Association between social health insurance and choice of hospitals among internal migrants in China: a national cross-sectional study.
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ABSTRACT:
SUBMITTER: Wang H
PROVIDER: S-EPMC5829819 | biostudies-other | 2018 Feb
REPOSITORIES: biostudies-other
Publications
Association between social health insurance and choice of hospitals among internal migrants in China: a national cross-sectional study.
Wang Haiqin H Zhang Donglan D Hou Zhiying Z Yan Fei F Hou Zhiyuan Z
BMJ open 20180210 2
<h4>Objectives</h4>There is a tendency to pursue higher-level hospitalisation services in China, especially for internal migrants. This study aims to investigate the choices of hospitalisation services among internal migrants, and evaluate the association between social health insurance and hospitalisation choices.<h4>Methods</h4>Data were from a 2014 nationally representative cross-sectional sample of internal migrants aged 15-59 years in China. Descriptive analyses were used to perform the dis ...[more]
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| S-EPMC7819672 | biostudies-literature
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Project description:Internal migrants (IMs) are a large, vulnerable population in China and are mostly driven by national economic reform. IMs who were born before and after 1980, when the general social and economic reform began to appear in China, are considered to be two separate generations. The generational differences in mental health across IMs remain undocumented. In this study, the intergenerational disparity in IMs' mental health, using data from a national cross-sectional study, was assessed. Cross-sectional data from the "National Internal Migrant Dynamic Monitoring Survey 2014" were used. IMs were divided into the "old" or "new" generation, based on their date of birth (before 1980 vs. from 1980 onwards). Mental health includes psychological distress, which was measured using the Kessler Screening Scale for Psychological Distress (K6), and perceived stress, which was measured with the Perceived Stress Scales (PSS-4). Two-level Generalized Linear Mixed Models were performed so as to assess the generation gap and associated factors of each group's mental health. IM demographics, migration characteristics, and social integration indicators were controlled for when assessing the intergenerational disparity in mental health. A total of 15,999 IMs from eight different cities participated in the survey. New generation migrants accounted for 61.5% (9838/15,999) of the total sample. After controlling for participants' characteristics, new generation migrants had higher psychological distress scores (βad = 0.084, 95% CI: (0.026,0.193) and higher perceived stress scores (βad = 0.118, 95% CI: 0.029, 0.207) than the older generation. For both generations, factors associated with good mental health included high levels of social integration, personal autonomy, and life satisfaction, as well as self-rated good physical health. For the new generation, the mental health of urban-to-urban IMs (βad = 0.201, 95%CI: 0.009, 0.410) for the K6, βad = 0.241, 95% CI: 0.073, 0.409 for the PSS-4), IMs with a longer migration duration (βad = 0.002, 95% CI: (0.000, 0.003) for the PSS-4) and IMs with a higher annual income (βad = 0.124, 95% CI: (0.029, 0.218) for the K6) was significantly poorer than their counterparts. New-generation migrants' mental health is worse compared to older IMs. An array of services for addressing these generation-specific needs may facilitate the promotion of mental health among IMs in China.
| S-EPMC6678572 | biostudies-literature
Project description:BACKGROUND:Patients transferred between hospitals are at high risk of adverse events and mortality. The relationship between insurance status, transfer practices, and outcomes has not been definitively characterized. OBJECTIVE:To identify the association between insurance coverage and mortality of patients transferred between hospitals. DESIGN:We conducted a single-institution observational study, and validated results using a national administrative database of inter-hospital transfers. SETTING:Three ICUs at an academic tertiary care center validated by a nationally representative sample of inter-hospital transfers. PATIENTS:The single-institution analysis included 652 consecutive patients transferred from 57 hospitals between 2011 and 2012. The administrative database included 353,018 patients transferred between 437 hospitals. MEASUREMENTS:Adjusted inpatient mortality and 24-h mortality, stratified by insurance status. RESULTS:Of 652 consecutive transfers to three ICUs, we observed that uninsured patients had higher adjusted inpatient mortality (OR 2.67, p?=?0.021) when controlling for age, race, gender, Apache-II, and whether the patient was transferred from an ED. Uninsured were more likely to be transferred from ED (OR 2.3, p?=?0.026), and earlier in their hospital course (3.9 vs 2.0 days, p?=?0.002). Using an administrative dataset, we validated these observations, finding that the uninsured had higher adjusted inpatient mortality (OR 1.24, 95% CI 1.13-1.36, p?<?0.001) and higher mortality within 24 h (OR 1.33 95% CI 1.11-1.60, p?<?0.002). The increase in mortality was independent of patient demographics, referral patterns, or diagnoses. LIMITATIONS:This is an observational study where transfer appropriateness cannot be directly assessed. CONCLUSIONS:Uninsured patients are more likely to be transferred from an ED and have higher mortality. These data suggest factors that drive inter-hospital transfer of uninsured patients have the potential to exacerbate outcome disparities.
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