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.

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.

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.

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.

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.

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".