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

Objectives The purpose of this study is to investigate the factors influencing the occurrence of medical insurance opportunistic behavior among the public in Northeast China and its importance ranking. Methods Data are from a self-administered anonymous questionnaire survey of participants in Northeast China conducted from January to December 2019. Using a stratified sampling method, a sample of 895 residents aged 18 years or older was selected for the study and analysis. We used a stepwise logistic regression model to analyze the factors influencing the opportunistic behavior of the public within the medical insurance domain and standardized the coefficients of the independent variables in the model to further determine the degree of importance of the relevant influencing factors. Results Opportunistic behavior was found in 34.2% of the participants. The order of importance of the factors influencing participants’ opportunistic behavior were the frequency of occurrence of overmedication by medical practitioners, age, participants’ evaluation of the harm of opportunistic behavior in medical insurance, marital status, participants’ evaluation of the nature of opportunistic behavior in medical insurance, and participants’ evaluation of the prevalence of opportunistic behavior in medical insurance. Conclusion One-third of the participants in northeastern China engage in medical insurance opportunistic behavior. Among them, the frequency of occurrence of overmedication by medical practitioners is the most important factor influencing whether opportunistic behavior occurs.

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

目的:了解全国范围内未参保人群特征以及影响因素,为促进全民医保制定相关政策提供参考依据.方法:利用2019年中国家庭金融调查(CHFS)数据进行分析.对未参保人群特征进行描述性统计分析,并采用logistic回归分析未参保的影响因素.利用多重对应二维图分析未参保人群与影响因素的对应关系.结果:有94.49%的居民参加了社会医疗保险,5.51%的居民未参加任何社会医疗保险.年龄、家庭年收入、婚姻状况、居住地、地理位置、工作性质和个人负债等都影响个人的未参保行为(P＜0.05).多重对应结果显示,未参保与东北、中部、西部地区,初中和小学学历,年收入1～5万以及务农的群体特征联系密切.结论:虽然我国医疗保障覆盖率稳步提升,但仍有一部分群体未参保.为了实现全民医保的目标,国家相关部门应采取相应措施提高居民的参保率.

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

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

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

目的:分析公众医保关心对参与医保基金监管意愿的影响以及政府信任在二者之间的调节效应.方法:在2022年2月～3月间对全国居民进行调查,共纳入634名研究对象.利用二元Logistic回归探究政府信任在公众医保关心及参与医保基金监管间的调节作用.结果:对医保关心及参与医保基金监管意愿呈现正相关(P＜0.001).政府信任负向调节二者之间的关系(β=-0.362,P＜0.05).结论:公众医保关心对参与医保基金监管意愿存在显著正效应;政府信任对医保关心-公众参与医保基金监管意愿之间的关系存在负向调节作用.因此,提升公众对医保的关心,有助于提高公众对参与医保基金监管的意愿.

Mobile Internet use has profoundly affected people's traditional ways of living in the modern era. The elderly are a particular group of individuals. Although older people are less able to learn to use new things, the simplicity of mobile Internet use has lowered the “threshold” of mobile Internet use for older people. As a result, more older people are using mobile Internet and changing their lifestyles, which may impact mental health. This study used the 2018 China Family Panel Studies (CFPS) data. In this study, 7110 older adults aged 60 and above were analyzed. We investigated whether mobile Internet use affects older people's loneliness using generalized linear regression models. Propensity score matching was used to prove the robustness of the findings, which dealt with the endogeneity of sample selection. A moderating effect was used to analyze whether health status could modify the relationship between mobile Internet use on loneliness in older adults. Heterogeneity analysis of mobile Internet use on loneliness among older adults was also conducted. The study found that 20.45% of older people felt lonely 1–2 days per week. In addition, 6.8% felt lonely 3–4 days per week, and 4.94% were lonely 5–7 days per week. A total of 848 elderly individuals used mobile Internet, representing 11.93% of the overall population. The results of generalized linear regression indicated that mobile Internet use negatively influenced loneliness among older people by −0.064. Analysis of the moderating mechanism showed that the coefficient of the moderating relationship between health status on mobile Internet use and loneliness was −0.150. It has been found that mobile Internet use shows some potentials for loneliness reduction among older adults. Health status positively moderated the relationship between mobile Internet use and older adults' loneliness, with mobile Internet use further reducing their loneliness when they were in poor health or better health.

医疗保险立法体系是医疗保险领域法治建设的重要内容.在《"十四五"全民医疗保障规划》的指导下,借鉴英国和德国这两个先行国家的经验以优化和完善我国医疗保险立法体系.英国和德国的医疗保险立法体系总体上体现出层次分明、结构严密、相互协调和分散式立法等特征.以英、德两国为鉴,中国要积极推进统领性法律建设,提升医疗保险领域的法律位阶;在加强国家层级的医疗保险立法开发的同时规范地方层级医疗保险立法;建立医疗保险"上位"与"下位"法律的衔接联动机制;借鉴英、德两国分散立法的优势.

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

目的:对公众医保基金骗保行为进行分析,探讨公众使用医保基金中存在骗保行为的深层次原因,为促进公众合理使用医保基金提供参考.方法:基于头脑风暴、文献分析和专家咨询等方法设计的调查问卷对黑龙江省和山东省的公众进行调查,并结合因子分析法对公众医保基金骗保行为的原因进行研究.结果:经过因子分析,共提取由16个条目组成的3个公因子,分别为公众认知局限影响因子、公众逐利心理因子和医保制度不完善因子,累计方差贡献率为73.596％.结论:公众医保基金骗保行为由多种原因耦合作用下发生.其中公众医保相关知识匮乏、对医保相关知识主动获取的意愿不强是产生骗保行为的关键原因;公众在使用医保基金中存在"逐利心理"是其产生骗保行为的主要促使动机;医保制度不完善是公众使用医保基金"失序"的环境因素.

目的 了解东北三省老年人对养老方式的选择情况,并分析其影响因素,为更快更好地满足养老需求提供有力依据.方法 于2021年9-10月采用多阶段整群随机抽样方法,对东北三省450名老年人展开现场问卷调查,了解其养老方式选择以及经济条件、子女探望、生活与健康状态等情况,并先后应用卡方检验和多元无序logistic回归方程进行单因素和多因素分析.结果 选择家庭养老的人数最多,占45.2％,其次为候鸟式养老,占28.2％,选择机构养老的人数最少,仅占5.9％.居住地、居住方式、文化程度、经济条件、有无医疗保险、生活自理程度、邻里关系、子女探望方式和探望频率均对养老方式的选择产生影响.结论 东北三省老年人对养老方式的选择仍以家庭养老为主,同时对异地养老需求很大,城乡性质与经济条件、健康状态与医疗保障、人际关系与精神需求是其养老方式选择的重要影响因素.据此,应逐步构建和完善异地养老及医养保一体化的养老模式,并注重养老服务中的人文关怀.

BACKGROUND:Several studies have found a negative association between obesity and depression in Chinese middle-aged and elderly, suggesting the existence of "jolly fat". This study aims to investigate whether "jolly fat" is applicable among middle-aged and elderly with different education levels, and to provide a new perspective for depression screening and obesity interventions in middle-aged and older adults. METHODS:10,018 individuals aged 45 years and over in China Family Panel Study (2018) were selected for analysis. A short version of Center for Epidemiological Research Depression Scale was used to assess depression. Body mass index was applied to define obesity status. Subgroup analysis of multiple logistic regression was performed to explore whether the relationship between obesity and depression was influenced by education levels. RESULTS:The prevalence of obesity and depression was 9.02 % and 22.96 % among participants. Obesity reduced the probability of depression in middle-aged and elderly with primary school education or below (OR = 0.71, 95 % CI = 0.56-0.91) while not affecting those with junior high school education or above (OR = 0.80, 95 % CI = 0.57-1.13). LIMITATIONS:The results cannot be interpreted as causality due to the cross-sectional design. Besides, we cannot directly measure the body composition of the participants. CONCLUSIONS:"Jolly fat" existed among middle-aged and elderly with low education, but not in those with junior high school education or above. Health care providers need to monitor the psychological status of low-educated middle-aged and older adults who are seen as needing to lose weight, while the underweight group should be the key target of depression screening.

Purpose: An individual's willingness to report is largely related to whether he or she is a direct victim. This study takes two scenarios of whether medical insurance fraud results in a direct loss of personal benefit and explores the differences in individuals' willingness to report and influencing factors in the two scenarios.Methods: In this study, questionnaires were used and participants were selected from 571 individuals in eastern, central, and western China. Analysis was performed using descriptive statistics and logistic regression models.Results: 51.0% of individuals were willing to report when no direct loss of personal benefit was caused, and conversely, 78.3% of individuals were willing to report when direct loss of personal benefit was caused. The factors influencing the attitude dimension of individuals toward whistleblowing behavior were consistent in the two scenarios. In contrast, there were significant differences among the influences in the perceived behavioral control, consequence perception, and subjective norm dimensions.Conclusion: There were significant differences in the willingness of individuals to report medical insurance fraud and the factors influencing it in both scenarios. The most significantly influencing factor difference was perceived behavioral control, a dimension that had an effect only when it did not result in a direct loss of personal benefit. When an individual's direct interests are at stake, the individual's fear for his or her safety is not a deterrent to his or her willingness to report. And when there is no loss of direct personal benefit, individuals care more about government measures to protect whistleblowers. There are differences in the subjects that influence individuals' willingness to report in the two scenarios. The factors influencing the attitude dimension are the same in both scenarios, and the more supportive the attitude toward the whistleblower, the stronger the individual's willingness to report will be.

Background In recent years, due to the increasing number of cross-regional medical patients, countries around the world have issued a series of policies or regulations to reduce their out-of-pocket burden. In this context, this study intended to explore the impact of the Spatio-temporal characteristics of cross-regional medical treatment on total medical expenses, medical insurance payments, and out-of-pocket expenses of patients with malignant tumors in low-income areas. Methods This study included 54,904 data of cross-provincial medical treatment of malignant tumor patients insured in Heilongjiang Province, China in 2020. Firstly, Microsoft Excel 2019 and ArcGIS 10.2 were applied to conduct a descriptive analysis of the Spatio-temporal characteristics of their cross-provincial medical treatment. Then, binary and multivariate logistic regression models were used to explore the specific impact of economic level and geographical distance of medical regions on total medical expenses, medical insurance payments, and out-of-pocket expenses. Results The number of cross-regional medical patients showed a gradual upward trend from February to December, and fell back in January. They were concentrated in regions with high economic level and short distance from the insured region, where were more likely to form the group with high out-of-pocket expenses (AOR = 3.620, P < 0.001; AOR = 1.882, P < 0.001). While this possibility in middle-distance medical regions were less (AOR = 0.545, P < 0.001). Afterwards, two sensitivity analysis methods showed that the results were robust. Conclusion The number of cross-regional medical patients with malignant tumors in low-income areas is affected by seasonal factors, meanwhile, their total medical expenses, actual medical insurance payment levels, and out-of-pocket expenses are all affected by the economic level and geographical distance of medical regions. And the middle-distance medical regions may be the best choice for patients with planned cross-regional medical treatment. These provide some evidence for policymakers to improve the fairness and sustainability of medical security for cross-regional medical patients and reduce their direct economic burden of disease.

医疗保障基金使用监督管理是深化医疗保障制度改革的重要内容.本文利用多源流理论模型,系统梳理《医疗保障基金使用监督管理条例》的制定过程,分析政策提出的推动因素,探究问题源流、政策源流和政治源流在政策推出过程中发挥的作用,强化政策执行者对医保基金使用监管政策的认知,为整合多元主体,开启全面治理,保证政策的可持续推进,进一步提升我国医保基金使用监管法治建设水平.

目的:从后果感知的视角,探讨公众对骗保造成社会影响的后果感知与其参与医疗保险基金监管意愿的关系,以期提高公众参与医保基金监管的意愿与效率,为优化医保监管协同治理体系提供依据.方法:采用分层抽样和方便抽样,抽取1732名公众作为样本,利用倾向性得分匹配法分析骗保行为的后果感知对公众参与医保基金监管意愿的平均处理效应.结果:81.24％的受访人群对医保基金有监管意愿,认为骗保会对社会产生严重后果的公众对医保基金的监管意愿提高了 9.4％,认为骗保现象扰乱了正常医疗秩序、增加了社会不公平性、加重了国家财政负担的公众对医保基金的监管意愿分别提高了 5.4％、8.3％、8.1％.结论:骗保行为造成的社会影响会明显提升公众参与医保基金监管意愿,有关部门要加强数据信息的及时披露与解读,进一步宣传骗保行为对国家财政负担的危害性;在构建医保监管协同治理体系时考虑将患者群体重点纳入到监管主体中,增强公众的社会认同感,强化公众的社会责任与权利意识,从源头上提升医保基金协同治理效能.

BackgroundObesity among the elderly imposes a significant health and economic burden. The purpose of this study was to measure the obesity prevalence and income-related inequality among older adults in China and to explore the determinants of the inequity.MethodsData were obtained from 4,541 older adults (60 years and older) participating in the China Family Panel Study, 2018. Obesity was defined as body mass index (BMI) ≥28 kg/m2. Normalized concentration index and concentration curve were calculated to measure the income-related inequality. Decomposition analysis was used to measure the contribution of each factor to the overall unfairness.ResultsThe prevalence of obesity among the respondents was 7.99%. The 95% confidence interval for the overall prevalence was 7.20–8.78%. The normalized concentration index of obesity in the elderly was 0.075 (95% confidence interval: 0.047–0.103), indicating that obesity was more concentrated among the rich (p < 0.05). Socioeconomic factors contributed the most to the overall inequality (68.73%). Health behavior factors explained 16.38% of the observed income-related inequality in obesity among the elderly in China.ConclusionsIn 2018, obesity was more concentrated among the elderly with higher incomes in China. The pro-poor income-related inequality was mainly due to the higher socioeconomic status of higher-income older adults. Health behaviors and psychosocial factors could also exacerbate the inequality. To prevent the heavy burden of obesity on the health and finances of older adults, more attention should be paid to those who are financially better off, especially those who smoke and are physically inactive, while extroverted older adults also need to be focused on. For developing countries, concern needs to be given to the obesity of the wealthy elderly as a result of economic development.

目的:探究我国老年群体的抑郁症状及其影响因素,为促进老年人心理健康提供参考.方法:利用中国家庭追踪调查2018年的数据,构建logit模型分析各影响因素对老年人抑郁症状的影响,通过随机森林模型度量各影响因素的重要性.结果:25.00％的老年人存在抑郁症状.女性、无配偶、低学历、农村地区的老年人出现抑郁症状的可能性分别是男性、有配偶、高学历、城镇地区老年人的1.475、1.916、1.379、1.374倍;子女劳动支持与老年人抑郁症状呈负相关,精神支持则是老年人抑郁症状的保护因素;生理健康与医疗服务对老年人的抑郁症状有重要影响.在抑郁症状的影响因素中,排在前3位的是老年人子女个数、所在经济地区和自评健康.结论:老年人抑郁症状存在地区及人群差异,应重点对经济不发达地区、农村、无配偶、学历低、女性老年人给予必要关心和支持;子女给予老年人更多精神支持尤为重要;提升医疗保障水平,促进老年人生理健康对改善其抑郁症状有显著作用.