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Medical expenditure risk is widely believed to reduce households' willingness to bear other risks and in turn alter their behavior. In this paper, we investigate the role of health insurance in household financial decision. To this end, we consider a double-multinomial discrete-factor model of insurance choice and portfolio allocation. Using data from a Chinese household survey, we find that enrolling in a health insurance scheme with better policies is associated with a higher probability of owning risky assets. This positive effect is stronger for households with lower risk aversion. Our findings suggest that risk attitudes could indirectly influence portfolio outcomes through affecting households' responsiveness to changes in medical expenditure risk. K E Y W O R D Shealth insurance, medical expenditure risk, portfolio choice, risk attitudes | INTRODUCTIONA widely accepted view in the literature is that exposure to background risk will reduce an individual's tolerance of other risks (Gollier & Pratt, 1996;Kimball, 1993;Pratt & Zeckhauser, 1987). During the past few decades, the dramatic increase in healthcare cost has led medical expenditure to become an important component of background risk in China. According to Li et al. (2012), 13.0% of households in China face catastrophic out-of-pocket payments from health expenditure, and 7.5% of them are even impoverished by unaffordable medical expenses. As these numbers are expected to grow in the future, one of the key issues drawing extensive attention is how medical expenditure risk affects the willingness of households to invest in risky assets.Since medical expenditure risk is a compound risk related to both health risk and out-of-pocket payment, one strand of the literature has examined the effect of health risk on portfolio choices. Using health status as an indicator for health risk, it has been found that risky health is associated with a larger share of financial wealth allocated to safer assets, especially for the elderly (

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The study examined the effect of household socioeconomic status and other socio-demographic characteristics on antenatal care (ANC) utilization among 819 women within the reproductive ages across eight rural communities in Delta State, Southern part of Nigeria. Characteristics of the women were described using simple proportion and frequency. The chi-square test was used to examine factors that were significantly associated with a minimum of four (≥4) and eight (≥8) antenatal care contacts, which were respectively in line with the focused ANC and WHO's new guideline. The multivariable logistic regression was used to examine the determinants of a minimum of four and eight ANC. Statistical analyses were set at 5%. The results showed that 31.4% (257/819) and 2.2% (18/819) of mothers, respectively, made ≥ 4 and ≥ 8 ANC contacts in the course of their last pregnancies. According to the results, the odds for reporting 4≥ and ≥ 8 ANC improved with both wealth and educational attainment. Distance to the health center and cost are barriers to maternal care utilization and they reduce the odds for undertaking ≥ 4 and ≥8 ANC contacts. Women on higher media exposure were more likely to undertake ≥ 4 and ≥8 ANC contacts, and those on the highest media exposure were more likely to undertake ≥8 ANC contacts. Financing maternal care through health insurance and free maternal care significantly improves the odds to undertake ≥ 4 and ≥ 8 ANC contacts. Intervention programs should be designed to improve access to maternal care services and should expand education opportunities for mothers, improve household socioeconomic conditions, and encourage enrolment in health insurance and free maternal care in the study area.

The Future Health Index (FHI) is developed by the Royal Philips to help determine the readiness of countries to address global health challenges and build sustainable, fit-for-purpose national health systems. The FHI 2018 presents the Value Measure to measure the value of 16 health systems, which is formulated by taking the arithmetic average of Access, Satisfaction and Efficiency. However, this scheme is not the Pareto optimal and loses association with weights. For these reasons, this paper proposes to apply the social choice theory and Stochastic Multicriteria Acceptability Analysis for group decision making (SMAA-2) to measure the value of health systems, by means of reconstructing the Value Measure. Specifically, we begin with considering all possible individual preferences among Access, Satisfaction and Efficiency, which is mathematically represented by ranked weights of them; the pessimistic and optimistic outcomes under certain individual preference are derived in a closed-form manner, according to which an interval decision matrix is then formulated; the SMAA-2 is then lastly applied to compute the holistic acceptability index, which is considered as a revised Value Measure. An empirical study using the data of 16 health systems is conducted to show the effectiveness and superiority of our method. It is demonstrated that our method always outperforms the Value Measure, by means of comparing the Spearman's rank correlation coefficients.