个人收入与医疗服务需求及其弹性

通常情况下，当收入增长时，消费者对霜种商品需求的增加减少将做出必然的反映，两者之间增量的比即是消费者对这种商品的收需求弹性。分析医疗服务需求收入弹性，从总体上讲呈弱势，高收入组弹性大于低收入组弹性；医疗费用占收入的比重是一个增长的趋势，贫困和低收入人群医疗费用支出占收的比重高于高收入人群。     

Concurrent self-administration of ethanol and an alternative nondrug reinforcer in monkeys: effects of income (session length) on demand for drug

Eight rhesus monkeys (Macaca mulata) were trained to self-administer orally delivered ethanol (8%) and saccharin (0.03 or 0.3% wt/vol) or water under concurrent fixed-ratio (FR) schedules. The FR requirement for saccharin was fixed at 32, while the FR for ethanol was varied (4, 8, 16, 32, 64 and 128) in a nonsystematic order to assess demand for drug. Demand was defined as consumption plotted as a function of price (FR). Income was defined as the duration of access to available resources. Income was varied by allowing access to the concurrently available liquids 20, 60 or 180 min per day. Order of testing was counter-balanced across monkeys. Saccharin deliveries were much higher than ethanol deliveries under the 180-min income condition; however, they were lower than ethanol deliveries when income was reduced to 20 min and the ethanol FR was 4, 8 or 16. Thus, when the price of drug was relatively low, consumption of drug exceeded that of the nondrug reinforcer, and that relationship was reversed as income decreased. Saccharin deliveries sustained a proportionally greater reduction due to decreased income compared to ethanol deliveries. As income decreased from 180 to 20 min, saccharin deliveries were reduced by an average of 79.1% (across ethanol FR conditions) while ethanol deliveries were reduced by an average of 41.2 and 40.8% when concurrent saccharin or water were available, respectively; thus, drug self-administration was more resistant to income changes than saccharin. The demand for ethanol was shifted downward in a parallel fashion as income decreased. As ethanol cost (FR) increased, there were proportionately greater decreases in ethanol intake when saccharin was concurrently available compared to when water was available. There was a 35–50% reduction in ethanol deliveries due to concurrent saccharin (versus water) at FR 4, compared to a 55–75% reduction at FR 128. Cost of ethanol (FR), income level and the availability of a nondrug reinforcer are all variables that modify ethanol-reinforced behavior, and income alters the relative preference for a drug versus nondrug reinforcer.     

我国5省艾滋病流行对个人和家庭影响情况调查

目的了解、分析艾滋病对个人和家庭影响的主要表现特征。方法采用问卷调查获得我国5个省份的相关数据,通过对比的方法,比较分析感染者家庭和非感染者家庭在婚姻、家庭结构、收入、消费等方面的差异特征。结果41．1％的感染者家庭是主干家庭,高于非感染者家庭的这一比例（33．4％）;感染者家庭中生活在低收入阶层的比例为49．5％,比非感染者家庭多16．0％;感染者家庭医疗花费占家庭全部消费支出的比例为17．4％,明显高于非感染者家庭（7．9％）;感染者家庭中60岁以上劳动参与率为55．9％,高于非感染者家庭（41．7％）;女性感染者的劳动时间（含家务）比男性感染者多2．2个小时,而非感染者家庭中女性的劳动时间比男性仅多0．7小时;目前只有40．4％的感染者家庭获得了相关的救助。结论艾滋病给感染者及其家庭带来了家庭结构改变、家庭功能削弱、贫困加剧、家庭消费结构改变等一系列问题,扩大贫富差距,加剧了性别不平等,普遍缺乏有效的应对措施,迫切需要持续的关怀和救助。     

Prevalence of Childhood Asthma and Associated Morbidity in Los Angeles County: Impacts of Race/Ethnicity and Income

Racial/ethnic and socioeconomic disparities in the prevalence of childhood asthma have been reported nationally but few population-based studies in local and regional settings have been reported. To assess variation in the prevalence of childhood asthma and associated morbidity across race/ethnic and income groups in the Los Angeles County population, we analyzed data on a random sample of 6004 children (≤17 years old) enrolled in a countywide health survey from 09 1999 through 04 2000. The prevalence of childhood asthma was highest in blacks (15.8%), intermediate in whites (7.3%) and Asians (6.0%), and lowest in Latinos (3.9%; p<0.001). These differences persisted after controlling for income, measures of health care access, and other covariates. Asthma prevalence was inversely related to income in all racial/ethnic groups except Latinos from Spanish-speaking households. Among children with asthma, blacks and Latinos were more likely than whites to report asthma-related limitations in physical activity and need for urgent medical services. These findings indicate marked disparities in asthma prevalence and related morbidity in this large urban child population and highlight the importance of efforts to identify high-risk subpopulations for focused prevention and treatment interventions.     

Transitions from private to public health coverage among children: estimating effects on out-of-pocket medical costs and health insurance premium costs

Objective. To assess the effects of transitions from private to public health insurance by children on out‐of‐pocket medical expenditures and health insurance premium costs. Data Sources. Data are drawn from the 1996 and 2001 panels of the Survey of Income and Program Participation. We construct a nationally representative, longitudinal sample of children, ages 0–18, and their families for the period 1998–2003, a period in which states raised public health insurance eligibility rates for children. Study Design. We exploit the Survey of Income and Program Participation's longitudinal design to identify children in our sample who transition from private to public health insurance. We then use a bootstrapped instrumental variable approach to estimate the effects of these transitions on out‐of‐pocket expenditures and health insurance premium costs. Principal Findings. Children who transition from private to public coverage are relatively low‐income, are disproportionately likely to live in single‐mother households, and are more likely to be Black or of Hispanic origin. Child health status is highly predictive of transitions. We estimate that these transitions provide a cash‐equivalent transfer of nearly U.S.$1,500 annually for families in the form of reduced out‐of‐pocket and health insurance premium costs. Conclusions. Transitions from private to public health coverage by children can bring important social benefits to vulnerable families. This suggests that instead of being a net societal cost, such transitions may provide an important social benefit.     

Effect of Ecuador's cash transfer program (Bono de Desarrollo Humano) on child development in infants and toddlers: a randomized effectiveness trial

We examined the effects of Ecuador's Bono de Desarrollo Humano (BDH)--an unconditional cash transfer program that was rolled-out using a randomized design--on health and development outcomes in very young children. Communities that were randomly assigned to the treatment group began receiving the BDH in 2004 and those randomly assigned to the comparison group began receiving benefits two years later. Families enrolled in the BDH received a monthly cash stipend ($15USD) representing an approximate 6-10% increase in household income. Participants analyzed in this study are children aged 12-35 months from treatment (n = 797) and comparison (n = 399) communities in rural and urban Ecuador. Main outcomes measured were language skills (the Fundación MacArthur Inventorio del Desarollo de Habilidades Comunicativas-Breve), height-for-age z-score, and hemoglobin concentration. Results indicate that in rural areas, being randomized to receive the BDH in very early childhood led to significantly better performance on the number of words a child was saying, and on the probability that the child was combining two or more words. There were no significant effects on language development for children in urban areas and there were no effects on height-for-age z-score or hemoglobin concentration in rural or urban areas. A limited number of potential pathways with respect to cognitive/language stimulation, health behaviors, and parenting quality were also explored. Findings indicate that compared to children in comparison areas, rural children in treatment areas were more likely to have received vitamin A or iron supplementation and have been bought a toy in the past six months. This study provides evidence for significant benefits of an unconditional cash transfer program for language development in very young children in rural areas.     

Distinct impact of education and income on habitual exercise: a cross-sectional analysis in a rural city in Japan

Education and income are important socioeconomic indicators that reflect different aspects of social hierarchy. However, only a few studies have explicitly examined how different the relationship between education and health behaviour is from that between income and health behaviour. According to the human capital theory of health investment, education would reflect knowledge assets that allow an efficient investment in health, while income would relate to the value of healthy days and/or the time cost of health investment. Since time cost and the relative price of health would differ across age strata, we examined the significance of effect modification by age strata to distinguish the effects of education on habitual exercise from the effects of income. A cross-sectional survey was conducted using a self-administered questionnaire in a rural city in northern Japan in January 2007 (n = 3385). Logistic regression analyses were conducted to assess the association of educational attainment and household income with habitual exercise. Interaction terms of these socioeconomic indicators with age strata (<60 years versus ≥60 years) were included to test the distinctive association across age, followed by a stratified analysis. As theoretically predicted, higher income was significantly associated with habitual exercise among those aged 25–59 years, while the association was null or negative among those aged 60 and above. Education was significantly associated with habitual exercise regardless of the age groups. These results suggest that the effects of socioeconomic factors on health behaviours vary according to which socioeconomic indicators are analysed, and which age group is selected. We conclude that studies on the socioeconomic disparity of health behaviours should carefully choose socioeconomic indicators to explain specific health behaviours to reveal underlying mechanisms and provide relevant policy implications, based on explicit behavioural models.     

Horizontal inequity in the utilisation of healthcare services in Australia

The Australian universal healthcare system aims to ensure affordable and equitable use of healthcare services based on individual health needs. This paper presents empirical evidence on the extent of horizontal inequity (HI) in healthcare services (unequal utilisation by income for equal need) in Australia during the period of promoting reliance on private healthcare financing. Using data from the most recent Australian National Health Survey of 2011−12 and 2014−15, we examined and measured the extent of HI in eight indicators of out-of-hospital services and hospital-related care. Contrary to earlier studies, our results show a small but pro-rich inequity in the probability of general practitioner visits. Inequity in the distribution of specialist and dentist visits was in favour of richer people, a result that is commonly found in other developed countries and is also consistent with existing Australian evidence. Hospital-related care was equitably distributed compared to the pro-poor pattern found in earlier studies. Despite the universal health insurance system in Australia, there was inequity in the utilisation of needed healthcare services. Our evidence is relevant to similar health systems as governments move to higher out-of-pocket payments and other private sources to reduce pressure on public healthcare expenditure.     

Suicide rates across income levels: Retrospective cohort data on 1 million participants collected between 2003 and 2013 in South Korea

Background

The relation of income and socioeconomic status with suicide rates remains unclear. Most previous studies have focused on the relationship between suicide rates and macroeconomic factors (e.g., economic growth rate). Therefore, we aimed to identify the relationship between individuals' socioeconomic position and suicide risk.