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. 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.

Associations between vision impairment and multimorbidity among older Chinese adults: results from the China health and retirement longitudinal study

“…The above reasons may prompt this association to be stronger in women. Our result also showed that individuals with lower education levels are more likely to have VI, which may be that they are less likely to have health insurance or healthcare and worse health conditions [ 32 , 33 ].…”

Trends in the prevalence of vision impairment among the oldest-old Chinese population from 1998 to 2018

“…We observed urban-rural differences in the trends of vision impairment, although the discrepancy in the prevalence diminished after adjusting for all covariates. A plausible explanation is that rural older people in China bear higher financial burdens than urban residents when seeking eye care services before the New Cooperative Medical Scheme was established in 2003 [42]. Moreover, the shortage of eye care professionals in rural areas could limit access to ophthalmic services, therefore contributing to the high vision impairment prevalence among rural older adults [42].…”

“…A plausible explanation is that rural older people in China bear higher financial burdens than urban residents when seeking eye care services before the New Cooperative Medical Scheme was established in 2003 [42]. Moreover, the shortage of eye care professionals in rural areas could limit access to ophthalmic services, therefore contributing to the high vision impairment prevalence among rural older adults [42]. Although the number of ophthalmologists and county-level hospitals has increased since 2003, exceeding the goal of Vision 2020, these resources are distributed unequally across China, as most are allocated to urban areas [27,43,44].…”