Abstract Background Annually, nearly 2 million hip, knee, and spinal inpatient surgeries are performed in Canada and the US for osteoarthritis (OA), costing over $37 billion in hospital expenditures. However, 15-30% of patients experience limited or no improvement, resulting in poor value for money. This study evaluated the one-year cost-utility of joint and spine procedures for OA by comparing non-responders to responders, considering various responder definitions. Methods Individual micro-costing data were collected for 1,175 elective hip, knee, and spine patients enrolled in the Longitudinal Evaluation in the Arthritis Program – Osteoarthritis (LEAP-OA) between 2014 and 2018. Quality-adjusted life years (QALYs) were derived using the SF-6D utility index. One-year incremental cost-utility ratios (ICURs) were calculated from the hospital perspective. Results Responder rates varied by definition, ranging from 78%-94% for hip replacements, 64%-90% for knee replacements, 60%-64% for spine fusions, and 50%-68% for spine decompressions. Corresponding ICURs were: $45,956-$51,773/QALY for responders versus $108,593-$485,762/QALY for non-responders for hip replacements; $54,831-$71,151/QALY for responders versus $200,486-$1,203,596/QALY for non-responders for knee replacements; $65,980-$74,422/QALY for responders versus $262,039-$729,686/QALY for non-responders for spine fusions; and $29,947-$42,168/QALY for responders versus $63,195-$662,586/QALY for non-responders for spine decompressions. Conclusions While surgical response rates were highly dependent on the responder definition, ICURs for non-responders were significantly higher than those for responders across all definitions. Beyond the negative impact on patients, there is a compelling economic argument for investment in improved pre-operative identification of patients at risk of surgical non-response. Such efforts could enable more personalized, value-based care pathways and reduce the provision of low-value surgical interventions.

BACKGROUND: The literature has demonstrated that the Diagnostic Related Group (DRG) payment model has been effective in controlling healthcare expenditures. However, there has been a growing concern that an excessive focus on cost reduction could potentially undermine the quality of care provided to patients. This study investigated whether the adoption of the DRG payment model could achieve the dual goal of cost containment and quality enhancement. METHODS: This repeated cross-sectional analysis included 256,438 individuals aged under 18 years with at least one inpatient visit at a Children’s specialized hospital in China from 5 May, 2019 to 31 December, 2022. Individuals with public health insurance coverage form the treatment group, while those without such coverage form the control group. Inpatient expenditures were measured by total inpatient expenditures, inpatient expenditures reimbursed by public health insurance programs, and out-of-pocket inpatient expenditures. Inpatient quality was assessed by readmission rates, length of stay, and recovery rates. The difference-in-difference framework was used to estimate the impacts of adopting the DRG payment model on inpatient expenditures and quality. RESULTS: Before the implementation of the DRG payment model, the total inpatient expenditures for the control group and the treatment group averaged at 9,553 CNY (1,311 USD) and 10,685 CNY (1,466 USD), respectively. The implementation of the DRG payment model led to a reduction of -1,351 CNY (185 USD) in total inpatient expenditures. The reduction in total inpatient expenditures was attained through a decrease of -1,787 CNY (245 USD) in inpatient expenditures reimbursed by public health insurance programs but was offset by an increase of 437 CNY (60 USD) in out-of-pocket inpatient expenditures. In terms of quality outcomes, the implementation of the DRG payment model was associated with a 17%, 3% and 25% decrease in readmission rates, length of stay, and recovery rates, respectively. CONCLUSIONS: After the implementation of the DRG payment model, inpatients incurred significantly lower inpatient expenditures but experienced a decline in their recovery rates. Establishing a monitoring system alongside the implementation of a reward and punishment system is crucial to ensure the quality of care under prospective payment reforms.

OBJECTIVES:The aim of this study was to investigate the longitudinal association between adverse childhood experiences (ACEs) and subjective life expectancy (SLE) among middle-aged and older adults in China, as well as to assess whether socioeconomic position (SEP) and individual health serve as moderators of this association. METHODS:Data were drawn from five waves (2011, 2013, 2015, 2018, and 2020) of the China Health and Retirement Longitudinal Study (CHARLS), which surveyed adults aged 45 years and older. The final analytical sample included 17,407 respondents. Hierarchical linear modeling was conducted to assess the main effects of ACEs on SLE. Interaction terms were included to examine whether this association was moderated by SEP and individual health. RESULTS:There was a significant negative association between the number of ACEs and SLE among middle-aged and older adults. After adjusting for all covariates, each additional ACE was associated with a 0.031 decrease in SLE. Moderation analyses showed that wealth and depression significantly moderated this association. Specifically, individuals in the highest wealth quintile (β  =  0.049, p < .01) and those with depression (β  =  0.021, p < .05) showed a weaker negative association between ACEs and SLE. DISCUSSION:This study underscores the lasting impact of ACEs on SLE in later life. The moderating effects of wealth and depressive symptoms highlight the role of adult socioeconomic and psychological conditions in shaping this association. Reducing ACEs and promoting financial security and mental health in later life may enhance positive expectations of aging and support healthier aging trajectories.

China's "one-child policy" limited many households in China to only one child. This policy had an impact on birth outcomes due to the birth order effects, as firstborn infants typically have lower birth weights. This study aimed to estimate the impact of the "universal two-child policy" on birth weight in China by analyzing individual-level data collected from a major tertiary obstetrics hospital located in Shanghai, the largest metropolitan area in China. Medical records for all births were obtained from a major metropolitan obstetrics hospital between 2013 and 2018. Using difference-in-differences (DID) and quantile DID (QDID) methods while controlling for maternal characteristics and socioeconomic factors, we examined the policy's impact on birth weight. Analyses included stratification by maternal migrant status, age, and delivery mode. Insurance was found to mediate the treatment effect significantly. Analysis of 133 358 live births showed the policy increased birth weight by 21 g, corresponding to approximately 0.04 standard deviations of birth weight in our sample, with effects varying across maternal age groups and residency status. Insurance coverage mediated 41.3% of the total effect on birth weight. The "universal two-child policy" demonstrated beneficial impact on birth weight in China during the study period, particularly affecting older women, Shanghai residents, and those with natural births.

Since children's participation in social health insurance (SHI) in China is voluntary, fluctuations in enrollment or dropout are inevitable. Using data from the two waves of the China Family Panel Study in 2020 and 2022, this study aims to examine these participation dynamics and their impact on children's health service utilization and medical expenses. Specifically, a balanced panel of 1958 children under the age of 15 was constructed, first-difference and difference-in-difference models were employed to assess the factors influencing children's SHI enrollment or dropout, as well as the impact of these changes on health service utilization and medical expenses. Robustness checks were conducted after excluding new enrollees and dropouts separately. Our analysis showed that between 2020 and 2022, 263 children (13.4%) were newly enrolled in SHI, while 135 (6.9%) dropped out. Maternal SHI enrollment increased the likelihood of children's enrollment and reduced the probability of dropout. Children with commercial insurance were 34% less likely to enroll and 58% more likely to dropout. Compared to children with unchanged participation status, newly enrolled children were about 8% more likely to use outpatient services and had 77% higher medical expenses in the past year, whereas no significant changes were observed among those who dropped out. These findings highlight the dynamic nature of children's SHI participation in China and suggest that passive enrollment policies and parental participation could help promote universal coverage. Improving the reimbursement system, particularly for children's outpatient care, is also recommended.

Background:Telemedicine has expanded rapidly in recent years, with particularly pronounced growth following the COVID-19 pandemic. By improving access to care and offering greater flexibility in service delivery, it has become an important component of health care. Although the benefits of telemedicine for patients are well documented, its effects on physician job satisfaction remain insufficiently understood. Given the importance of job satisfaction for workforce stability, physician well-being, and quality of care, further examination of how telemedicine affects physician job satisfaction is warranted. Objective:This study aims to examine the association between telemedicine adoption and physician job satisfaction and to assess whether the physician-patient relationship mediates this association. Methods:A cross-sectional survey was conducted among health care professionals in Xi'an, China. Data were collected between November 7 and December 8, 2023, via an online questionnaire administered using the REDCap (Research Electronic Data Capture; Vanderbilt University) platform. A total of 12,052 physicians were included in the analysis. Physician job satisfaction was measured using a validated 6-point Likert scale. Telemedicine adoption was assessed through self-report. A partial proportional odds model was used to examine the association between telemedicine adoption and job satisfaction, adjusting for a comprehensive set of potential confounders. Additionally, the Karlson-Holm-Breen (KHB) decomposition method was used to explore the mediating role of physician-patient relationship quality in this association. Results:Among 12,052 surveyed physicians, 1642 (13.62%) reported adopting telemedicine, whereas 10,410 (86.38%) did not. After adjusting for demographic characteristics, work-related factors, psychological factors, and physician-patient relationship, telemedicine adoption was significantly associated with higher job satisfaction (odds ratio [OR] 1.17, 95% CI 1.05-1.30). Findings were robust across multiple sensitivity analyses. Subgroup analyses indicated that the association did not vary across physician subgroups, and no significant interaction effects were observed. Mediation analysis revealed a total effect of telemedicine on job satisfaction of 0.33 (95% CI 0.17-0.50), with an indirect effect of 0.10 (95% CI 0.07-0.13) through improved physician-patient relationships, accounting for 30.30% of the total effect. Conclusions:These findings suggest that telemedicine adoption is positively associated with physician job satisfaction, partially mediated by the physician-patient relationship. Policies should promote telemedicine adoption while prioritizing platform designs that support effective physician-patient interactions to enhance provider well-being and care outcomes.

Global climate change poses a significant threat to public health in general and to the health of children, in particular. In response to this threat, many countries have implemented a series of policies to mitigate climate change, among which China's low-carbon city pilot program has attracted widespread attention. This study used longitudinal data drawn from the China Family Panel Studies between 2012 and 2018 to evaluate the impact of China's low-carbon city pilot program on the health of children. A difference-in-differences model was employed to investigate the effects of the policy, with further exploration of potential impact mechanisms. The results demonstrated that China's low-carbon city pilot program substantially improved the health of children by fostering environmental quality and promoting slow mobility (i.e., travel on foot or by bicycle). The study also showed that the impact of the pilot program on the health of children was proportional to their proximity to school. Our findings are significant not only for the expansion of China's pilot policy, but also generally for low- and middle-income countries in their efforts to combat air pollution and understand the scale of its impact on the health of children.

BackgroundAlthough the implementation of a hierarchical medical system (HMS) has been shown to improve the allocation of medical resources and patient health-seeking behaviour, its role in patient's perceived quality of primary care remains unexplored. This study aimed to assess the impact of HMS implementation on rural and urban residents' perceived quality of primary care.MethodsData were obtained from the China Family Panel Study for 2012, 2014, 2016, and 2018. A total of 40,011 rural and 22,482 urban residents were included in the research participants for analysis. This study adopted a quasi-natural experimental design, and the multiple-period difference-in-differences method was used to capture changes in patient's perceived quality of primary care before and after the introduction of HMS.ResultsWe found that HMS implementation declined the perceived quality of primary care by an average of 18% among rural residents (OR: 0.82, 95% CI 0.68-0.99), while there was no significant change among urban residents (OR: 1.13, 95% CI 0.87-1.46). There was a 24% reduction in the perceived quality of primary care (OR: 0.76, 95% CI 0.61-0.96) one year after HMS among rural residents, and there was no statistically significant difference two years after HMS. After HMS implementation, the level of perceived quality of primary care by rural patients with chronic diseases decreased by 72% (OR: 0.28, 95% CI 0.11-0.78).ConclusionsHMS has a limited effect on improving residents' perceived quality of primary care, especially for those living in rural areas. Policymakers are suggested to establish a quality monitoring system that incorporates patient experience as an essential standard to systematically evaluate the impacts of the HMS, with more efforts being put into helping vulnerable groups such as residents under 60 years old and patients with chronic diseases.

BACKGROUND:Acupuncture has been used for pain relief for thousands of years in China, and could be an alternative to drug prophylaxis for migraine prevention. Recently, promising clinical data on acupuncture for migraine prevention has emerged. However, few studies have investigated the economic impact of acupuncture on migraine prevention in Taiwan. METHODS:This study aims to assess the lifetime economic impact of acupuncture in migraine prevention from both a Taiwanese healthcare payer and a societal perspective. An economic cost-benefit evaluation was constructed to compare acupuncture with drug prophylaxis and with no active treatment among patients with episodic migraine and chronic migraine over their lifetime in Taiwan. Epidemiological and clinical inputs were collected from the published literature. Healthcare costs and utilization were based on a retrospective longitudinal analysis of the National Health Insurance Research Database. Productivity loss was derived from a labor economic study. Health gains were valued at 3× average national income. All costs were adjusted to 2023 New Taiwan dollars using the consumer price index in Taiwan and reported as the present value with a discount rate of 3%. RESULTS:From both health system and societal perspectives, acupuncture treatment was associated with significantly more lifetime net economic gains than no active treatment ($1,248,464 and $1,321,994, respectively). Similarly, there was a net lifetime economic gain when acupuncture was compared to drug prophylaxis: $909,571 (health system) and $963,510 (societal), respectively. The economic gain of acupuncture was driven by cost savings from reducing productivity loss and increased value from quality-adjusted life-year gain from fewer migraine days. Lifetime economic gain was greatest among young, female, and chronic migraine patients. CONCLUSION:Acupuncture was associated with greater lifetime net economic gains in migraine prevention compared to no active treatment or drug prophylaxis. Decision-makers in Taiwan should consider increasing reimbursements for acupuncture sessions to encourage its utilization.

It is already a common practice for many health care systems in the world to opt for mixed markets where different types of health care facilities compete against each other to offer high-quality health care to patients. Nevertheless, little is known about the effects of the interaction between hospitals of the same or different type on patient health outcomes. This study estimated the impacts of aggregate and specific types of hospital competition by hospital-type on the quality of inpatient care using an analysis dataset comprising 267,183 individuals from China. The Herfindahl-Hirschman index was employed to measure the degree of hospital competition, with length of stay, readmission and mortality being used to measure the quality of inpatient care. The Poisson and binomial logistic models combined with the instrumental variable approach were constructed to estimate the impacts of hospital competition. This study generated three key findings: 1) aggregate hospital competition reduced the quality of inpatient care, as evidenced by a rise in the odds of readmission and length of stay; 2) intra-type hospital competition reduced the quality of inpatient care and in general had larger effects on reducing the quality of inpatient care than inter-type hospital competition; and 3) the only exception was in the way that competition between private nonprofit hospitals contributed to better quality of inpatient care. The overarching suggestion is that instead of treating competition as a panacea for improving health, a flexible plan tailored to specific conditions is needed.

The health of ethnic minority migrant women is a significant public health concern due to their relative vulnerability in comparison to men. However, there exists a paucity of research on the relationship between ethnic status and the health of migrant women in low-to-middle-income countries, such as China. The objectives of this study is to examine the impact of ethnic status on self-reported health and medical history among migrant women in China. Data were drawn from the 2017 nationally representative China Migrants Dynamic Survey (CMDS), which represents a cross-sectional study of 72,444 female migrants in households across China. An ordered logistic regression model was used to assess the association between self-reported health and ethnic minority status among female migrants, with results reported as odds ratios. A propensity score matching (PSM) method was employed to address the issue of endogeneity in the regressions arising from potential selectivity bias inherent in migration. Analysis of 72,444 female migrants revealed significant disparities in health outcomes between ethnic minority and Han migrants. The odds of ethnic minority migrants reporting “Healthy” were 0.776 times the odds for Han migrants (OR = 0.776, p < 0.001), indicating lower odds of reporting good health for ethnic minority migrants. For selected health conditions over the past year, the odds of ethnic minority migrants reporting these conditions were 1.119 times the odds for Han migrants (OR = 1.119, p < 0.001), suggesting higher odds of experiencing health issues among ethnic minority migrants. Further stratification by migration distance revealed more pronounced disparities for interprovincial migrants. Among interprovincial migrants, the odds of ethnic minority females reporting “Healthy” were 0.653 times the odds for Han females (OR = 0.653, p < 0.001), indicating a larger health gap compared to interprovincial migrants. When stratified by time since migration, ethnic minority females who migrated 11 or more years ago had 0.738 times the odds of reporting “Healthy” compared to Han females (OR = 0.738, p < 0.001). This suggests that health disparities persist even for long-term migrants. Compared to Han migrant women in China, we found that ethnic minority migrant women were more likely to report being in poor health and having a health condition in the past year. In addition, interprovincial migrants and ethnic minority females who migrated more than 11 years ago were more likely to report poor health.

Introduction:China's progress towards achieving Sustainable Development Goals for maternal health is largely attributed to a reduction in maternal mortality rates, driven by increased in-hospital delivery services utilisation. However, recent reductions in the number of obstetric hospitals have raised concerns about compromised access to these services. This study investigates the impact of reduced obstetric hospitals on spatial accessibility and the utilisation of in-hospital delivery services. Methods:Data from 2016 to 2020 were collected from a densely populated province with approximately 83 million residents. Directed Acyclic Graph was applied to identify a minimally sufficient set of confounders, including residential characteristics and transportation-related factors. Multilevel regression models were employed to analyse the causal effects, with sensitivity analysis using fixed effect and quantile regression models. Results:Between 2017 and 2020, the number of obstetric hospitals decreased by 21.3% (from 1209 to 951), leading to a decline in the proportion of pregnant women covered within a 2-hour driving radius (from 97.4% to 97.1%) and an increase in the maximum of shortest driving time within county (from 117.2 to 121.0 min). Multilevel regression models, adjusted for confounders, showed that a 1 percentage point increase in the proportion of pregnant women covered within a 2-hour driving radius was associated with a 13 percentage point (95% CI: 11.4 to 14.7) increase in in-hospital delivery rates, especially in areas with lower coverage and in-hospital delivery rates. Conclusions:The reduction in obstetric hospitals increased travel distances, negatively impacting in-hospital delivery utilisation. Expanding the proportion of pregnant women covered within a 2-hour driving radius may be more effective than reducing the maximum of shortest travel distance within a county when optimising obstetric hospital locations. These findings provide insights for optimising obstetric facility locations in similar low- and middle-income countries. While improving spatial accessibility is important, the potential quality gains from centralising obstetric resources should also be considered.

We estimated the monetary value of informal care from the perspectives of informal caregivers and care recipients in China using the contingent valuation method. Data were obtained from a specially designed survey of 1458 informal caregivers and 972 care recipients. The mean for caregivers' willingness to pay (WTP) for reducing informal care by 1 h per week was CNY32.37 (€4.11), while the mean for willingness to accept (WTA) increasing informal care by 1 h was CNY46.21 (€5.87). The mean for care recipients' WTP (WTA) values for increasing or reducing informal care by 1 h per week were CNY28.74 (€3.65) and CNY44.78 (€5.69), respectively. The WTP and WTA values varied according to care hours and tasks, kinship, and living arrangements, and correlated with the characteristics of both caregivers and care recipients. The WTP and WTA values were also sensitive to a broad range of factors such as health, level of education, employment status, and household income. We highlight the contribution made by informal caregivers to elderly care and recommend the promotion of informal care activities to support and incentivize them.

While previous studies have delved into the formation and development of medical alliances in China, there has been limited focus on investigating inequity in the referral rates and the quality of care received provided to patients with experience of referral and those without under the introduction of medical alliances. This study explored: (1) inequity in the odds of being referred to healthcare institutions within medical alliances; and (2) inequity in the quality of care received between the referred and non-referred patients. This study employed a dataset comprising 440,950 individuals who had at least one outpatient visit at healthcare facilities in Hangzhou city, Zhejiang province, China from January 1, 2020 to September 24, 2021. Quality of outpatient care was measured by the odds of having seven-day all-cause follow-up encounters to any healthcare institution. Binary regression models combined with random effects were constructed to examine inequity in the referral rates and the quality of care received. A set of sensitivity analyses were conducted to check the robustness of study findings. This study has three key findings. First, outpatients’ insurance status, rather than their specific diseases and health conditions, was identified the most significant determinant driving healthcare institutions’ referral decisions. Compared with outpatients covered by public health insurance programs, those without such coverage were more likely to be referred by tertiary hospitals to primary care facilities (coefficient = 1.33; 95

Purpose:The COVID-19 pandemic disrupted healthcare services globally, necessitating innovative care delivery models for non-communicable diseases. Remote healthcare pathways, including telehealth with pharmacy at home (PAH) and deferred care (DC), emerged as potential solutions for managing stable hypertension (HT) and diabetes mellitus (DM) patients. This study aims to estimate the budget impact of implementing PAH and DC compared to usual care (UC) for HT and DM patients in Thai tertiary care hospitals from the government perspective. Methods:A retrospective budget impact analysis was conducted using data from July-December 2021 (COVID-19 period) and July-December 2022 (new normal period). The study included stable patients from 35 tertiary care hospitals in Thailand. Direct medical costs were obtained from administrative databases and national costing studies. Multivariate log-linear regression models estimated conditional costs, controlling for patient characteristics. The analysis compared baseline scenario (UC only) versus alternative scenario (UC+PAH+DC). Sensitivity analyses were performed using 95% confidence intervals and ±20% population variations. Results:The alternative scenario demonstrated lower total budgets in both periods. During COVID-19, total costs were 12.23 versus 12.94 million USD (baseline), yielding 0.71 million USD in savings. In the new normal, costs were 11.93 versus 12.54 million USD (baseline), generating 0.61 million USD in savings. Cost-saving ratios were 0.06 USD and 0.05 USD per dollar allocated during the COVID-19 and new normal periods, respectively. Sensitivity analyses confirmed robustness across parameter variations. Conclusion:PAH and DC pathways represent economically advantageous alternatives, demonstrating cost savings from the government perspective. These findings support implementing remote healthcare delivery in resource-constrained settings, though comprehensive evaluations incorporating societal and patient perspectives are warranted. The findings are based on extrapolation-based results and should be interpreted with caution due to variability in parameters including adoption rates of PAH/DC, unit costs applied, patient numbers, retrospective design, bundled interventions, and the savings ratio.

Purpose:In the context of a rapidly aging population, this study focuses on an important issue concerning long-term care institutions, attempting to explore the relationship between structural characteristics and initial operating budgets. Methods:Data analysis was performed based on 581 long-term care institutions collected from the Shanghai Municipal Civil Affairs Bureau. Statistical analyses were conducted using IBM SPSS Statistics 24.0 with the PROCESS macro (version 3.5) for moderation analyses and Stata 16.0 for endogeneity tests. Results:The analyses revealed a significant U-shaped relationship between the gross floor areas of long-term care institutions and their initial operating budgets. Industry competition negatively moderated the effect of gross floor area on initial operating budget and also significantly exerted a direct negative effect on budgets. In addition, staffing arrangement showed a positive effect on initial operating budgets. Ownership type mattered: publicly constructed institutions had significantly lower initial operating budget compared to privately constructed institutions, whereas publicly operated institutions were associated with significantly higher initial operating budgets than privately operated ones. Institutions with leased property reported lower initial operating budgets than those with self-owned property. Conclusion:This study demonstrates that the initial operating budgets of long-term care institutions are significantly associated with their structural characteristics.

Background Management of non-communicable diseases (NCDs), including hypertension (HT) and diabetes mellitus (DM), was significantly impacted by the COVID-19 pandemic. Many institutions adopted alternative care pathways, e.g. pharmacy at home (PAH), and the deferred care (DC). While PAH has been studied for clinical outcomes, evaluation of the DC remains limited. Consequently, this study evaluates both the clinical and economic outcomes of the PAH and DC as alternatives to usual care.Method A retrospective study was conducted at a tertiary care hospital in Thailand from 1 July 2021, to 30 June 2023. Data from outpatients with HT and DM were classified into PAH, DC, or discharged home with follow-up at the hospital. Clinical outcomes included changes in systolic blood pressure (SBP), diastolic blood pressure (DBP), and fasting blood sugar (FBS), calculated from baseline to follow-up. Economic outcome was the cost of illness (COI) per patient visit. Multivariate multilevel mixed-effects linear regression assessed clinical outcomes, while log-linear regression evaluated economic outcome.Results There were 3,518 patients in the pandemic period and 4,135 patients in the post pandemic period. There was no statistically significant impact of PAH and DC on changes in SBP, DBP, and FBS. However, both care pathways significantly reduced COI during both periods (p < 0.001). During the pandemic period, COI reductions were 32.3% in PAH and 93.5% in DC compared to usual care. Similar trends were observed in the post pandemic period, with COI reductions of 40.0% for PAH and 96.1% for DC.Conclusion PAH and DC pathways did not worsen the clinical outcomes and reduced costs during and following the pandemic. As a result, these two pathways, developed during the COVID-19 pandemic, can be adapted for regular use. When these pathways are integrated into regular use, they can be promptly and fully reactivated in future emergencies.

While studies have reported a positive association between medical insurance and life satisfaction, there is a lack of studies assessing the underlying impact mechanism. The present study aims to investigate the association between Urban and Rural Resident Basic Medical Insurance (URRBMI) and life satisfaction in China, focusing on the mediating role of depression. Using 2018 wave of China Health and Retirement Longitudinal Study, we employed ordered logit regression models to examine the correlation between URRBMI and life satisfaction. Causal mediation analysis was used to analyze the mediating effect of depression on this association. URRBMI participation was related to greater life satisfaction (p < 0.01). Depression mediated the correlation between URRBMI and life satisfaction, and the percentage of total effect mediated was 18.20

BackgroundInternal migrants in China have long been at a disadvantage in terms of access to publicly financed services, as well as the utilization of public health services. The aim of the study was to examine inequities in the use of basic public health services between internal migrants and the local population and estimate the factors that contributed to inequity in use.MethodsThe data for this study was derived from the 2017 wave of the China Migrants Dynamic Survey. Basic public health services utilization was measured by the establishment of health records, health education and chronic disease management. We performed multivariable logistic regressions to examine inequities in the utilization of basic public health services between locals and internal migrants, and Oaxaca-Blinder decomposition was used to explore possible explanations for such inequities between the two groups.ResultsA total of 27,998 cases were included in the analysis. We found that the utilization rates for establishment of health records, health education and chronic disease management among internal migrants were 71.3%, 49.2% and 65.7% lower than their local counterparts, respectively. The decomposition results indicated that the inequities in the establishment of health records between locals and internal migrants were mainly explained by whether people had heard of the National Basic Public Health Services Program (NBPHSP) (17.67%) and by health insurance (5.99%). The contributors to the inequities in health education between locals and internal migrants were community involvement (14.71%) and whether people had heard of the NBPHSP (13.89%). The main factors contributing to the difference in utilization of chronic disease management between the two groups were whether people had heard of the NBPHSP (14.49%) and community involvement (8.43%).ConclusionsTo reduce inequities in the utilization of basic public health services between locals and internal migrants, measures need to be taken to improve knowledge about the basic public health services and to help migrants integrate into the local community.