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Healthy life expectancy in China: Modelling and implications for public and private insurance

Published online by Cambridge University Press:  14 May 2020

Han Li ,
Katja Hanewald Open the ORCID record for Katja Hanewald [Opens in a new window]  and
Shang Wu
Han Li*
Affiliation:
Department of Actuarial Studies and Business Analytics, Macquarie University, Australia, and ARC Centre of Excellence in Population Ageing Research (CEPAR)
Katja Hanewald
Affiliation:
School of Risk & Actuarial Studies, UNSW Sydney, and Centre of Excellence in Population Ageing Research (CEPAR)
Shang Wu
Affiliation:
First State Super and ARC Centre of Excellence in Population Ageing Research (CEPAR)
*
*Corresponding author. E-mail: han.li@mq.edu.au
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Abstract

Already home to 23% of the global elderly population, China will experience further demographic change in the coming decades. To address the consequences of population ageing, the Chinese government is implementing major social insurance reforms and promotes the development of private insurance markets. We aim to inform these initiatives by developing a new method to project healthy life expectancy (HLE) in different regions. HLE is an important population health measure which is increasingly used in the actuarial literature. Our new approach relies on publicly available data from the Global Burden of Disease Study for life expectancy and HLE for 139 countries. We use the model to estimate HLE at birth in 2015 for 31 province-level regions in China for both males and females. We discuss the implications of our results for planned increases in the retirement age in China and for long-term care insurance pricing.

Keywords

Healthy life expectancyPredictive regression modellingHealth inequalityChina
Type
Paper
Information
Annals of Actuarial Science , Volume 15 , Issue 1 , March 2021 , pp. 40 - 56
Copyright
© Institute and Faculty of Actuaries 2020

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References

Acciai, F., Noah, A.J., & Firebaugh, G. (2015). Pinpointing the sources of the Asian mortality advantage in the USA. Journal of Epidemiology and Community Health, 69(10), 1006–1011.CrossRefGoogle ScholarPubMed
Babiarz, K.S., Eggleston, K., Miller, G. & Zhang, Q. (2015). An exploration of China’s mortality decline under Mao: A provincial analysis, 1950–80. Population Studies, 69(1), 39–56.CrossRefGoogle Scholar
Banister, J. & Hill, K. (2004). Mortality in China 1964–2000. Population Studies, 58(1), 55–75.CrossRefGoogle ScholarPubMed
Barford, A., Dorling, D., Smith, G.D. & Shaw, M. (2006). Life expectancy: Women now on top everywhere: During 2006, even in the poorest countries, women can expect to outlive men. BMJ: British Medical Journal, 332(7545), 808.CrossRefGoogle Scholar
Brønnum-Hansen, H. (2005). Health expectancy in Denmark, 1987–2000. European Journal of Public Health, 15(1), 20–25.CrossRefGoogle Scholar
China Data Online. (2017). Statistical tables. Available online at the address http://chinadataonline.org/member/macroyr/ [accessed: 17-Jan-2017].Google Scholar
Chowdhury, A. (2007). Handbook on the Northeast and Southeast Asian Economies. Edward Elgar Publishing, Cheltenham, UK.CrossRefGoogle Scholar
Crimmins, E.M., Saito, Y. & Ingegneri, D. (1997). Trends in disability-free life expectancy in the United States, 1970-90. Population and Development Review, 23(3), 555–572.CrossRefGoogle Scholar
Dubois, M.-F. & Hébert, R. (2006). Cognitive-impairment-free life expectancy for Canadian seniors. Dementia and Geriatric Cognitive Disorders, 22(4), 327–333.CrossRefGoogle ScholarPubMed
Elo, I.T. & Preston, S.H. (1997). Racial and ethnic differences in mortality at older ages. In Martin, L.G. & Soldo, B.J. (Eds.), Racial and Ethnic Differences in the Health of Older Americans (pp. 10–42). National Academy Press, Washington, DC.Google Scholar
Evandrou, M., Falkingham, J., Feng, Z. & Vlachantoni, A. (2014). Individual and province inequalities in health among older people in China: Evidence and policy implications. Health & Place, 30, 134–144.CrossRefGoogle ScholarPubMed
Fang, H. & Feng, J. (2018). The Chinese pension system. NBER Working Paper No. 25088.CrossRefGoogle Scholar
Giles, J., Lei, X., Wang, Y. & Zhao, Y. (2015). One country, two systems: Evidence on retirement patterns in China. Asian Bureau of Finance and Economic Research Working Paper, February.Google Scholar
Greene, W.H. (2003). Econometric Analysis, 5th edition. Prentice Hall.Google Scholar
Gu, D., Dupre, M.E., Warner, D.F. & Zeng, Y. (2009). Changing health status and health expectancies among older adults in China: Gender differences from 1992 to 2002. Social Science & Medicine, 68(12), 2170–2179.CrossRefGoogle ScholarPubMed
Hammond, R., Baxter, S., Bramley, R., Kakkad, A., Mehta, S. & Sadler, M. (2016). Considerations on state pension age in the United Kingdom. British Actuarial Journal, 21(1), 165–203.CrossRefGoogle Scholar
Hanewald, K., Li, H. & Shao, A. W. (2019). Modelling multi-state health transitions in China: A generalised linear model with time trends. Annals of Actuarial Science, 13(1), 145–165.CrossRefGoogle Scholar
Hanewald, K., Bateman, H., Fang, H. & Wu, S. (2020). Is there a demand for reverse mortgages in China? Evidence from two online surveys. Journal of Economic Behavior & Organization, 169, 19–37.CrossRefGoogle Scholar
Härdle, W. (1990). Applied Nonparametric Regression. Cambridge University Press, Cambridge, UK.CrossRefGoogle Scholar
Huang, F. (2017). Mortality forecasting using a modified CMI Mortality Projections Model for China II: Cities, towns and counties. Annals of Actuarial Science, 11(1), 46–66.CrossRefGoogle Scholar
Imai, K. & Soneji, S. (2007). On the estimation of disability-free life expectancy: Sullivan’s method and its extension. Journal of the American Statistical Association, 102(480), 1199–1211.CrossRefGoogle ScholarPubMed
Jagger, C. (2015). Trends in life expectancy and healthy life expectancy, technical report, Foresight, UK Government Office for Science, London.Google Scholar
Jagger, C., Gillies, C., Cambois, E., Van Oyen, H., Nusselder, W. & Robine, J.-M. (2009). Trends in Disability-free Life Expectancy at age 16 and age 65 in the European Union 1995-2001: A comparison of 13 EU countries, technical report, European Health Expectancy Monitoring Unit, Montpellier, France.Google Scholar
Jagger, C., Van Oyen, H. & Robine, J.-M. (2014). Health expectancy calculation by the Sullivan method: A practical guide, 4th edition, technical report, Newcastle University, Institute for Ageing.Google Scholar
Kaneda, T., Zimmer, Z. & Tang, Z. (2005). Socioeconomic status differentials in life and active life expectancy among older adults in Beijing. Disability and Rehabilitation, 27(5), 241–251.CrossRefGoogle ScholarPubMed
Kassebaum, N.J., Arora, M., Barber, R.M., Bhutta, Z.A., Brown, J., Carter, A., Casey, D.C., Charlson, F.J., Coates, M.M., Coggeshall, M., et al. (2016). Global, regional, and national disability-adjusted life-years (DALYs) for 315 diseases and injuries and healthy life expectancy (HALE), 1990-2015: A systematic analysis for the global burden of disease study 2015. The Lancet, 388(10053), 1603.CrossRefGoogle Scholar
Law, C. & Yip, P. (2003). Healthy life expectancy in Hong Kong special administrative region of China. Bulletin of the World Health Organization, 81(1), 43–47.Google Scholar
Li, L. & Fu, H. (2017). China’s health care system reform: Progress and prospects. The International Journal of Health Planning and Management, 32(3), 240–253.CrossRefGoogle ScholarPubMed
Li, Z., Shao, A.W. & Sherris, M. (2017). The impact of systematic trend and uncertainty on mortality and disability in a multistate latent factor model for transition rates. North American Actuarial Journal, 21(4), 594–610.CrossRefGoogle Scholar
Lièvre, A., Alley, D. & Crimmins, E.M. (2008). Educational differentials in life expectancy with cognitive impairment among the elderly in the United States. Journal of Aging and Health, 20(4), 456–477.CrossRefGoogle ScholarPubMed
Litterman, R.B. (1986). Forecasting with Bayesian vector autoregressions—five years of experience. Journal of Business & Economic Statistics, 4(1), 25–38.Google Scholar
Liu, J., Chen, G., Chi, I., Wu, J., Pei, L., Song, X., Zhang, L., Pang, L., Han, Y. & Zheng, X. (2010). Regional variations in and correlates of disability-free life expectancy among older adults in China. BMC Public Health, 10(1), 446.CrossRefGoogle ScholarPubMed
Lu, B., Mi, H., Zhu, Y. & Piggott, J. (2017). A sustainable long-term health care system for aging China: A case study of regional practice. Health Systems & Reform, 3(3), 182–190.CrossRefGoogle Scholar
Mac Nally, R. (2000). Regression and model-building in conservation biology, biogeography and ecology: The distinction between – and reconciliation of – ‘predictive’ and ‘explanatory’ models. Biodiversity and Conservation, 9(5), 655–671.CrossRefGoogle Scholar
Majer, I.M., Stevens, R., Nusselder, W.J., Mackenbach, J.P. & van Baal, P.H. (2013). Modeling and forecasting health expectancy: Theoretical framework and application. Demography, 50(2), 673–697.CrossRefGoogle ScholarPubMed
Manton, K.G., Gu, X. & Lamb, V.L. (2006). Long-term trends in life expectancy and active life expectancy in the United States. Population and Development Review, 32(1), 81–105.CrossRefGoogle Scholar
Mondal, M.N.I. & Shitan, M. (2014). Relative importance of demographic, socioeconomic and health factors on life expectancy in low-and lower-middle-income countries. Journal of Epidemiology, 24(2), 117–124.CrossRefGoogle ScholarPubMed
Murray, C.J. & Lopez, A.D. (1997). Global mortality, disability, and the contribution of risk factors: Global burden of disease study. The Lancet, 349(9063), 1436–1442.CrossRefGoogle ScholarPubMed
Murray, C.J., Barber, R.M., Foreman, K.J., Ozgoren, A.A., Abd-Allah, F., Abera, S.F., Aboyans, V., Abraham, J.P., Abubakar, I., Abu-Raddad, L.J., et al. (2015). Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990–2013: Quantifying the epidemiological transition. The Lancet, 386(10009), 2145–2191.CrossRefGoogle ScholarPubMed
Murtagh, K.N. & Hubert, H.B. (2004). Gender differences in physical disability among an elderly cohort. American Journal of Public Health, 94(8), 1406–1411.CrossRefGoogle ScholarPubMed
Murthy, V.N. & Okunade, A.A. (2014). Population health status and economic growth in Chinese provinces: Some policy implications. Applied Economics Letters, 21(6), 377–382.CrossRefGoogle Scholar
National Bureau of Statistics of China. (2017a). 1% Population Sample Census 2015. Available online at the address http://data.stats.gov.cn/easyquery.htm?cn=E0103 [accessed 5-May-2017].Google Scholar
National Bureau of Statistics of China. (2017b). Statistical tables. Available online at the address http://data.stats.gov.cn/english/easyquery.htm [accessed 17-Jan-2017].Google Scholar
National Institute on Ageing. (2011). Global health and aging, technical report, U.S. Department of Health and Human Services, Washington, DC.Google Scholar
National Statistics Republic of China (Taiwan). (2017). Statistical Tables. Available online at the address https://eng.stat.gov.tw [accessed 24-Jan-2017].Google Scholar
OECD. (2017). Economic Indicators. Available online at the address https://data.oecd.org/ [accessed 10-Jan-2017].Google Scholar
Oeppen, J. & Vaupel, J.W. (2002). Broken limits to life expectancy. Science, 296(5570), 1029–1031.CrossRefGoogle ScholarPubMed
Ramsey, J.B. (1969). Tests for specification errors in classical linear least-squares regression analysis. Journal of the Royal Statistical Society. Series B (Methodological), 31(2), 350–371.CrossRefGoogle Scholar
Salomon, J.A., Wang, H., Freeman, M.K., Vos, T., Flaxman, A.D., Lopez, A.D. & Murray, C.J. (2013). Healthy life expectancy for 187 countries, 1990–2010: A systematic analysis for the Global Burden Disease Study 2010. The Lancet, 380(9859), 2144–2162.CrossRefGoogle Scholar
Sanders, B.S. (1964). Measuring community health levels. American Journal of Public Health and the Nations Health, 54(7), 1063–1070.CrossRefGoogle ScholarPubMed
Schwarz, G. (1978). Estimating the dimension of a model. The Annals of Statistics, 6(2), 461–464.CrossRefGoogle Scholar
Sede, P.I. & Ohemeng, W. (2015). Socio-economic determinants of life expectancy in Nigeria (1980–2011). Health Economics Review, 5(1), 2.CrossRefGoogle Scholar
Shmueli, G. (2010). To explain or to predict? Statistical Science, 25(3), 289–310.CrossRefGoogle Scholar
Smith, M., Edgar, G., & Groom, G. (2008). Report: Health expectancies in the United Kingdom, 2004-06. Health Statistics Quarterly, 40, 77–80.Google Scholar
The Economist. (2015). If China’s provinces were countries… Noodles of longevity. The Economist, 31 October 2015.Google Scholar
Tibshirani, R. (1996). Regression shrinkage and selection via the lasso. Journal of the Royal Statistical Society. Series B (Methodological), 58(1), 267–288.CrossRefGoogle Scholar
United Nations. (2017). World Population Prospects: The 2017 Revision. United Nations, Department of Economic and Social Affairs, Population Division, New York. Custom data acquired via website. Available online at the address https://population.un.org/wpp/ [accessed 26-Feb-2019].Google Scholar
Van Oyen, H., Nusselder, W., Jagger, C., Kolip, P., Cambois, E. & Robine, J.-M. (2013). Gender differences in healthy life years within the EU: An exploration of the “health-survival” paradox. International Journal of Public Health, 58(1), 143–155.CrossRefGoogle ScholarPubMed
Wong, C.H. & Tsui, A.K. (2015). Forecasting life expectancy: Evidence from a new survival function. Insurance: Mathematics and Economics, 65, 208–226.Google Scholar
World Bank. (2017). World Development Indicators. Available online at the address http://data.worldbank.org/indicator [accessed 10-Jan-2017].Google Scholar
World Bank. (2019). World Development Indicators. Available online at the address http://data.worldbank.org/indicator [accessed 26-Feb-2019].Google Scholar
World Data Atlas. (2017). Development Statistics of Taiwan. Available online at the address https://knoema.com/TWDS2014/development-statistics-of-taiwan-2013 [accessed 24-Jan-2017].Google Scholar
Yang, W., Jingwei He, A., Fang, L. & Mossialos, E. (2016). Financing institutional long-term care for the elderly in China: A policy evaluation of new models. Health Policy and Planning, 31(10), 1391–1401.CrossRefGoogle ScholarPubMed
Zhang, J. & Li, L.W. (2015). Provincial variation in marketization and successful aging in China: A multilevel analysis. Journal of Population Ageing, 8(3), 203–222.CrossRefGoogle Scholar