BackgroundTo curb the growth of medical expenses, the Chinese government has implemented the medical insurance payment reform based on Diagnosis-Related Groups (DRG). This study evaluates the impact of the DRG policy on hospitalization costs, length of stay, and 30-day readmission rates for patients with fractures and intervertebral disc herniation.MethodsHospitalization settlement records for patients with fractures and intervertebral disc herniation from a tertiary hospital in a city in eastern China between 2016 and 2025 were selected. An Interrupted Time Series (ITS) analysis was employed, with January 2020 designated as the intervention point.ResultsFollowing the implementation of the DRG policy, the total hospitalization costs accelerated from a monthly decrease of 0.12% to a monthly decrease of 1.03% (p < 0.001). Specifically, costs for the medical insurance group accelerated from a monthly decrease of 0.32 to 0.96% (p < 0.01), while the self-pay group shifted from no significant pre-reform trend to a monthly decrease of 1.18% (p < 0.001). Western medicine expenses reversed from a pre-reform monthly increase of 0.49% to a monthly decrease of 1.31% (p < 0.001). In contrast, Traditional Chinese Medicine (TCM) diagnosis and treatment fees shifted from a monthly decrease of 2.72% to a monthly increase of 1.92% (p < 0.01). The rate of decline in length of stay slowed from a monthly reduction of 4.23 to 2.80%, but no statistically significant change was observed (p > 0.05). For the medical insurance group, the decrease slowed significantly from 4.83 to 1.61% per month (p < 0.01), whereas for the self-pay group, the decrease accelerated from 2.51 to 4.94% per month (p > 0.05). No statistically significant change was observed in the 30-day readmission rate before and after the reform (p > 0.05).ConclusionDRG effectively controlled hospitalization and boosted TCM use without hurting quality. But length of stay kept falling with slower decline, especially in insured patients, showing heterogeneous effects. Policymakers should target payment types to improve equity and effectiveness. Sensitivity and placebo analyses further supported these findings.

Background: Chronic Obstructive Pulmonary Disease (COPD) poses a substantial publichealth challenge in China owing to its increasing prevalence and substantial economicburden. In response, the diagnosis-intervention packet (DIP) payment reform was imple-mented to control healthcare costs and enhance service efficiency. Methods: To evaluate theeffect of the DIP reform on medical costs, hospitalization days, and individual out-of-pocketpayments for COPD inpatients in M City, a pilot city in central China, we conducted aninterrupted time series (ITS) analysis using monthly reimbursement records from January2020 to December 2023. The study included 84,410 hospitalized patients from a city-widedatabase of 3,241,233 inpatient records with COPD who met the inclusion criteria. Theanalysis focused on the total healthcare costs, length of stay, and individual out-of-pocketcosts. Results: The DIP reform resulted in a 3.7% reduction (95% CI: 0.9% to 6.5%) in thetotal hospitalization costs in the first month post-reform, with a sustained monthly declineof 0.8% (95% CI: 0.5% to 1.1%). The length of stay decreased from 9.53 (95% CI: 9.31 to 9.75)to 8.74 days (95% CI: 8.62 to 8.86). Conversely, the proportion of out-of-pocket paymentsrelative to total costs increased. Conclusions: While the DIP reform effectively reducedhospitalization costs and days, it led to an increase in individual out-of-pocket payments.Future research should focus on optimizing payment rules, enhancing the supervision ofmedical services, and refining health insurance policies to achieve the reform's objectivesbetter and alleviate the financial burden on patients.

BackgroundIn order to regulate the surging medical spending, the Chinese government conducted a reform of medical insurance payment directed to regional global budgets and Diagnosis-Intervention Packet (DIP) system.MethodsAn interrupted time series analysis was conducted using monthly medical insurance claims data from 45,900 T2DM inpatients in S City, China between January 2020 and December 2023, comparing outcomes before and after the January 2021 DIP reform implementation across insurance types (UEBMI vs. URRBMI) and hospital types (TCM vs. general hospitals).ResultsThe DIP reform significantly reduced total hospitalization costs and length of stay overall, but divergently affected out-of-pocket ratios—decreasing them for UEBMI enrollees while significantly increasing them for URRBMI patients and TCM hospital patients—indicating worsened financial equity for vulnerable subgroups despite improved cost.ConclusionWhile the DIP payment reform effectively reduced hospitalization costs and length of stay for T2DM patients, it simultaneously exacerbated out-of-pocket inequities across insurance schemes and hospital types, indicating that future payment policies must integrate cost containment with health equity.

BACKGROUND:Chinese government has been adjusting its strategies in response to rapid domestic and international changes to devise effective health policies and enhance public health. However, with the rapid socio-economic development and the COVID-19 outbreak, many researchers have identified issues of inefficiency and uneven distribution in health resource allocation within China. Therefore, how to scientifically allocate and efficiently use Chinese health resources has become an urgent issue. METHODS:The super-efficiency SBM model and global Malmquist model were used to measure and dynamically monitor the health resource allocation efficiency of 31 provinces in China from 2008 to 2020. Moran's I was applied to test the spatial autocorrelation of the efficiency, and the spatial Dubin model was constructed to analyze influencing factors. All data were collected from the China Health Statistical Yearbook and China Statistical Yearbook from 2008 to 2020. RESULTS:The super-efficiency SBM model revealed an average health resource allocation efficiency score of 0.632. The average Malmquist productivity index for the same period was 1.090, indicating a generally positive growth. Moran's I test showed a notable spatial autocorrelation in efficiency distribution. And the regression results of the spatial Dubin model showed that the efficiency was affected by the dependency ratio, illiteracy rate, per capita disposable income, per capita public health budget expenditure, number of medical insurance participants, and the balance of medical insurance fund revenue and expenditure. DISCUSSIONS:The results revealed that China's health resource allocation exhibited low efficiency and regional disparities, primarily driven by uneven regional development. From 2008 to 2020, overall productivity increased by 9%, which were predominantly attributable to technological advancements. Under conditions of strong spatial autocorrelation, the efficiency of health resource allocation was shaped by multiple factors operating through distinct spatial channels. CONCLUSION:Given the challenges of health resource allocation efficiency in China, it is vital to implement targeted strategies. These include strengthening policy support for inefficiency regions, relying on technological progress and scientific management, fostering cross-regional collaboration to leverage spatial effects, and considering multiple factors for rational health resource allocation to ensure the sustainability of the health services.

Objective:In the context of medical insurance payment reform, this study aims to evaluate the impact of the Diagnosis-Intervention Packet (DIP) payment policy on hospitalization costs across different types and levels of hospitals. In order to provide empirical evidence to support the high-quality collaboration between hospitals and medical insurance, while reducing the economic burden on patients. Method:Our study collected medical insurance reimbursement data from January 2019 to December 2022 in S city, covering 2,467,746 patients. Based on the intervention time point of the DIP reform implementation in 2021, an interrupted time series analysis was conducted on a monthly basis to compare the trend changes in hospitalization costs between traditional Chinese medicine hospitals (TCMHs) and general hospitals (GHs), as well as to examine the differences in impacts across hospitals of various levels. Results:Firstly, our study found that tertiary hospitals had the highest average hospitalization costs ( Y TCMH 3 = 6170.33 , Y GH 3 = 12181.32 ), followed by secondary hospitals ( Y TCMH 2 = 4617.47 , Y GH 2 = 5344.60 ), and primary hospitals, which had the lowest costs ( Y TCMH 1 = 2490.93 , Y GH 1 = 1916.57 ). Secondly, after the implementation of the DIP reform, the average hospitalization costs immediately decreased in both TCMHs and GHs, with a more significant reduction observed in GHs ( β 2 - TCMH = - 0.023, p = 0.059, β 2 - GH = - 0.016, p = 0.039). Thirdly, when further categorized by hospital level, we found that the instantaneous effect of the reform on average hospitalization costs was most significant in primary TCMHs ( β 2 - TCMH 1 = - 0.080, p = 0.008), followed by tertiary TCMHs ( β 2 - TCMH 3 = - 0.033, p = 0.012), while the effect in secondary TCMHs was not significant ( β 2 - TCMH 2 = - 0.024, p = 0.087). In GHs, the most significant instantaneous effect was observed in tertiary hospitals ( β 2 - GH 3 = - 0.046, p = 0.004), while no significant changes were observed in secondary and primary hospitals ( β 2 - GH 2 = - 0.026, p = 0.077, β 2 - GH 1 = - 0.022, p = 0.201). In terms of the long-term effects of the DIP reform, both TCMHs and GHs showed significant changes in average hospitalization costs, with a larger reduction observed in GHs, indicating better reform outcomes ( β 3 - TCMH = - 0.006, p < 0.001, β 3 - GH = - 0.010, p < 0.001). Conclusion:The government should adjust policies in a differentiated and refined manner based on the type and level of hospitals to achieve the goals of controlling medical costs and improving the incentive mechanisms. Meanwhile, optimizing the healthcare service structure can improve quality and efficiency, as well as better meet patient needs.

Background: The Diagnosis-Intervention Packet Payment (DIP) system is regarded as a localized cost-control strategy in China. It aims to improve healthcare efficiency, curb the growth of medical expenses, and optimize the allocation of medical resources among diverse groups. Objective: This study aims to assess the impact of DIP payment reforms on differential changes in patients' hospitalization expense and to explore the degree of concentration of hospitalization expense for patients with different insurance schemes undergoing treatment for typical diseases, with a view to providing policy recommendations for improving the medical insurance system. Methods: Data were collected from patients with cerebral infarction (CI) and coronary atherosclerotic heart disease (CAD) treated at primary, secondary, and tertiary hospitals in S City of China, from 2020 to 2023. Patients were classified into the Urban Employees' Basic Medical Insurance (UEBMI) group and the Urban and Rural Residents' Medical Insurance (URRMI) group based on two health insurance schemes. Propensity Score Matching (PSM) was employed to ensure a balanced sample. The changes and trends in hospitalization expenses across different groups were analyzed using the interquartile Range (IQR), standard deviation (SD), and concentration index. Results: Post-DIP reform, hospitalization expenses for patients with different diseases at various levels of hospitals have decreased annually. Regarding expenses variation, the standard deviation (SD) of hospitalization expenses for both UEBMI and URRMI exhibited a downward trend, with a decrease in the double-difference value each year. From the perspective of expenses concentration, all concentration indices were less than 0 (statistically significant, p < 0.01), indicating a higher concentration in hospitalization expenses for UEBMI. Conclusion: The DIP reform can effectively increase the concentration of hospitalization expenses, reduce the variability of changes in hospitalization expenses for both UEBMI and URRMI, and drive medical practices toward standardization and consistency. However, the degree of this expense reduction varies among the hospitals at all levels.

Background: To control the growth of healthcare costs, the Chinese government introduced a diagnosis-intervention package (DIP)-based health insurance payment reform. This study evaluated the impact of the DIP policy on hospitalization costs, Length of Hospital Stay, and Out-of-Pocket Ratio for patients with coronary heart disease (CHD). Methods: Hospitalization claims data from 2020 to 2023 in City S, central China, were selected and analyzed using interrupted time series (ITS), covering 264 hospitals with January 2022 as the intervention point. Results: After the implementation of DIP, hospitalization costs decreased from 8.81 to 8.57 for employee health insurance (UEBMI) (p < 0.001) and from 8.18 to 7.97 for resident health insurance (URRBMI) (p < 0.001), with even greater decreases for primary and secondary hospitals. The number of days of hospitalization decreased, from 8.82 to 7.78 (p < 0.001) for UEBMI and from 8.24 to 7.46 (p < 0.001) for URRBMI, with the largest decrease in primary hospitals. As for out-of-pocket ratio, the URRBMI increased from 20.71 to 25.2% (p < 0.001), and the UEBMI decreased from 28.67 to 23.57% (p < 0.001). Conclusion: The DIP policy was effective in controlling hospitalization costs and days, especially in primary and secondary hospitals. However, the out-of-pocket ratio of URRBMI increased and UEBMI decreased, suggesting differential impact of the policy. It is recommended that policy makers pay attention to differences in health insurance types and hospital grades to optimize the fairness and effectiveness of the policy.

As global healthcare costs continue to rise, concerns about health equity have become increasingly prominent. In response, China introduced the Diagnosis-Intervention Packet (DIP) reform in 2021 to optimize healthcare resource allocation and control costs. While the reform has been widely discussed in terms of its overall cost-control effects, its heterogeneous impact on low-income populations, especially across different hospital tiers, remains unclear. This study aims to fill this gap by examining the differentiated impact of the DIP reform on low-income patients' inpatient service utilization. Using multi-stage interrupted time series (ITS) analysis, we analyzed 1.17 million hospitalization records from low-income patients in City S, a pilot city in central China. The study reveals that DIP significantly reduced total hospitalization costs and length of stay (LOS) but led to increased readmission rates, indicating a trade-off between efficiency gains and potential risks to care quality. The reform's effects varied by hospital tier: primary hospitals saw increased demand for non-acute hospitalization due to reduced out-of-pocket (OOP) payments, exposing resource shortages; secondary hospitals balanced cost control and revenue by shortening stays and increasing admission frequency, which raised readmission risks; and tertiary hospitals, treating critically ill patients, enhanced treatment completeness, though multiple hospitalizations were still needed for full recovery. The study introduces a two-dimensional framework- "hospital tier-policy cycle"-demonstrating that differences in service capacity across hospital levels are central to the heterogeneous effects of the DIP reform. These findings suggest that future policies should strengthen primary care resources, introduce quality assurance mechanisms, and consider bundled payment models for critical care. This research contributes valuable insights for optimizing equity in DIP reform and offers implications for similar healthcare payment systems globally.

ObjectiveThis study explored the factors and influence degree of job satisfaction among medical staff in Chinese public hospitals by constructing the optimal discriminant model.MethodsThe participant sample is based on the service volume of 12,405 officially appointed medical staff from different departments of 16 public hospitals for three consecutive years from 2017 to 2019. All medical staff (doctors, nurses, administrative personnel) invited to participate in the survey for the current year will no longer repeat their participation. The importance of all associated factors and the optimal evaluation model has been calculated.ResultsThe overall job satisfaction of medical staff is 25.62%. The most important factors affecting medical staff satisfaction are: Value staff opinions (Q10), Get recognition for your work (Q11), Democracy (Q9), and Performance Evaluation Satisfaction (Q5). The random forest model is the best evaluation model for medical staff satisfaction, and its prediction accuracy is higher than other similar models.ConclusionThe improvement of medical staff job satisfaction is significantly related to the improvement of democracy, recognition of work, and increased employee performance. It has shown that improving these five key variables can maximize the job satisfaction and motivation of medical staff. The random forest model can maximize the accuracy and effectiveness of similar research.

The cost fluctuations associated with chemotherapy, radiotherapy, and immunotherapy, as primary modalities for treating malignant tumors, are closely related to medical decision-making and impose financial burdens on patients. In response to these challenges, China has implemented the Diagnosis-Related Group (DRG) payment system to standardize costs and control expenditures. This study collected hospitalization data from patients with malignant tumors who received chemotherapy, radiotherapy, and immunotherapy at Hospital H from 2018 to 2022. The dataset was segmented into two groups: the intervention group, treated with traditional Chinese medicine (TCM) alongside standard therapies, and the control group, treated with standard therapies alone. Changes and trends in hospitalization costs under the DRG policy were analyzed using propensity-score matching (PSM), standard deviation (SD), interquartile range (IQR), and concentration index (CI). Findings showed a decreasing trend in the standard deviation of hospitalization costs across all treatment modalities. Radiotherapy exhibited the most significant decrease, with costs reducing by 2547.37 CNY in the control group and 7387.35 CNY in the intervention group. Following the DRG implementation, the concentration indexes for chemotherapy and radiotherapy increased, while those for immunotherapy did not exhibit this pattern. Costs were more concentrated in patients who did not receive TCM treatment. In summary, DRG reform positively impacted the cost homogeneity of inpatient treatments for malignant tumors, particularly in the control group not receiving TCM treatment. The effects of DRG reform varied across different treatment modalities. Although short-term fluctuations in hospitalization costs may occur, initial evidence during the study period shows the positive impact of DRG reform on cost homogeneity.

ObjectivesThis study constructed an evaluation index system of Traditional Chinese Medicine (TCM) service capacity of county-level TCM hospitals, investigated the status quo of TCM service capacity of county-level TCM hospitals in Zhejiang Province, aiming to provide suggestions and references for the high-quality development of TCM hospitals in China.MethodsDelphi expert consultation method and analytic hierarchy process were used to construct the comprehensive evaluation index system and its weight. Field investigation method was used to conduct a cross-sectional survey of 71 county-level TCM hospitals in Zhejiang Province, to calculate the scores of each index, and to compare the service capacity of county-level TCM hospitals.ResultsThe evaluation index system includes 6 first-level indicators, 15 ​second-level indicators and 42 third-level indicators. The average score of service capacity of 71 county-level TCM hospitals was 60.73 points, among which the highest score was 80.72 points, and the lowest score was only 33.52 points. There are great differences in TCM service capacity among hospitals.ConclusionsWe have come to the conclusions that the index system can evaluate the service capacity of TCM hospitals effectively. In addition, there are still problems in the development of county-level TCM hospitals in Zhejiang Province, such as insufficient service capacity, great gap of development between regions, and inadequate development of characteristic advantages of TCM. Thus, it is necessary to consolidate the development foundation, pay more attention to the balance of regional development, and improve the service capacity of county-level TCM hospitals.

IntroductionChina is a large agricultural nation with the majority of the population residing in rural areas. The allocation of health resources in rural areas significantly affects the basic rights to life and health for rural residents. Despite the progress made by the Chinese government in improving rural healthcare, there is still room for improvement. This study aims to assess the spatial spillover effects of rural health resource allocation efficiency in China, particularly focusing on township health centers (THCs), and examine the factors influencing this efficiency to provide recommendations to optimize the allocation of health resources in rural China.MethodsThis study analyzed health resource allocation efficiency in Chinese rural areas from 2012 to 2021 by using the super-efficiency SBM model and the global Malmquist model. Additionally, the spatial auto-correlation of THC health resource allocation efficiency was verified through Moran test, and three spatial econometric models were constructed to further analyze the factors influencing efficiency.ResultsThe key findings are: firstly, the average efficiency of health resource allocation in THCs was 0.676, suggesting a generally inefficient allocation of health resources over the decade. Secondly, the average Malmquist productivity index of THCs was 0.968, indicating a downward trend in efficiency with both non-scale and non-technical efficient features. Thirdly, Moran’s Index analysis revealed that efficiency has a significant spatial auto-correlation and most provinces’ values are located in the spatial agglomeration quadrant. Fourthly, the SDM model identified several factors that impact THC health resource allocation efficiency to varying degrees, including the efficiency of total health resource allocation, population density, PGDP, urban unemployment rate, per capita disposable income, per capita healthcare expenditure ratio, public health budget, and passenger traffic volume.DiscussionTo enhance the efficiency of THC healthcare resource allocation in China, the government should not only manage the investment of health resources to align with the actual demand for health services but also make use of the spatial spillover effect of efficiency. This involves focusing on factors such as total healthcare resource allocation efficiency, population density, etc. to effectively enhance the efficiency of health resource allocation and ensure the health of rural residents.

Objective: This study aimed to investigate the health performance of the Urban and Rural Residents Medical Insurance (URRMI) scheme in China and to make practical recommendations and scientific references for its full implementation in China. Methods: This is a panel study that uses data from the China Family Panel Studies from 2018 to 2020, which is separated into treated and control groups each year, utilizing the key approach of propensity score matching and difference-in-difference (PSM-DID). Using 1-to-1 k-nearest neighbor matching, we proportionate the baseline data. Using difference-in-difference model, we examine the mean treatment impact of the outcome variables. Using a 500-time random sample regression model, we validate the robustness of the model estimation. Results: The result was credible after matching, minimizing discrepancies. Good overall performance of self-rated health with an average Hukou status of, respectively, 0.8 and 0.4 in the treated and control group, primarily in rural and urban regions separately. The participation of URRMI significantly impacted self-rated health of residents, with a 0.456-unit improvement probabilities observed (p < 0.1). Additionally, the individuals are categorized into urban and rural, and those with urban hukou had a 0.311 expansion in the probability of having better health status compared to rural hukou (p < 0.05). Other factors, such as age, highest education, annual income, medical expenditure, hospital scale, clinic satisfaction, and napping, also impacted self-rated health. Moreover, elder individuals, higher education levels, and higher medical expenditure having a higher probability of improvement. The study utilized a placebo test to verify the robustness of the URRMI regression. The estimated coefficients showed that basic medical insurance did not significantly improve the health of insured residents under the URRMI scheme. Conclusion: The study demonstrates the crucial role of PSM-DID in determining the influence of URRMI on self-rated health status. It indicates that purchasing in URRMI has a favorable influence on the health of residents, advancing enhanced self-rated health effectiveness. It does, however, reveal geographical disparities in health, with urban dwellers faring far better than those who live in the suburb. Study suggests expanding URRMI coverage, narrowing urban-rural divide, increasing insurance subsidies, reforming laws, and developing effective advertising strategies.

ObjectiveAnalysing and evaluating how efficiently health resources are allocated to county-level Traditional Chinese Medicine (TCM) hospitals in Zhejiang Province, this study aims to provide empirical evidence for improving operational efficiency and optimising resource allocation in these hospitals.Design and settingThe study employed a three-stage Data Envelopment Analysis (DEA) model to assess efficiency, using data from 68 county-level TCM hospitals. Four input and five output variables related to TCM services were selected for the analysis.ResultsThe first-stage DEA results indicated that in 2022, the technical efficiency (TE) of TCM hospitals in Zhejiang Province was 0.788, the pure technical efficiency (PTE) was 0.876 and the scale efficiency (SE) was 0.903. The classification of hospitals into four groups based on the bed size showed statistically significant differences in returns to scale (p<0.001). The Stochastic Frontier Analysis regression results were significant at the 1% level across four regressions, showing that environmental variables such as per capita GDP, population density and the number of hospitals impacted efficiency. In the third stage DEA, after adjusting the input variables, the TE, PTE and SE improved to 0.809, 0.833 and 0.917, respectively. The adjusted mean TE rankings by region were West (0.860) > East (0.844) > South (0.805) > North (0.796) > Central (0.731).ConclusionThere is an imbalance between the inputs and outputs of county-level TCM hospitals. Each region must consider factors such as the local economy, population and medical service levels, along with the specific development characteristics of hospitals, to reasonably determine the scale of county-level TCM hospital construction. Emphasis should be placed on improving hospital management and technical capabilities, coordinating regional development, promoting the rational allocation and efficient use of TCM resources and enhancing the efficiency of resource allocation in county-level TCM hospitals.

Abstract Background: The Chinese government has been adapting to rapid changes in the domestic and international situation in order to formulate appropriate health policies. However, under the socioeconomic impact of the COVID-19 pandemic, China’s medical and health resource allocation still has problems in terms of insufficiency and uneven distribution. Therefore, how to scientifically allocate and efficiently use medical and health resources has become an urgent issue. Methods: The super-efficiency slack-based measure model and the global Malmquist model were used to measure the efficiency of medical and health resource allocation in 31 provinces in China from 2008 to 2020. Moran’s I was used to test the spatial correlation of the efficiency. A spatial Dubin model was constructed to analyze influencing factors. All data were collected from the China Health Statistics Yearbook and China Statistics Yearbook from 2008 to 2020. Results: The efficiency of medical and health resource allocation calculated by the super-efficiency slack-based measure model showed that the average score was 0.632. The average Malmquist productivity index of the efficiency of medical and health resource allocation of 31 provinces in China from 2008 to 2020 was 1.0897, which was generally positive. The Moran’s I test results showed that the efficiency had a significant spatial positive correlation in the spatial distribution. The regression results of the spatial Dubin model showed that the efficiency was affected by the dependency ratio, the illiteracy rate, the per capita disposable income, the per capita public health budget expenditure, the number of medical insurance participants, and the balance of medical insurance fund revenue and expenditure. Discussion: In view of the problems revealed in the efficiency of medical and health resource allocation from 2008 to 2020, Chinese provinces should fully consider the impacts of the dependency ratio, the illiteracy rate, the per capita disposable income, the per capita public health budget expenditure, the number of medical insurance participants, and the balance of medical insurance fund revenue and expenditure. Local governments should scientifically formulate their own health planning by giving full attention to the radiation outcomes of the spatial spillover effect on the efficiency of medical and health resource allocation.

Objective The aim of this study is to explore the effect of commercial health insurance on the health performance of middle-aged and elderly people in China,in order to provide a scientific reference for improving the multi-level medical security system and further playing the role of commercial health insurance.Methods This paper used data of the 2018 China Health and Retirement Longitudinal Study(CHARLS)and employed the elderly dependency ratio as an instrumental variable.The effect of purchasing commercial health insurance on the health performance of middle-aged and elderly people was measured by using instrumental variable models and two-stage least squares regression models.Results Among the 17,651 samples included in the analysis,the average self-rated health score was 3.056,indicating an overall"good"level of health.The instrumental variable of the elderly dependency ratio was effective in addressing the endogenous issue between commercial health insurance and self-rated health status.After incorporating the instrumental variable,the effect of commercial health insurance on self-rated health status increased from 0.210 units to 7.805 units.Individual factors such as gender,age,educational background,marital status,social insurance,and income also had an impact on self-rated health status.Conclusions The purchase of commercial health insurance can improve the health performance of middle-aged and elderly people,and can also further alleviate the working population's economic burden caused by disease,serving as a supplement to health policy.However,there is still a need to increase the coverage rate of commercial health insurance for middle-aged and elderly people,and to improve the healthcare insurance system.

Background: The correlation between residents’ health level and social support has been confirmed by most studies, most of which were conducted in elderly adults. Less attention has been paid to whether social support affects the health status of rural residents. Improving the health level of rural residents has been a research priority by the government, society, and scholars. This study aimed to explore the impact of different types of social support on the health level of rural residents in China, and provide theoretical support and practical suggestions for promoting the health level of rural residents.Methods: Based on the data of the 2020 China Family Panel Studies, 5185 rural residents in China were selected to measure the impact of different types of social support on the health of rural residents using residents’ self-rated health status, formal and informal social support variables, and residents’ demographic-related characteristic factors.Results: Among the 5185 rural residents, 1351 (26.06%) had formal social support, and 3834 (73.94%) did not. There were 2825 (54.48%) residents with informal social support and 2360 (45.52%) without informal social support. The unmatched results showed no significant effect on the health status of rural residents with or without formal social support (P > 0.05). The health level of rural residents with informal social support was 29.74% higher than that of rural residents without informal social support. After matching the propensity scores of demographic factors, formal social support had no significant effect on the health of rural residents (P > 0.05), and the influence of informal social support on the health of rural residents was significant (P < 0.01).Conclusions: The health level of rural residents is affected by the presence or absence of informal social support rather than by the presence or absence of formal social support, and rural residents with informal social support have a higher level of health. When improving the health status of rural residents, the government should focus on increasing the level of informal social support of rural residents to continuously improve the health of rural residents.

目的:分析我国60～69岁居家老年人的生活状况及生活满意度,为提升老年人生活质量和生活满意度提供对策和建议.方法:采用中国社会科学院"2019年中国社会状况综合调查"数据,从中筛选出60～69岁的居家老年人,对他们的基本信息、生活状况和生活满意度进行统计分析;采用多因素logistic回归模型,分析影响居家老年人生活满意度的因素.结果:2278名居家老年人的生活满意度中位数得分为8(6,10)分;多因素logistic回归分析结果显示,婚姻状况、工作状态、养老保险/退休金、上年度家庭收支情况、家庭关系不和、医疗支出大难以承受、家庭收入低日常生活困难、家人无业/失业或工作不稳定是老年人生活满意度的主要影响因素.结论:我国60～69岁居家老年人对生活的满意度总体处于中等偏上水平,建议相关管理部门从建立健全社区养老服务体系、加强普惠性养老服务资源、鼓励多元化供给等方面提升老年人的生活满意度.

Background: A high-risk prevention strategy is an effective way to fight against human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). The China AIDS Fund for Non-Governmental Organizations (CAFNGO) was established in 2015 to help social organizations intervene to protect high-risk populations in 176 cities. This study aimed to evaluate the role of social organizations in high-risk population interventions against HIV/AIDS. Methods: This study was based on the CAFNGO program from 2016 to 2020. The collected data included the number and types of social organizations participating in high-risk group interventions and the amount of funds obtained by these organizations each year. We explored the factors influencing the number of newly diagnosed AIDS cases using a spatial econometric model. Furthermore, we evaluated the effectiveness of intervention activities by comparing the percentages of the individuals who initially tested positive, and the individuals who took the confirmatory test, as well as those who retested positive and underwent the treatment. Results: Overall, from 2016 to 2020, the number of social organizations involved in interventions to protect HIV/AIDS high-risk populations increased from 441 to 532, and the invested fund increased from $3.98 to $10.58 million. The number of newly diagnosed cases decreased from 9128 to 8546 during the same period. Although the number of cities with overall spatial correlations decreased, the spatial agglomeration effect persisted in the large cities. City-wise, the number of social organizations (direct effect 19.13), the permanent resident population (direct effect 0.12), GDP per capita (direct effect 17.58; indirect effect - 15.38), and passenger turnover volume (direct effect 5.50; indirect effect - 8.64) were the major factors influencing new positive cases confirmed through the testing interventions performed by the social organizations. The initial positive test rates among high-risk populations were below 5.5%, the retesting rates among those who initially tested positive were above 60%, and the treatment rates among diagnosed cases were above 70%. Conclusions: The spatial effect of social organizations participating in interventions targeting high-risk populations funded by CAFNGO is statistically significant. Nevertheless, despite the achievements of these social organizations in tracking new cases and encouraging treatment, a series of measures should be taken to further optimize the use of CAFNGO. Working data should be updated from social organizations to CAFNGO more frequently by establishing a data monitoring system to help better track newly diagnosed AIDS cases. Multichannel financing should be expanded as well.