Health insurance enrollment and vision health in rural China: an epidemiological survey
Abstract Background Vision health is an important aspect of health worldwide. Visual impairment (VI) is associated with poor quality of life and is usually more prevalent in rural areas. To help rural populations obtain vision care, health insurance policies have emerged throughout the world. Howeve...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-07-01
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| Series: | BMC Health Services Research |
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| Online Access: | https://doi.org/10.1186/s12913-021-06754-0 |
| _version_ | 1819073549851164672 |
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| author | Xiaochang Yan Baoqun Yao Xi Chen Shaoye Bo Xuezheng Qin Hua Yan |
| author_facet | Xiaochang Yan Baoqun Yao Xi Chen Shaoye Bo Xuezheng Qin Hua Yan |
| author_sort | Xiaochang Yan |
| collection | DOAJ |
| description | Abstract Background Vision health is an important aspect of health worldwide. Visual impairment (VI) is associated with poor quality of life and is usually more prevalent in rural areas. To help rural populations obtain vision care, health insurance policies have emerged throughout the world. However, some existing literatures show that health insurance enrollment’s impact on the overall physical health of rural population has been minimal. Focusing on vision health among adults in rural China, our study aims to investigates the impact of health insurance on vision health, heterogeneity of the effect, and the moderating effect of health insurance enrollment on the impact of chronic physical diseases and basic eye diseases on vision health. Methods Primary data were collected through a nation-wide epidemiological survey of vision health conducted in rural China in 2018, with a sample size of 28,787 used in our statistical analysis. Instrumental variables regression and Heckman selection models were conducted to examine the impact of health insurance enrollment and reimbursement ratio adults’ vision health outcomes. Subsample regressions by sex, age, education level, and whether with eye diseases were further conducted to explore the heterogeneity in our results. We then examined whether health insurance enrollment moderates the impact of chronic physical diseases and basic eye diseases on vision health through the method of introducing interaction terms. Results Participating in health insurance reduced the probability of VI by 2.15 %. The reimbursement rate increasing by 1 % point may reduce the probability of worsening VI by 6.12 %. Men (-0.0235, P = 0.0002) benefit more from insurance enrollment than women (-0.0201, P = 0.0082) with respect to vision health. From the young adult group to the oldest group, the marginal effect of health insurance increased from − 0.0068 (P = 0.0394) to -0.0753 (P < 0.0001). The marginal effect on VI was most significant in people with lower education levels and weakened with increased education levels. People with basic eye diseases (-0.0496, P = 0.0033) benefit more from participating insurance than the people without basic eye diseases (-0.0196, P = 0.0001) with respect to vision health. The moderating effects of health insurance enrollment on the impacts of cerebral infarction (-0.1225, P < 0.0001), diabetes (-0.0398, P = 0.0245), hyperlipidemia (-0.1364, P = 0.0271), mental illness (-0.1873, P = 0.0010), glaucoma (-0.1369, P = 0.0073), diabetic retinopathy (-0.1560, P = 0.0043), and retinal vein obstruction (-0.2018, P = 0.0155) on vision health were significantly negative. Conclusions The results suggest that participation in health insurance and higher health insurance reimbursement ratios reduced the risk of VI in the sampled adults. Health insurance has the most significant effect in in vulnerable groups. Heath insurance enrollment moderates the impacts of several chronic physical and basic eye conditions on vision health. Our findings have potential implications for reforming health insurance policies to improve vision health conditions in rural areas of developing countries. |
| first_indexed | 2024-12-21T17:55:24Z |
| format | Article |
| id | doaj.art-afa75057dd6542ac96441af0a81d3af4 |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-12-21T17:55:24Z |
| publishDate | 2021-07-01 |
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| series | BMC Health Services Research |
| spelling | doaj.art-afa75057dd6542ac96441af0a81d3af42022-12-21T18:55:14ZengBMCBMC Health Services Research1472-69632021-07-0121111410.1186/s12913-021-06754-0Health insurance enrollment and vision health in rural China: an epidemiological surveyXiaochang Yan0Baoqun Yao1Xi Chen2Shaoye Bo3Xuezheng Qin4Hua Yan5National School of Development, Peking UniversityDepartment of Ophthalmology, Tianjin Medical University General HospitalDepartment of Occupational and Environmental Health, School of Public Health, Tianjin Key Laboratory of Environment, Nutrition, and Public Health, Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin Medical UniversityChina Foundation for Disabled PersonsSchool of Economics, Peking UniversityDepartment of Ophthalmology, Tianjin Medical University General HospitalAbstract Background Vision health is an important aspect of health worldwide. Visual impairment (VI) is associated with poor quality of life and is usually more prevalent in rural areas. To help rural populations obtain vision care, health insurance policies have emerged throughout the world. However, some existing literatures show that health insurance enrollment’s impact on the overall physical health of rural population has been minimal. Focusing on vision health among adults in rural China, our study aims to investigates the impact of health insurance on vision health, heterogeneity of the effect, and the moderating effect of health insurance enrollment on the impact of chronic physical diseases and basic eye diseases on vision health. Methods Primary data were collected through a nation-wide epidemiological survey of vision health conducted in rural China in 2018, with a sample size of 28,787 used in our statistical analysis. Instrumental variables regression and Heckman selection models were conducted to examine the impact of health insurance enrollment and reimbursement ratio adults’ vision health outcomes. Subsample regressions by sex, age, education level, and whether with eye diseases were further conducted to explore the heterogeneity in our results. We then examined whether health insurance enrollment moderates the impact of chronic physical diseases and basic eye diseases on vision health through the method of introducing interaction terms. Results Participating in health insurance reduced the probability of VI by 2.15 %. The reimbursement rate increasing by 1 % point may reduce the probability of worsening VI by 6.12 %. Men (-0.0235, P = 0.0002) benefit more from insurance enrollment than women (-0.0201, P = 0.0082) with respect to vision health. From the young adult group to the oldest group, the marginal effect of health insurance increased from − 0.0068 (P = 0.0394) to -0.0753 (P < 0.0001). The marginal effect on VI was most significant in people with lower education levels and weakened with increased education levels. People with basic eye diseases (-0.0496, P = 0.0033) benefit more from participating insurance than the people without basic eye diseases (-0.0196, P = 0.0001) with respect to vision health. The moderating effects of health insurance enrollment on the impacts of cerebral infarction (-0.1225, P < 0.0001), diabetes (-0.0398, P = 0.0245), hyperlipidemia (-0.1364, P = 0.0271), mental illness (-0.1873, P = 0.0010), glaucoma (-0.1369, P = 0.0073), diabetic retinopathy (-0.1560, P = 0.0043), and retinal vein obstruction (-0.2018, P = 0.0155) on vision health were significantly negative. Conclusions The results suggest that participation in health insurance and higher health insurance reimbursement ratios reduced the risk of VI in the sampled adults. Health insurance has the most significant effect in in vulnerable groups. Heath insurance enrollment moderates the impacts of several chronic physical and basic eye conditions on vision health. Our findings have potential implications for reforming health insurance policies to improve vision health conditions in rural areas of developing countries.https://doi.org/10.1186/s12913-021-06754-0Health insurance enrollmentVision healthEpidemiological surveyRural China |
| spellingShingle | Xiaochang Yan Baoqun Yao Xi Chen Shaoye Bo Xuezheng Qin Hua Yan Health insurance enrollment and vision health in rural China: an epidemiological survey BMC Health Services Research Health insurance enrollment Vision health Epidemiological survey Rural China |
| title | Health insurance enrollment and vision health in rural China: an epidemiological survey |
| title_full | Health insurance enrollment and vision health in rural China: an epidemiological survey |
| title_fullStr | Health insurance enrollment and vision health in rural China: an epidemiological survey |
| title_full_unstemmed | Health insurance enrollment and vision health in rural China: an epidemiological survey |
| title_short | Health insurance enrollment and vision health in rural China: an epidemiological survey |
| title_sort | health insurance enrollment and vision health in rural china an epidemiological survey |
| topic | Health insurance enrollment Vision health Epidemiological survey Rural China |
| url | https://doi.org/10.1186/s12913-021-06754-0 |
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