Background: The disparities in healthcare access due to varying insurance coverage significantly impact hospital outcomes, yet what is unclear is the role of insurance in providing care once the patient is in the hospital for a preventable admission, particularly in a weak gatekeeping environment. This study aimed to investigate the association between insurance types and readmission rates, healthcare expenditures, and length of hospital stay among patients with chronic ambulatory care sensitive conditions (ACSCs) in China. Methods: This retrospective observational study utilized hospitalization data collected from the Nanhai District, Foshan City, between 2016 and 2020. Generalized linear models (GLMs) were employed to analyze the relationship between medical insurance types and readmission rates, lengths of hospital stay, total medical expenses, out-of-pocket expenses, and insurance-covered expenses. Results: A total of 185,384 records were included. Among these, the participants covered by urban employee basic medical insurance (UEBMI) with 44,415 records and urban and rural resident basic medical insurance (URRBMI) with 80,752 records generally experienced more favorable outcomes compared to self-pay patients. Specifically, they had lower readmission rates (OR = 0.57, 95% CI: 0.36 to 0.90; OR = 0.59, 95% CI: 0.42 to 0.84) and reduced out-of-pocket expenses (β = −0.54, 95% CI: −0.94 to −0.14; β = −0.41, 95% CI: −0.78 to −0.05). However, they also experienced slightly longer lengths of hospital stay (IRR = 1.08, 95% CI: 1.03 to 1.14; IRR = 1.11, 95% CI: 1.04 to 1.18) and higher total medical expenses (β = 0.26, 95% CI: 0.09 to 0.44; β = 0.25, 95% CI: 0.10 to 0.40). Conclusions: This study found that different types of health insurance were associated with varying clinical outcomes among patients with chronic ambulatory care sensitive conditions (ACSCs) in China. Since the hospitalization of these patients was initially avoidable, disparities in readmission rates, lengths of hospital stay, and medical expenses among avoidable inpatient cases exacerbated the health gap between different insurance types. Addressing the disparities among different types of insurance can help reduce unplanned hospitalizations and promote health equity.

Household air pollution from solid cooking fuel use influences multiple health outcomes, but its association with body pain remains poorly understood. This was a longitudinal study of 8880 adults who participated in the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2018. Household cooking fuels were extracted from the baseline household questionnaire. Transitions in cooking fuels from 2011 to 2018 were also identified. Body pain status was reported in the three waves of surveys conducted in 2011, 2015, and 2018. The associations between cooking fuel type, fuel transition, and pain site number were examined using generalized estimating equations. Among the 8880 participants, 41.4% (n = 3680) primarily used clean fuels for cooking, and 58.6% (n = 5200) used solid ones at baseline. Cooking with solid fuels was associated with more pain sites (incidence rate ratio (IRR): 1.14; 95% confidence interval (CI): 1.08 to 1.21), but a slower rate of pain sites increases from 2011 to 2018 (IRR = 0.78; 95% CI: 0.71 to 0.86, for 2018 × solid fuels). Compared with those who persistently used clean fuels for cooking, the number of pain sites increased by 10% in participants who transiting from using solid to clean fuels (IRR = 1.10; 95% CI: 1.04 to 1.18), by 21% in those transiting from cooking with clean to solid fuels (IRR = 1.21: 95% CI: 1.08 to 1.35) and by 25% among those persistent using solid fuels for cooking (IRR = 1.25; 95% CI: 1.18 to 1.34). Our findings provided new evidence linking using solid fuels for cooking with more pain sites, but a slower rate of pain sites increases. Public health efforts should focus on fuel transition and take measures to help clean fuels spread.

Background: Both distance to the hospital and hospital reputation influence patient choice of hospital; but the combined effect of these factors and how they relate to hospitalization outcomes has yet to be determined. The purpose of this study was to assess the combined influence of distance to hospital and hospital reputation on the hospitalization outcomes in patients with stroke. Methods: This retrospective observational study utilized data from 69,107 stroke patients hospitalized in southern Chinese megacity between 2019 and 2021. A generalized linear model was used to assess the association between hospital reputation, distance to the hospital, hospitalization costs, and the length of stay. Multivariate logistic regression was used to estimate the combined effect on in-hospital mortality. Results: Compared with patients who chose hospitals without a good reputation and close to home, those who chose hospitals with a good reputation had lower hospitalization costs (−0.05; 95% CI: −0.08 to −0.02), a shorter length of stay (−0.18; 95% CI: −0.20 to −0.16), and lower in-hospital mortality (0.52; 95% CI: 0.40 to 0.67). However, patients who chose hospitals with a good reputation but farther distance experienced higher hospitalization costs (0.20; 95% CI: 0.17 to 0.23). Conclusions: A shorter distance to the hospital and a higher reputation of the hospital are associated with lower costs and better outcomes. Our study indicates that improving outcomes for patients with stroke requires equitable distribution of quality medical resources.