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OBJECTIVE: The integration of the health insurance fund pool may threaten the sustainability of the fund by increasing its expenditures through the exacerbation of the moral hazard of participations. The purpose of this paper is to assess and predict the impact of the single pool reform of China's Urban Employee Basic Medical Insurance (UEBMI) on the expenditure and sustainability of the health insurance fund. METHODS: In this paper, we consider the pilot implementation of the single pool reform in some provinces of China as a quasi-natural experiment, and develop a staggered DID model to assess the impact of the single pool reform on medical reimbursement expenditure. Based on the results, an actuarial model is developed to predict the impact on the accumulated balance of China's health insurance fund if the single pool reform is continued. RESULTS: We found that the medical reimbursement expenditure would increase by 66.4% per insured person after the unified provincial-level pool reform. There is individual heterogeneity in the effects of the unified single pool reform on medical reimbursement expenditure, and the reimbursement expenditure of retired elderly has the largest increase. If the unified single pool reform is gradually promoted, the current and accumulated balance of the UEBMI pooling fund would have gaps in 2031 and 2042, respectively. CONCLUSION: We verified that a larger fund pool will bring unreasonable growth of fund expenditures, which will threaten the sustainable development of health insurance. To minimize the impact of the unified single pool reform on the sustainability of the health insurance fund, we suggest strengthening the monitoring of moral hazard behavior, promoting the delayed retirement system, and encouraging childbearing.

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This paper empirically investigates the impact of public long-term care insurance (LTCI) on the utilization of inpatient services and associated expenditures among disabled Chinese individuals, using data from the China Health and Retirement Longitudinal Study from 2011 to 2018. Employing a staggered difference-in-difference approach within a propensity score matching framework (PSM-DID), the study finds that the introduction of LTCI significantly reduces the likelihood of inpatient service usage by 4.2%, the annual number of inpatient admissions by 10.2%, the annual inpatient cost by 16.2%, the out-of-pocket expenses by 20.7%, and the reimbursement expenditure by the public medical insurer by 9.9%. The study further explores the mechanisms underlying these effects and identifies that the Substitution Effect, where care services in community healthcare centers and nursing homes replace hospitalizations, outweighs the Income Effect generated by LTCI benefits. By leveraging the quasi-natural experimental setting of diverse LTCI policies across cities, the study also examines the heterogeneous impacts of LTCI based on household income, eligibility criteria, and reimbursement methods. The findings underscore the positive role of LTCI in controlling medical expenses and alleviating congestion in urban hospitals, offering valuable insights for promoting "Healthy Aging".

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Since the emergence of smart logistics as a vital paradigm, it has garnered significant interest from independent firms and governments worldwide, including China. This study aims to examine the relationship between Smart Logistics Policy (SLP) and firm performance both theoretically and empirically. Utilizing data from A-share companies listed on the Shanghai and Shenzhen stock exchanges between 2012 and 2017, this study analyzes the relationship between SLP and firm performance using Propensity Score Matching (PSM) and Difference-in-Differences (DID). The results indicate that SLP significantly enhances a firm's financial performance. Additionally, a heterogeneity test on financial performance reveals that the impact of SLP varies based on ownership and industrial sector. Unexpectedly, SLP has a negative impact on corporate social responsibility (CSR) performance. The heterogeneity test on CSR performance shows that the SLP effect on CSR exhibits no significant difference based on ownership. Furthermore, the impact of SLP on CSR is significantly greater for manufacturing firms compared to non-manufacturing firms. Consequently, this study offers theoretical support and empirical evidence regarding the effects of SLP on firm performance.

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Carbon emissions trading scheme (ETS) will change the internal and external operating environment of related companies, increase new carbon reduction costs, and may affect their investment behavior and decision-making. This study constructs the policy effect evaluation model to evaluate the net effect of China's ETS pilot policy on the investment efficiency of related companies in high-carbon industries. This study indicates that: first, China's ETS pilot policy has reduced the inefficient investment of related companies by 11.40% during the sample period. Second, innovation ability plays an enhanced moderating effect in the inhibitory effect of China's ETS pilot policy on the inefficient investment of related companies in the short term, but the effect is weakened in the long-term. Third, the policy effect is relatively obvious for non-state-owned companies and companies with more institutional shareholdings. This research has important reference value for the continuous improvement of China's national carbon market, and the steady transformation from simple investment-driven to investment-efficiency-driven economic development in China.

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The implementation of the environmental protection tax (EPT) is a crucial step in the tasks of achieving the "double-carbon" objective and fostering comprehensive green economic and social growth. The literature on the effect of EPT policies has focused mainly on environmental effects and economic effects and has rarely paid attention to social effects, such as the impact of such policies on employment. By reference to data regarding pollution-intensive listed companies in China from 2014 to 2022, this article uses the 2018 EPT reform as a quasi-natural experiment to explore the effects of EPT on employment within these industries. The EPT reform is shown to have a significant dampening effect on corporate employment in the pollution industry, a conclusion that continues to hold after a number of robustness tests, including the differences-in-differences-in-differences (DDD) tests, the parallel trend test, the placebo test, and the PSM-DID test. Further analysis shows that the EPT reform suppressed employment in polluting industries mainly through two pathways: the output effect and the factor substitution effect. Moreover, the EPT reform generated more significant disincentives to employment in non-state-owned enterprises, large-scale enterprises, and mining industries. This study's findings can serve as a crucial reference for policies in China that aim to promote high-quality full employment in the context of environmental governance. The results of this research can also serve as a reference for a cost‒benefit analysis of environmental policies in China in terms of employment and provide a theoretical basis for and practical experience regarding the task of coordinating the relationship between environmental governance and employment regulation in China.

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The "Broadband China" has enabled China to achieve leapfrog development in the construction of its high-speed broadband networks, thereby accelerating the development of digital infrastructure and unleashing the potential for financial sector growth. This has created a strong impetus for economy to shift towards high-quality development. An in-depth understanding of the empirical correlation between the development of digital infrastructure and financial progress is absent, leaving an unexplored domain of research concerning the impact of the "Broad China" strategy on financial agglomeration (Finagg), financial scale (Finscal), and digital finance (Digfina). In order to evaluate the dynamic impacts of this policy on financial development, this research builds a multi-period difference in differences (DID) model using panel data from 269 prefecture-level cities between 2011 and 2020. The study concludes that the "Broadband China" policy significantly fosters the growth of Finagg, Finscal, and Digfina, in China, and found that the "Broadband China" policy has a significant impact on the regional heterogeneity of financial agglomeration and digital finance. There are significant variations in the effects of this policy on different regions, while the regional heterogeneity differences in the impact on financial scale are relatively small. Additionally, the three mediating variables of technological innovation, fund support, and talent agglomeration play a mediating role in the mechanism of digital infrastructure on financial development.

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Bacterial extracellular vesicles (BEVs) are nano-size vesicles containing a cargo of bioactive molecules that can play key roles in microbe-microbe and microbe-host interactions. In tracking their biodistribution in vivo, BEVs can cross several physical host barriers including the intestinal epithelium, vascular endothelium, and blood-brain-barrier (BBB) to ultimately accumulate in tissues such as the liver, lungs, spleen, and the brain. This tissue-specific dissemination has been exploited for the delivery of biomolecules such as vaccines for mucosal delivery. Although numerous strategies for labeling and tracking BEVs have been described, most have constraints that impact on interpreting in vivo bioimaging patterns. Here, we describe a general method for labeling BEVs using lipophilic fluorescent membrane stains which can be adopted by non-expert users. We also describe how the procedure can be used to overcome potential limitations. Furthermore, we outline methods of quantitative ex vivo tissue imaging that can be used to evaluate BEV organ trafficking.

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Intelligent manufacturing is an important driving force for improving quality and efficiency and promoting green innovation. Based on the data of Chinese listed companies and taking the Chinese intelligent manufacturing pilot demonstration projects as a quasi-natural experiment, this paper constructs a difference-in-differences (DID) model to explore the effect and mechanism of intelligent manufacturing on enterprise green innovation. The results show that intelligent manufacturing has significantly promoted green innovation in China, and this effect is still valid after considering various robustness tests. Heterogeneity analysis shows that in areas with a good green development foundation and poor information infrastructure, the impact is more obvious. In non-state-owned enterprises and mature enterprises, the impact is more obvious. Mechanism analysis indicates that intelligent manufacturing enhances green innovation through cost management effects, efficiency improvement effects, and employment structure optimization effects. The conclusions provide clear policy implications for developing countries to promote intelligent manufacturing practices and green high-quality development.

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China's new urbanization strategy serves as a key instrument for achieving sustainable development goals in urban areas. However, a consensus on how and whether new urbanization affects urban green total factor productivity (GTFP) has yet to be reached. This analysis targets 276 prefecture-level and above cities, using panel data from 2011 to 2019 to assess the impact of the new urbanization pilot policy (NUPP) on GTFP. The research findings demonstrate that implementing China's NUPP has significantly enhanced urban GTFP. Furthermore, the population-land-industry coupling coordination degree (PLICCD), as well as the industry-environment-economy coupling coordination degree (IEECCD), play crucial facilitating roles in the aforementioned enhancement effects. The results remain robust even after employing PSM-staggered difference-in-differences (DID) estimation and excluding other policy interferences. Furthermore, heterogeneity analysis, based on urban characteristics, reveals that the NUPP significantly enhances GTFP in resource-based, non-resource-based, industrial, non-intensive compactness, and non-expansionary urbanization cities. Finally, the paper offers three policy recommendations. First, new urbanization initiatives should be more actively promoted in China and other developing countries. Second, the construction of new urbanization plans should focus on the coordinated development of "population-land-industry" and "industry-environment-economy." Third, the government should implement new urbanization initiatives tailored to the specific characteristics of different cities. This study provides valuable insights for the general public, policymakers, and scholars to better understand the potential of coordinating the development of population, land, industry, the environment, and the economy to improve GTFP. Moreover, it offers a broad perspective for evaluating sustainable urban development.

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BACKGROUND: The Diagnosis-Intervention Packet (DIP) payment system, initiated by China's National Healthcare Security Administration, is designed to enhance healthcare efficiency and manage rising healthcare costs. This study aims to evaluate the impact of the DIP payment reform on inpatient care in a specialized obstetrics and gynecology hospital, with a focus on its implications for various patient groups. METHODS: To assess the DIP policy's effects, we employed the Difference-in-Differences (DID) approach. This method was used to analyze changes in total hospital costs and Length of Stay (LOS) across different patient groups, particularly within select DIP categories. The study involved a comprehensive examination of the DIP policy's influence pre- and post-implementation. RESULTS: Our findings indicate that the implementation of the DIP policy led to a significant increase in both total costs and LOS for the insured group relative to the self-paying group. The study further identified variations within DIP groups both before and after the reform. In-depth analysis of specific disease groups revealed that the insured group experienced notably higher total costs and LOS compared to the self-paying group. CONCLUSIONS: The DIP reform has led to several challenges, including upcoding and diagnostic ambiguity, because of the pursuit of higher reimbursements. These findings underscore the necessity for continuous improvement of the DIP payment system to effectively tackle these challenges and optimize healthcare delivery and cost management.

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The Aspirational District Program (ADP) is a unique initiative of Government of India launched in 2018 that aims to reduce inter-district multidimensional inequality. ADP aims to bring the least developed districts to catch up with the rest of the other districts in the country. The program is comprehensive in its scope as it targets improvement of several key development indicators spanning health and nutrition, education, agriculture and water resources, financial inclusion and skill development and basic infrastructure indicators. Aspirational districts (ADs) are eligible for enhanced funding and priority allocation of various initiatives undertaken by the central and the state governments. Our research estimates the causal impact of ADP on the targeted health and nutrition indicators using a combination of propensity score matching and difference-in-differences (PSM-DID). We use the fourth and fifth rounds of National Family Health Survey (NFHS) data collected in 2015-16 and 2019-21 respectively which serve as the pre and post-treatment data for our analysis. Moreover, we take advantage of the transparent mechanism outlined for the identification of ADs under ADP, which we use for propensity score matching for our PSM-DID. While we observe negative impact of ADP on early initiation of breastfeeding, we believe that the impact is confounded with the effects of Covid-19 since part of NFHS-5 data was collected during the pandemic. However, the negative impact of ADP on early initiation of breastfeeding disappears when we only use pre-covid data (i.e. data for districts from states surveyed before the pandemic). Additionally, using pre-covid data we find a reduction in the prevalence of underweight children younger than 5 years to an extent of 2 to 4 percentage points in ADs as an impact of ADP, which is robust across multiple specification. We do not find evidence of a positive or a negative impact of ADP on any other health and nutrition indicators. Future research efforts should be made towards impact evaluation of all the targeted indicators in order to get a comprehensive unbiased evaluation of ADP.

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Introduction: The national volume-based drug procurement policy initiated in China since 2018 represents a significant reform in China's pharmaceutical distribution system. It has largely squeezed out the price bubble of low-end generic drugs, making competition in the pharmaceutical sales segment more intense and transparent. This policy intervenes in the distribution link of the pharmaceutical industry by intensifying market competition, thereby enhancing the innovation willingness and R&D capabilities of pharmaceutical companies. Methods: Taking the national volume-based drug procurement policy as the policy shock, we used the multi-period difference-in-difference method to study the impact of the policy on innovation input, innovation output quantity and innovation output quality of listed pharmaceutical companies and its impact mechanism. Results: We found that the volume-based policy can significantly promote the pharmaceutical companies' innovation input and the innovation output quality, but significantly reduced the innovation output quantity. For innovative and generic drug companies, this policy has limited impact on innovative drug companies, but force generic drug companies to pay more attention to cost control and market positioning, and the quality and cost-effectiveness of R&D output to ensure competitiveness in the market. For bid-winning and non-winning companies, the policy has a greater innovation incentive for non-winning companies than winning companies, by imposing greater survival pressure on non-winning companies, forcing them to increase R&D investment intensity and adopt the innovation strategy of preferring quality to quantity. Discussion: The results show that the national volume-based drug procurement policy should be expanded to lower drug prices and lighten the medical burden on patients, with enhanced quality and safety supervision. Additionally, it suggests cautious application of such policies to innovative and high-end generic drugs to encourage continued pharmaceutical innovation and industry advancement.

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Water resource management, as a foundation for supporting sustainable urban development, has garnered increasing attention from scholars. Developing effective water resource management plans is a major challenge faced by countries worldwide. This study uses the 2015 Water Pollution Control and Prevention Action Plan (WPCAP) in China as a natural experiment and employs a Difference-in-Differences (DID) model to estimate the relationship between WPCAP and urban water pollution from 2010 to 2021. The findings are as follows: 1) WPCAP reduces water pollution. 2) WPCAP decreases water pollution in high-policy-pressure cities but increases water pollution in low-policy-pressure cities within a 60 km radius, particularly having a significantly negative impact on water pollution in low-policy-pressure cities with low altitude. 3) optimizing industrial and domestic water use, as well as enhancing sewage treatment capabilities, are crucial pathways through which WPCAP reduces water pollution. Additionally, WPCAP significantly improves water pollution control capabilities in cities with abundant water resources, large cities, and industrialized cities. 4) although WPCAP's ability to control water pollution increases management costs, it also raises residential income and promotes population growth. These findings have important implications for the sustainable development of water resources in emerging countries, including China.

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This article reports on a study that examined the impact of a flipped English as a Foreign Language (EFL) course on college students' second language (L2) development. Specifically, an 18-week quasi-experiment was administered in a general English course at a Chinese university, with a total of 612 first-year students randomly assigned to the treatment (n = 137) and control (n = 475) groups. Using the propensity score matching and difference-in-differences (PSM-DID) model, we analyzed norm scores on high-stakes assessments administered on the entry and completion of the intervention. The results revealed a causal link between flipped learning (FL) and improved L2 language performance though the impact of FL had substantial heterogeneity as greater gains were found in reading than in writing and listening. Quantile regression analysis suggested the effectiveness of FL varied greatly by proficiency level in that students in the lowest quantiles achieved high improvement in reading and listening but moderate improvement in writing. We discuss the pedagogical implications of these findings to college L2 flipped instruction and recommend that future research be conducted in a more rigorous experimental design to obtain robust and accurate estimates of the effectiveness of FL.

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While there are numerous brain regions that have been shown to play a role in this AUD in humans and animal models, the central nucleus of the amygdala (CeA) has emerged as a critically important locus mediating binge alcohol consumption. In this study, we sought to understand how relative gene expression of key signaling molecules in the CeA changes during different periods of abstinence following bouts of binge drinking. To test this, we performed drinking in the dark (DID) on two separate cohorts of C57BL/6J mice and collected CeA brain tissue at 1 day (acute) and 7 days (protracted) abstinence after DID. We used qRTPCR to evaluate relative gene expression changes of 25 distinct genes of interest related to G protein-coupled receptors (GPCRs), neuropeptides, ion channel subunits, and enzymes that have been previously implicated in AUD. Our findings show that during acute abstinence CeA punches collected from female mice had upregulated relative mRNA expression of the gamma-aminobutyric acid receptor subunit alpha 2 (Gabra2), and the peptidase, angiotensinase c (Prcp). CeA punches from male mice at the same time point in abstinence had upregulated relative mRNA encoding for neuropeptide-related molecules, neuropeptide Y (Npy) and somatostatin (Sst), as well as the neuropeptide Y receptor Y2 (Npyr2), but downregulated Glutamate ionotropic receptor NMDA type subunit 1 (Grin1). After protracted abstinence, CeA punches collected from female mice had increased mRNA expression of corticotropin releasing hormone (Crh) and Npy. CeA punches collected from male mice at the same timepoint had upregulated relative mRNA expression of Npy2r, Npy, and Sst. Our findings support that there are differences in how the CeA of male and female mice respond to binge-alcohol exposure, highlighting the need to understand the implications of such differences in the context of AUD and binge drinking behavior.

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BACKGROUND/OBJECTIVE: ED representation places a tremendous drain on resources with mental health (MH) representation among the most common. This study aimed to identify patient and clinical factors associated with 28-day and six-month ED MH representation of an index MH ED presentation. METHOD: All MH related ED presentations from 1 January 2017 to 30 June 2019 were extracted from routinely collected administrative data. Cox regression and multinomial logistic regression models tested associations between patient characteristics and risk of representation. RESULTS: For the 8,010 patients, 28-day and six-month representations were 8 % and 16 % respectively. Self-identifying with a MH problem at index presentation (28-day hazard ratio (HR) = 1.48, 95 % CI = 1.19-1.84; six-month HR = 1.52, 95 % CI = 1.29-1.78), leaving ED before completing treatment (28-day HR = 4.13, 95 % CI = 3.36-5.08; six-month HR = 2.52, 95 % CI = 2.12-2.99), no private health insurance (six-month HR = 1.34, 95 % CI = 1.08-1.66), and hospital admission within one year prior to index (six month MH-related admission vs non-MH, HR = 1.59, 95 % CI = 1.19-2.13) were associated with increased risk of representation. Being uninsured was associated with frequent six-month representation among adults aged 16-39 years (OR = 3.16, 95 %CI = 1.59-6.25). CONCLUSION: Self-identifying with a MH problem, leaving ED prematurely, being uninsured and prior hospitalisation are areas for in-depth investigation for improved understanding of unplanned representations.

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The Covid pandemic changed the daily routines for millions of people. This was the case for those who were gainfully employed, especially for those who work as psychoanalysts and psychodynamic psychotherapists. At least for a good while, the practice of psychotherapy and psychoanalysis moved from the consulting room to the virtual world of the internet. The author explores the impact virtual therapy had on three different patients. One began a three time a week analysis during the pandemic. The duo met virtually for a year and a half before their first in person meeting. The other two patients had begun twice a week analyses a few years before the pandemic, met virtually for two years, until in person sessions restarted. The patients and the author describe their experiences.

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As a global public health problem, sedentary behavior has attracted more and more attention. Although numerous studies have demonstrated many benefits of green spaces to health, causal evidence on how green spaces affect people's sedentary behavior is scarce. This study used a natural experiment to evaluate the impact of greenway intervention on sedentary behavior. Two waves of data were collected in 2016 and 2019 (before and after the intervention) at East Lake Greenway (102-km-long) in Wuhan, China, with 1020 participants in 52 neighborhoods. We adopted three major methods to evaluate the impact of greenway intervention on sedentary behavior, including Propensity Score Matching and difference-in-difference (PSM-DID) method (with both individual and neighborhood variables to match samples), continuous treatment DID method (with distance to the greenway as the continuous treatment), and mediation analysis (with moderate to vigorous physical activity or MVPA, and walking time as the mediator). The results revealed that the greenway intervention significantly reduced participants' sedentary time and the intervention has a distance decay effect. The closer to the greenway, the greater decrease in sedentary time after the greenway opening. Furthermore, we found that MVPA and walking time mediate the impact of the greenway intervention on the change in sedentary behavior. The effect of greenway intervention was more beneficial for those under the age of 60, those who were employed, or those who were married. Our findings provided robust evidence that exposure to urban greenways affects sedentary behavior and such green infrastructures help protect public health in high-density urban areas.

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China is constantly seeking rapid, high-quality growth in order to meet its carbon peaking and neutrality goals. Approximately 40% of China's carbon emissions come from the electric power industry, which is beset by issues of poor efficiency and excessive emissions. Thus, it is essential to determine if environmental restrictions increase economic benefits total factor productivity while still preserving the environment. We use the Quasi-DID method to examine the impact of carbon emissions trading scheme on firm-level total factor productivity of electric power companies. The findings demonstrate the following: (1) carbon emissions trading scheme considerably impedes total factor productivity development; (2) the primary cause of this detrimental impact is the need for additional improvements in marketization since green innovation is still in its infancy; (3) additional study indicates that law enforcement's heterogeneity is what affects this restriction. Our research may both enhance the Chinese carbon emissions trading scheme's effectiveness assessment framework and point out several potential avenues for high-quality growth.

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OBJECTIVES: Trail running is a popular off-road sport involving running in natural environments over various terrains, often in remote locations. This study aims to investigate the epidemiology and risk factors of injuries and illnesses, i.e. medical encounters, on race day among trail runners in a high-altitude ultra trail race. METHODS: This descriptive cross-sectional study on an ultra trail race (38 km, 65 km and 100 km) in South Africa, included participants 18 years or older. Of the 331 race participants, 285(86.1%) consented to participate in the study. Data collection included demographic details, injuries (body region, specific body area, tissue type, pathology) and illnesses (organ system, symptom cluster, etiology). Risk factor analysis includes sex, age, weight, height, race distance, illness and injury history, training and running experience. Frequency (n, %), prevalence (%) and odds ratios (OR; 95%CI) are reported. RESULTS: Eighty-nine (31.2%) individuals reported 131 medical encounters [49 injuries (37.4%); 82 illnesses (62.6%)]. Injuries were sustained by 14.7% of athletes, and 22.5% reported illnesses. For injuries, the lower limb was mainly involved (n = 41; 83.7%). Most injuries affected the foot (n = 18; 36.7%), ankle (n = 10; 20.4%) and knee (n = 7; 14.3%). Tissue types mainly involved skin (n = 21; 42.8%), ligament (n = 7; 14.3%) and muscle (n = 7; 14.3%). Multiple (n = 45; 54.9%) and gastrointestinal (n = 17; 20.7%) organ systems were mainly involved in illnesses. Only 100 km runners reported dehydration (n = 28; 31.5%), and one in every six of these runners (n = 5; 17.9%) did not finish. Runners reporting fatigue (n = 21; 23.6%) had a high (n = 8; 38.1%) did not finish rate. Two in every five participants (n = 36; 40.4%) with a medical encounter, did not finish. No medical encounter-associated risk factors were identified. CONCLUSIONS: Illnesses were more common than injuries during the mountainous ultra trail race. Sustaining a medical encounter increased the chance of not completing the race. Further research on the epidemiology of race day medical encounters in trail running is required.