Willingness to Pay for Antiretroviral Drugs Covered by Medical Insurance among People Living with HIV in 18 Chinese Cities

Objective Antiretroviral drugs covered by medical insurance have been gradually used by people living with human immunodeficiency virus(PLWH)in recent years in China.This study aimed to analyze their willingness to pay(WTP)for antiretroviral drugs.Methods A mixed-methods study design involving a cross-sectional survey and in-depth interviews was conducted.A cross-sectional survey was performed to collect data on the general characteristics,economic status,antiretroviral therapy(ART)status,and WTP of PLWH in 18 Chinese cities from August 2022 to February 2023.Multivariate logistic regression was used to analyze the factors associated with WTP.Representatives of PLWH were interviewed via in-depth interviews,and the data were thematically analyzed.Results Among the 941 PLWH,271(28.80%)were willing to pay for antiretroviral drugs covered by medical insurance.For basic medical insurance for urban and rural residents,PLWH with the following characteristics were more willing to pay:an educational level of senior high school or technical secondary school,having an undergraduate degree or higher,frequently working away from their hometowns,and homosexual transmission.Off-farm workers and recipients of government medical aid were more unwilling to pay.For basic medical insurance for urban employees,PLWH with the following characteristics were more willing to pay:frequently working away from their hometowns;homosexual transmission;personal annual income≥100,000 CNY;and adverse events of antiretroviral drugs.The main reasons for PLWH’s WTP for antiretroviral drugs covered by medical insurance were that the drugs had fewer adverse events and were easier to administer.The main reasons for PLWH’s unwillingness to pay were financial difficulties and privacy concerns.Conclusion Nearly one-third of PLWH are willing to pay for antiretroviral drugs covered by medical insurance.In the future,PLWH with a high WTP can be guided to use these drugs.

The impact of farmers’ assessments of risk management strategies on their adoption willingness

Farmers'assessments of risk management strategies and how the assessments influence their willingness to adopt these strategies are poorly understood.This study conducts a structured survey of 469 farmers to investigate how farmers assess both crop insurance and crop price insurance,the impact of the assessments on their adoption willingness,and in particular,the differences in assessments and adoption willingness between crop insurance and crop price insurance.Empirical results show that farmers’assessments on crop insurance can be significantly improved through communication and experience.The most effective way to improve farmers'assessments on crop price insurance is providing adequate information about the insurance products.Furthermore,farmers'adoption willingness would be enhanced by improved assessment of both crop yield and crop price insurance.This study provides the first empirical evidence that farmers have limited information to assess insurance,which significantly influences their willingness to adopt.This finding reflects that the dissemination of insurance policies,the effectiveness of insurance,and the availability of insurance services significantly enable farmers'ability to assess risk management strategies,which potentially increases farmers'willingness to adopt insurance.

OPTIONS-GAME ANALYSIS FOR FIRM WITH INSURED DEBT

The strategic model for insured bond of firm is a new model which is developed based on options pricing model and game theory. When firm’s bond was insured against bankruptcy, some interesting results about endogenous bankruptcy and optimal capital structure are obtained.

The Model of Participating, Payable, Profitable, Potent Insured Education System-4Ps IESM

In the field of education, there is a need for a financing system which is affordable, yet effective, as well as profitable, and is based on user participation. This need was the main reason the author has designed the model named ＂Insured Education System Model---IESM＂. The IESM is based on the principle that expenditures incurred at each stage of educational attainment should not be burdened upon the person himself/herself. There should be insurance companies willing to cover the educational expenditures of the buyers. The suggested IESM model also creates an auto-control mechanism within the financing system through which insurance companies, educational institutions （buyers）, and households will gain benefits. Furthermore, the IESM will increase the quality of service within the overall educational system, and create employment, as well as eliminating the number of school drop outs. The system will bring a significant decrease in the cost of the service. This study presents the results of the analyses on the data collected by the author on the perception of the proposed Insured Education System Models through surveys conducted in selected schools in Istanbul. The survey is unique in a sense that for the first time in literature such a model is suggested and the perception of relevant stake holders are tested through a questionnaire of 42 questions. The results show that there is an approval rate of more than 50% regarding to the IESM. And the frequency analysis suggests that the IESM is an applicable model.

Household Perceptions, Willingness to Pay, Benefit Package Preferences, Health System Readiness for National Health Insurance Scheme in Southern Nigeria

Introduction: Several Nigerians are completely denied access to adequate health care because of cultural, temporal and financial factors with inequity. Objectives: To ascertain the household perceptions, willingness to pay, benefit package preferences, and health systems readiness for Insurance Scheme. Methods: A cross-sectional study of 400 heads of households and 43 health workers in Enugu, Southern Nigeria. Results: Awareness of NHIS among the heads of household was 56.8%, while it was 86% among the health workers. Awareness of NHIS among heads of households was significantly associated to both educational level (X2 = 16.083, P = 0.001), and occupation (X2 = 5.694, P = 0.017). More males (61.6%) had correct perceptions of NHIS compared to females (58.6%), but not statistically significant (X2 = 0.336, P = 0.562). Majority of households respondents 89% are willing to pay for NHIS. Willingness to pay was significantly associated to occupation (X2 = 5.169, df = 1, P = 0.023), but willingness to pay mandatory 5% premium was not significantly associated to occupation (X2 = 0.884, P = 347). Only 11.6% of the health facilities are enlisted as providers in the scheme. Conclusion: Willingness to pay was high, but majority are not ready to pay 5% premium of their earnings. Awareness creation programmes should be improved for the public, and more health facilities enlisted for wider coverage.

The Participatory, Payable, Profitable, and Potent （4p＇s） Insured Education System Model （IESM）＂ Analyses of Frequency and Variance by Categories （One-Way ANOVA）

The biggest problem in the world as well as in Turkey is to increase efficiency of human capital, which can only be achieved by educating all people in accordance with their capacities and demands. And, the biggest problem in education is finance. In order for everybody to have education, there is a need to develop a finance system which will help overcome the financial problems faced by households or individuals. For this purpose, the participatory, payable, profitable, and potent （4p＇s） insured education system model （IESM） is developed. This paper focuses on principles of the IESM and the analyses of frequency and variance by categories （one-way ANOVA）.

Health Services Utilization and Health Status of Insured versus Uninsured Nigerian Children with Sickle Cell Disease

Introduction: Nigeria accounts for 150,000 infants born with the Sickle Cell Disease (SCD) every year. Children with SCD are affected by the deleterious effect of user fees which reduces affordability and utilization of health services. Evidences supported that institutionalized health insurance increases intensity of utilization. Methodology: The study was conducted at AKTH, Kano, and north-western, Nigeria. The study was retrospective comparative cross-sectional study. 100 patients were enrolled, 50 for each arm. Paediatric SCD clinic outpatients’ records and a specialty designed form containing the variables of interest were used. Data were analysed using Minitab 16. Proportions, percentages, tables, charts and chi squared test were used to compare the two groups. Result: The study found no association between the two groups in the likelihood of being insured based on age (χ2 = 1.478), gender (χ2 = 0.224) and dwellings (χ2 = 0.062). On health services utilization and insurance status, the study revealed that follow up clinic visits, unscheduled clinic visits and emergency room visits were more likely among the insured group compared to the uninsured group. While the health status and insurance status of the two groups over 12 months period showed a significant association with the insured more likely to have improved health status compared to uninsured (χ2 = 28.019, p = 0.0001). Similarly, health status and health services utilization were significantly associated with insurance status (χ2 = 12.191, p = 0.002). Conclusion: The insurance status of children with SCD is associated with their health services utilization and health status. However, age, gender and dwellings were not associated with insurance status of children with SCD. Therefore, when expanding insurance coverage (NHIS) among children with SCD considerations have to be given to increase health services utilization and resultant improvement in health status as these have the potential of reducing morbidity and mortality among children with SCD.

Can I Have My Life Insured?

A man went to an insurance(保险)office to have his life insured.The manager of the office asked him how old his parents were when they died. 'Mother had a bad heart and died at the age of thirty.Father died of tuberculosis when he was thirty- five.' 'I am very sorry,'said the manager.'We cannot insure your life as your parents were not healthy.'

How Group-Based Cardiovascular Health Education Affects Treatment Adherence and Blood Pressure Control among Insured Hypertensive Nigerians: A Pre-Test, Post-Test Study

In sub Saharan Africa (SSA), access to affordable hypertension care through health insurance is increasing. But due to poor adherence, hypertension treatment outcomes often remain poor. Patient-centered educational interventions may reverse this trend. Using a pre-test/post-test design, in this study we investigated the effects of a structured cardiovascular health education program (CHEP) on treatment adherence, blood pressure (BP) control and body mass index (BMI) among Nigerian hypertensive patients who received guideline-based care in a rural primary care facility, in the context of a community based health insurance program. Study participants included 149 insured patients with uncontrolled BP and/or poor self-reported medication adherence after 12 months of guideline-based care. All patients received three group-based educational sessions and usual primary care over 6 months. We evaluated changes in self-reported adherence to prescribed medications and behavioral advice (primary outcomes);systolic BP (SBP) and/or diastolic BP (DBP) and BMI (secondary outcomes);and beliefs about hypertension and medications (explora- tory outcomes). Outcomes were analyzed with descriptive statistics and regression analysis. 140 patients completed the study (94%). At 6 months, more participants reported high adherence to medications and behavioral advice than at baseline: respectively, 101 (72%) versus 70 (50%), (p < 0.001) and 126 (90%) versus 106 (76%), (p < 0.001). Participants with controlled BP doubled from 34 (24%) to 65 (46%), (p = 0.001). The median SBP and DBP decreased from 129.0 to 122.0 mmHg, (p = 0.002) and from 80.0 to 73.5 mmHg, (p < 0.001), respectively. BMI did not change (p = 0.444). Improved medication adherence was associated with a decrease in medication concerns (p = 0.045) and improved medication self-efficacy (p < 0.001). By positively influencing patient perceptions of medications, CHEP strengthened medication adherence and, consequently, BP reduction among insured hypertensive Nigerians. This educational approach can support cardiovascular disease prevention programs for Africa’s growing hypertensive population.

Tackling China’s Pension Fund Payment Crisis:Will the “Two-Child Policy” Be the Answer?——An example with the basic pension insurance program for urban employees

Based on the reality that 29 Chinese provinces have already implemented the policy allowing a couple to raise a second child if either parent is an only child, this paper provides an empirical study on the effect of this policy on the financial status of the social pooling fund of basic pension insurance for urban employees. Our study suggests the followings. First, under the previous unchanged family planning policy, current deficits and cumulative deficits will occur in the social pooling fund in the year 2047 and 2063 respectively. Second, if lO% to 50% of qualified couples choose to raise a second child, the financial status of the social pooling fund will improve; relative to the previous unchanged family planning policy, the contribution ratio can decrease from 20% to the range between 18.06% and 19.57% without causing any changes to the original financial status of income and expenditure. Third, if the percentage of couples choosing to raise a second child rises to 60% to 100%, the contribution ratio can even decrease to the range between 16.55% and 17. 7% without causing any changes to the financial status as under the previous unchanged family planning policy. The above conclusions have all passed the sensitivity test. Therefore, the ＂two-child policy＂ for qualified couples is favorable to alleviating the payment pressures of pension insurance but the policy effectiveness is subject to fertility desire and the intensity of government implementation.

Healthcare experiences of uninsured and under-insured American Indian women in the United States

Background:Extensive health disparities exist for American Indian groups throughout the United States.Although insurance status is linked to important healthcare outcomes,this topic has infrequently been explored for American Indian tribes.For state-recognized tribes,who do not receive healthcare services through the Indian Health Service,this topic has yet to be explored.The purpose of this study is to explore how having limited access to health insurance(being uninsured or under-insured)impact American Indian women’s healthcare experiences?.Methods:In partnership with a community advisory board,this study used a qualitative description approach to conduct thirty-one semi-structured life-course interviews with American Indian women who are members of a state-recognized tribe in the Gulf Coast(United States)to explore their Western healthcare experiences.Interview were conducted at community centers,participant homes,and other locations identified by participants.Interviews were transcribed verbatim and findings were analyzed in NVivo using conventional content analysis.Findings were presented at tribal council meetings and to participants for member checking.Results:Themes identified by participants included:(a)lack of insurance as a barrier to healthcare;(b)pre-paying for childbirth when uninsured;and(c)access to public health insurance coverage.Twenty-four women mentioned the role or importance of insurance in discussing their healthcare experiences,which was referenced a total of 59 times.Conclusion:These findings begin to fill an important gap in the literature about the health insurance experiences of American Indian tribal members.Not having insurance was an important concern for participants,particularly for elderly and pregnant tribal members.Not having insurance also kept tribal members from seeking healthcare services,and from getting needed prescriptions.In addition to promoting knowledge about,and expanding insurance options and enrollment,increased sovereignty and resources for state-recognized tribes is needed to address the health disparities experienced by American Indian groups.

INSURE技术联合T-piece治疗新生儿呼吸窘迫综合征的临床有效性

目的探讨新生儿呼吸窘迫综合征(respiratory distress syndrome,RDS)采用INSURE技术+Tpiece方法完成治疗的有效性。方法回顾性选取2023年1—12月齐齐哈尔医学院附属第二医院收治的50例RDS患儿的临床资料,根据不同的治疗方法分为对照组(25例,复苏囊+INSURE技术)、研究组(25例,INSURE技术+T-piece方法)。比较两组血氧饱和度最低值、平均吸氧浓度、鼻塞持续气道正压通气应用时间、心率、并发症发生率。结果研究组血氧饱和度最低值为(90.79±3.59)%,高于对照组的(81.33±2.85)%,差异有统计学意义(t=10.319,P<0.05)。研究组平均吸氧浓度、鼻塞持续气道正压通气应用时间、心率优于对照组,差异有统计学意义(P均<0.05)。两组并发症总发生率比较,差异无统计学意义(P>0.05)。结论临床对RDS患儿在治疗期间,将INSURE技术以及T-piece方法进行充分结合,可有效改善患儿的氧合及血气指标,促进病情康复。

Does community-based health insurance affect lifestyle and timing of treatment seeking behavior?Evidence from Ethiopia

Objectives This paper aims to investigate the effects of enrollment in the Ethiopian community-based health insurance(CBHI)scheme on household preventive care activities and the timing of treatment-seeking behavior for illness symptoms.There is growing concern about the financial sustainability of CBHI schemes in developing countries.However,few empirical studies have identified potential contributors,including ex-ante and ex-post moral hazards.Methods We implement a household fixed-effect panel data regression model,drawing on three rounds of household survey data collected face to face in districts where CBHI scheme is operational and in districts where it is not operational in Ethiopia.Results The findings show that enrolment in CBHI does not significantly influence household behaviour regarding preventive care activities such as water treatment before drinking and handwashing before meals.However,CBHI significantly increases delay in treatment-seeking behaviour for diseases symptoms.Particularly,on average,we estimate about 4-6 h delay for malaria symptoms,a little above 4 h for tetanus,and 10-11 h for tuberculosis among the insured households.Conclusions While there is evidence that CBHI improve the utilization of outpatient or primary care services,our study suggests that insured members may wait longer before visiting health facilities.This delay could be partly due to moral hazard problems,as insured households,particularly those from rural areas,may consider the opportunity costs associated with visiting health facilities for minor symptoms.Overall,it is essential to identify the primary causes of delays in seeking medical services and implement appropriate interventions to encourage insured individuals to seek early medical attention.

Chinese herbal medicine decreases incidence of hepatocellular carcinoma in diabetes mellitus patients with regular insulin management

BACKGROUND Type 2 diabetes mellitus(DM)is an independent risk factor for hepatocellular carcinoma(HCC),while insulin is a potent mitogen.Identifying a new therapeutic modality for preventing insulin users from developing HCC is a critical goal for researchers.AIM To investigate whether regular herbal medicine use can decrease HCC risk in DM patients with regular insulin control.METHODS We used data acquired from the Taiwan,Chinaese National Health Insurance research database between 2000 and 2017.We identified patients with DM who were prescribed insulin for>3 months.The herb user group was further defined as patients prescribed herbal medication for DM for>3 months per annum during RESULTS We initially enrolled 657144 DM patients with regular insulin use from 2000 to 2017.Among these,46849 patients had used a herbal treatment for DM,and 140547 patients were included as the matched control group.The baseline variables were similar between the herb users and nonusers.DM patients with regular herb use had a 12%decreased risk of HCC compared with the control group[adjusted hazard ratio(aHR)=0.88,95%CI=0.80–0.97].The cumulative incidence of HCC in the herb users was significantly lower than that of the nonusers.Patients with a herb use of>5 years cumulatively exhibited a protective effect against development of HCC(aHR=0.82,P<0.05).Of patients who developed HCC,herb users exhibited a longer survival time than nonusers(aHR=0.78,P=0.0001).Additionally,we report the top 10 herbs and formulas in prescriptions and summarize the potential pharmacological effects of the constituents.Our analysis indicated that Astragalus propinquus(Huang Qi)plus Salvia miltiorrhiza Bunge(Dan Shen),and Astragalus propinquus(Huang Qi)plus Trichosanthes kirilowii Maxim.(Tian Hua Fen)were the most frequent combination of single herbs.Meanwhile,Ji Sheng Shen Qi Wan plus Dan Shen was the most frequent combination of herbs and formulas.CONCLUSION This large-scale retrospective cohort study reveals that herbal medicine may decrease HCC risk by 12%in DM patients with regular insulin use.

微管注入PS与INSURE技术治疗早产儿RDS的临床效果评价

目的探讨微管注入肺表面活性物质(PS)技术与气管插管-PS给药-拔管(INSURE)技术治疗≥30周早产儿呼吸窘迫综合征(RDS)的临床效果。方法选取RDS早产儿80例,按随机数表法分为观察、对照2组各40例。对照组采用INSURE技术,观察组采用微管注入(LISA)技术给与PS治疗。比较2组临床疗效、血气指标(PaO_(2)、PaCO_(2)和pH值)、脑血流动力学参数(PSV、EDV和RI)、临床相关指标和出院前病死率及并发症发生率。结果观察组患儿疗效高于对照组(P<0.05)。观察组患儿治疗后PaO_(2)、pH值均高于对照组,PaCO_(2)低于对照组(P<0.05)。2组患儿T0~T3时PSV、EDV、RI水平比较差异无统计学意义(P>0.05)。观察组患儿氧疗时间、插管用时均短于对照组(P<0.05);2组无创通气时间、住院时间及出院前病死率比较差异无统计学意义(P>0.05)。2组患儿治疗期间并发症发生率比较差异无统计学意义(P>0.05)。结论LISA和INSURE技术给予PS技术治疗早产儿RDS,可显著提高临床疗效,改善患儿血气指标。

China Continues to Be World’s Second Largest Insurance Market

Allianz Group recently released the Allianz Global Insurance Report,predicting that China will consolidate its position as the world’s second largest insurance market in the next decade.The report analyzes the business performance of the global insurance market in 2023 and forecasts the development direction and trends of the global insurance industry in the next decade.2023:A year of significant growth According to the report,in 2023,the global insurance industry grew by an impressive 7.5%,which is the fastest rate since the pre-Global Financial Crisis(GFC)era.

The Extreme Machine Learning Actuarial Intelligent Agricultural Insurance Based Automated Underwriting Model

The paper presents an innovative approach towards agricultural insurance underwriting and risk pricing through the development of an Extreme Machine Learning (ELM) Actuarial Intelligent Model. This model integrates diverse datasets, including climate change scenarios, crop types, farm sizes, and various risk factors, to automate underwriting decisions and estimate loss reserves in agricultural insurance. The study conducts extensive exploratory data analysis, model building, feature engineering, and validation to demonstrate the effectiveness of the proposed approach. Additionally, the paper discusses the application of robust tests, stress tests, and scenario tests to assess the model’s resilience and adaptability to changing market conditions. Overall, the research contributes to advancing actuarial science in agricultural insurance by leveraging advanced machine learning techniques for enhanced risk management and decision-making.

Transcending Labor Relations:A Study on the Mechanisms for Protecting Social Insurance Rights and Interests of Workers in New Business Forms——An Empirical Analysis Based on Judicial Cases

Abstract:With the rise of new business forms,the traditional industrial-era model of binding social insurance to labor relations is facing unprecedented challenges.In the context of these new busi-ness forms,whether the protection of workers’social insurance rights and interests can be“decoupled from labor relations”has become a hotly debated topic in academia,with“the ability to establish labor relations”emerging as a key variable influencing government depart-ments’policy choices on classified social insurance coverage.Based on this,the paper constructs a theoretical model of the correlation be-tween social insurance and labor relations to analyze cases concern-ing the protection of social insurance rights and interests of workers in new business forms.It examines the advantages and disadvantages of binding social insurance to labor relations and suggests promoting so-cial insurance policy innovation by transcending labor relations.The paper advocates abandoning the path dependency that starts with la-bor relations and clarifying the theoretical basis that workers’access to social insurance rights should be based on labor rather than em-ployment.To adapt to the profit model of new business forms,it pro-poses establishing a rule of“proportional responsibility for commis-sions,”where the social insurance contribution base is determined by the proportion and amount of corporate commissions.By reasonably setting rates,it will protect the healthy development of new business forms in a balanced manner.In this way,enterprises can share social insurance responsibilities according to unified rules without worrying about being classified as having a labor relationship,which helps fully protect workers’social insurance rights and interests and promotes fair competition and healthy development among enterprises.

INSURE策略治疗早产儿呼吸窘迫综合征失败的危险因素分析

新生儿呼吸窘迫综合征(RDS)是因缺少肺泡表面活性物质(PS),导致新生儿肺发育不成熟,引起呼吸功能障碍的严重肺部疾病~([1])。该疾病多发于胎龄在34周以下的早产儿,主要症状为呼吸困难逐渐加重等,严重影响患儿生命健康,具有较高的病死率~([2])。