, and hypoglycemia, and lower total costs compared with those in sitagliptin arm. For an individual patient, compared with sitagliptin, once-weekly semaglutide 0.5 mg conferred a small QALY improvement of 0.08 and a lower cost of $5173, while once-weekly semaglutide 1 mg generated an incremental QALY benefit of 0.12 and a lower cost of $7142, as an add-on to metformin. Therefore, both doses of once-weekly semaglutide were considered dominant versus sitagliptin with more QALY benefits at lower costs.Conclusion Once-weekly semaglutide may represent a cost-effective add-on therapy alternative to sitagliptin for type 2 diabetes patients inadequately controlled on metformin in China.

IntroductionThe health issues that afflict middle-aged people and older individuals are a significant factor that affects their quality of life. It is crucial to investigate the impact of health shocks on the subjective wellbeing of this demographic and the mechanisms that underlie this impact to promote healthy aging.MethodsThis study utilized data from the China Family Panel Study in 2018 and 2020 to analyze the effects of HSs and their categories on the subjective wellbeing of middle-aged people and older individuals using the propensity score matching difference-in-differences method. Additionally, the study explored the mediating role of social participation.ResultsThe findings indicate that health shocks, both chronic and acute, diminish the subjective wellbeing of middle-aged people and older adults. Furthermore, these shocks have a more significant negative effect on the subjective wellbeing of individuals aged 60 and above, women in the middle-aged and older demographic, individuals in rural areas who belong to the middle-aged and older age groups, and individuals possessing activities of daily living. The mechanism analysis revealed that health shocks, both chronic and acute, reduce the subjective wellbeing of middle-aged people and older individuals by disrupting partnerships.DiscussionLowering the possibility of health shocks, the government should build a strong health management system and improve the health insurance system to enable timely treatment for persons suffering from health shocks. Individuals and families should live healthy lives and engage in social activities to avoid health shocks and improve subjective wellbeing.

Green work–life balance (GWLB) has emerged from sustainability and work–life balance (WLB) studies. The goal is to examine how GWLB policies benefit organisations. This focuses how individuals could reduce an organisation’s environmental impact. The sustainability of green human resource management (GHRM) practices and human resource (HR) operations has changed significantly in recent years. HR are an organisation’s most important assets. This study examines how GWLB and GHRM practices affect a corporate sustainability performance (CSP) and employee retention (ER) of UK’s industrial companies. It also examines how organisational culture (OC) andgreen innovation (GI), affect these aspects. This study surveyed 450 operational supervisors in a variety of manufacturing firms in the UK. A self-administered survey using a scale was used to collect data. SPSS 26 and Smart PLS 4 analysed the data. According to research, GHRM practices and GWLB programs improve CSP and ER. The data also show that GI mediates the relationship between GHRM practices, ER, GWLB, and CSP. In the UK manufacturing industry, OC helps maintain a GWLB, ER, implement environmentally friendly HR practices, and achieve CSP goals. This study will methodologically, practically, and theoretically affect HR specialists, academics, and corporate leaders.

在互联网社会与风险社会双重背景下,公众互联网使用经由风险的社会放大效应影响风险感知,探究互联网使用对风险感知的影响机制对政府风险治理具有重要意义.本文采用 2017 年中国社会状况综合调查数据,从差异化人际信任视角通过OLS与工具变量法(Ⅳ)探讨了互联网使用强度对公众风险感知的影响及差异化人际信任在其中发挥的间接效应.结果表明,互联网使用强度会增强公众风险感知水平,差异化人际信任均能够降低公众风险感知,公众与陌生人形成了"弱信任",与亲近人与周围人形成了"强信任".机制分析表明,特殊信任与普遍信任在间接效应中表现为遮掩效应,一般信任发挥部分中介作用.基于此,政府部门可通过加强多主体网络空间治理,通过增进社会融合构建公民社会以提升普遍信任,通过家风建设、公众教育等加强特殊信任与一般信任,最终降低公众风险感知水平,实现有效的风险治理.

本文从医疗卫生资源配置角度探讨了突发公共卫生事件应对中预防与治疗的关系问题,通过熵权法构建医疗与公共卫生资源变量,采用2011-2020年面板数据分析了医疗与公共卫生资源及两者间协同效应对突发公共卫生事件防控效果的影响.结果表明:医疗资源与公共卫生资源均能够提升地区突发公共卫生事件防控效果,现阶段医疗资源在突发公共卫生事件防控中更受重视,但理论上应更注重预防.从机制分析来看,公共卫生资源在医疗资源对防控效果影响机制中具有正向调节效应,医疗与公共卫生资源的协同能够提升防控效果.因此应对突发公共卫生事件要优化医疗卫生资源配置,提升预防在健康中国战略中的地位,并逐渐改善"轻预防、重医疗"格局,构建医疗与公共卫生资源的有效协同机制.

Managing the health of migrants has become a crucial aspect of promoting social harmony and cohesion in China. This study investigates the impact of public health education on the health status of migrants in China using cross-sectional data from the China Migrants Dynamic Survey 2017. A total of 169,989 migrants in China were selected as samples for empirical test. Data were analyzed using descriptive statistics, logistic regression, and the structural equation model. The findings show that health education significantly influences the health status of migrants in China. Specifically, health education related to occupational diseases, venereal diseases/AIDS, and self-rescue in public emergencies had a significant positive impact on migrants' health, while health education regarding chronic diseases had a significant negative impact. Health education delivered through lectures and bulletin boards had a significant positive impact on migrants' health, but online education had a significant negative effect on the health status of migrants. The effects of health education differ by gender and age, with a stronger positive impact on female migrants and elderly migrants aged 60 and above. The mediating effect of health behaviors was significant only in the total effect. In conclusion, health education can effectively enhance the health status of migrants in China by modifying their health behaviors.

Against the backdrop of the construction of an ecological civilization and the “Healthy China 2030” initiative, access to clean fuels is crucial for achieving optimal health and wellbeing, as well as sustainable social development. The purpose of this study is to investigate the effect of household clean fuel combustion (HCFC) on multiple dimensions of health among older adults while shedding light on the potential mechanisms. We performed a cross-sectional study of the data from the 2018 China Health and Retirement Longitudinal Survey, and we surmounted the underlying issues of endogeneity with the application of propensity score matching and the instrumental variable strategy. The results revealed that HCFC has positive effects on the health of older adults, particularly by improving their psychological wellbeing. The adoption of clean fuels among the elderly was associated with a significant increase in SRH by 3.06% to 3.42% and a decrease in CES-D by 7.96% to 8.28%. These positive environmental health effects became stronger among the elderly under the age of 75, as well as among those who were educated and had chronic diseases. Moreover, the results demonstrated that HCFC significantly alleviated chronic pain and increased social interaction among older adults, highlighting two potential pathways for promoting their wellbeing. Given that a significant number of rural households in China rely on polluting fuels, targeted strategies are crucial for promoting the use of clean fuels, particularly for vulnerable populations.

Abstract Public health education (PHE) effectively improves migrants' healthcare-seeking behavior (HSB). This study leverages data from the 2017 China Migrant Dynamic Survey (CMDS) to explore the association between PHE and HSB, employing the Probit model and Propensity Score Matching method. The results showed that: (1) PHE can significantly contribute to migrants’ attitudes(β=0.020, p<0.01), preferred primary(β=0.032, p<0.01), and local medical institutions (β=0.010, p<0.05) toward health care; (2) In healthcare attitudes and local medical institutions preferences, the impact is strongest among older adults, rural residents, higher education levels, women, and lower-income groups. HSB more effectively influences primary medical institution preference among older adults, urban residents, higher education levels, men, and lower-income groups. (3) Mechanism testing confirms that PHE influences the healthcare attitude (β=0.064, p<0.01; Z=5.627, p<0.01) and prioritizing primary medical institution (β=0.150, p<0.01; Z=8.526, p<0.01) of migrants through health literacy; (4) Regarding healthcare attitudes and preferences for primary medical institutions, New Rural Cooperative Medical Scheme (NRCMS) shows a positive moderating effect (β=0.008, p<0.01), whereas BMISUE has a contrary (β=-0.007, p<0.01; β=-0.025, p<0.01). However, when it comes to preferring local medical treatment, BMISUE exhibits a negative moderating effect (β=0.001, p<0.05). Based on the research, the government should enhance PHE, boost NRCMS participation and reimbursement, and target specific groups, such as middle-aged, lower-educated, and high-income individuals, improve healthcare utilization, promote preferred primary medical institutions, and reduce cross-regional treatment.

为推动国家医保谈判药品政策落地,2021年10月,南京市医保局和卫健委联合发布《关于建立完善国家医保谈判药品"双通道"管理机制的实施方案》(宁医发[2021]70号),旨在通过定点医疗机构和定点零售药店两个渠道满足临床和患者用药需求.政策实施以来,医保局作为政策的制定者和执行者,医疗机构作为国谈药配备使用的首要责任主体,定点零售药店作为国谈药供应补充保障的重要主体,共同保障国谈药"双通道"落地.但也存在一些亟待解决的问题,如"双通道"管理药品范围界定模糊、配套政策贯彻落实不到位、定点零售药店尚未建立动态管理机制、异地就医直接结算不畅通、罕见病用药供应保障不足等.对此,建议相关主体多方协同以推进国谈药"双通道"顺利落地,如明确界定"双通道"管理药品范围、提升医院配备"双通道"药品动力、建立"双通道"定点零售药店动态管理机制、畅通异地就医直接结算、提升罕见病用药供应保障水平等.

This study worked to investigate the effect of household polluting fuel use (HPFU), as an indicator of household air pollution exposure, on frailty among older adults in rural China. Additionally, this study aimed to examine the moderating effect of healthy lifestyle behaviors on the aforementioned association. This study employed cross-sectional data from the 2018 Chinese Longitudinal Healthy Longevity Survey, which conducted nationally representative sampling of older adults from 23 provinces in mainland China. The frailty index was calculated using 38 baseline variables that assessed health deficits through questionnaire surveys and health examinations. A total of 4535 older adults aged 65 years and above were included in our study, among whom, 1780 reported using polluting fuels as their primary household cooking fuel. The results of regression analyses and multiple robustness checks indicated a significant increase in the frailty index due to HPFU. This environmental health threat was more profound among women, illiterate individuals, and low-economic-status groups. Moreover, healthy dietary and social activities had significant moderating effects on the association between HPFU and frailty. HPFU can be regarded as a risk factor for frailty among older adults in rural China, with its effects exhibiting socio-economic disparities. The adoption of healthy lifestyle behaviors can alleviate the frailty associated with HPFU. Our findings underscore the significance of using clean fuels and improving household air quality for healthy aging in rural China.

目的:通过分析并借鉴国际养老机构疫情防控经验,完善我国养老机构疫情防控体系.方法:在PubMed、Web of Science和Embase进行系统检索,使用质性元分析法通过规范化的文献选取和整合编码技术聚合多篇养老机构疫情防控研究的共性结论,对疫情防控体系形成系统性认识.结果:基于 32 个研究,系统分析了养老机构内外联动的疫情防控体系.内部防控体系包括高层管理者和医护人员组成的疫情防控组织体系、感染监控与临床护理等疫情防控运行体系、资源协调与员工培训等疫情防控保障体系.外部联动体系包括养老机构与流动多学科团队协作的线下联动体系、多主体的线上联动体系、基于网络平台的线下线上协同联动体系.结论:养老机构应从组织、运行、保障层面建立系统的内部疫情防控体系,同时立足多主体线下线上联动,建立外部联动体系.本研究丰富和深化理论上对养老机构疫情防控体系的认识,对于推动我国养老机构的疫情防控实践有现实意义.

This study aimed to explore the effects of community-based home health care (HHC) on the physical and mental health of older adults with chronic diseases in China. The study data were retrieved from the 2018 wave of the Chinese Longitudinal Healthy Longevity Survey. Ordinary least squares regression model was used to assess the effects of community-based HHC on the health. Entropy balancing was used to test the robustness of the regression results. A total of 5571 older adults with chronic diseases were included. The results showed that older adults who had received community-based HHC reported significantly better self-rated health (coefficient = 0.051, 95

远程医疗伦理困境及其产生的原因主要是传统伦理评价中的理性缺陷,以及远程医疗利益相关者之间沟通的不确定性、异质性与对话普遍诉求难题.解决这一伦理困境需要运用对话伦理学的对话理性优势以克服传统伦理评价缺陷,以对话不断解决对话认识的开放性与异质性问题,并付诸远程医疗利益相关者之间不断进行的对话实践,最终达成伦理上的完善,由此建构一种不断在对话中进行且未来可行的动态多元远程医疗评价体系.

Health capital investment is a component of human capital and can increase labor productivity in the economy. This study analyzes the returns on health investment based on the perspective of medical insurance. China's basic medical insurance system provides a suitable institutional setting, which comprises three schemes: Urban Employee Basic Medical Insurance, Urban Resident Basic Medical Insurance, and New Rural Cooperative Medical Scheme. Using the China Health and Retirement Longitudinal Study and various econometric models, we find that medical insurance significantly impacts health outcomes of Chinese population aged 45 years and more. The result differs by the types of medical insurance, health indicators, and age groups. Furthermore, the convenience of obtaining medical insurance benefits, rarely mentioned in academic literature, is a significant factor affecting population health. From the perspective of health capital investment, investment in medical insurance must target younger groups.

运用CHARLS 2011、2013、2015年三期数据,采用双重差分模型和准自然实验框架,分析城乡居民大病保险制度对中老年居民医疗服务利用和健康的影响及其作用机制,并从城乡和收入两个角度对制度实施效应的异质性进行探究.研究表明:大病保险制度实施能够显著促进中老年居民住院医疗服务及健康,增加中老年居民住院概率1.03％,提高住院次数0.022次,提高住院总费用10.4个百分点,总体健康水平提高0.023个单位;制度实施主要促进了农村和中等收入群体的住院医疗服务利用和健康水平的改善,对低收入人群住院医疗服务影响有限,且对城镇居民和高收入群体的影响并不显著;作用机制分析显示大病保险制度实施通过提高居民医疗服务利用进而起到改善其健康水平的作用.研究表明大病保险制度对中老年居民的住院服务利用和健康起到积极作用,但对于低收入群体的效应仍有待进一步改善.