<|begin_of_text|><|start_header_id|>system<|end_header_id|>You are an expert on climate change, human mobility and migration. Answer the question truthfully.<|eot_id|><|start_header_id|>user<|end_header_id|>Here are the title and abstract of a scientific paper probably related to climate change, human mobility and migration..
Title:"Does health insurance reduce out-of-pocket expenditure? Heterogeneity among China's middle-aged and elderly."
Abstract:"China's recent healthcare reforms aim to provide fair and affordable health services for its huge population. In this paper, we investigate the association between China's health insurance and out-of-pocket (OOP) healthcare expenditure. We further explore the heterogeneity in this association. Using data of 32,387 middle-aged and elderly individuals drawn from the 2011 and 2013 waves of China Health and Retirement Longitudinal Study (CHARLS), we report five findings. First, having health insurance increases the likelihood of utilizing healthcare and reduces inpatient OOP expenditure. Second, healthcare benefits are distributed unevenly: while low- and medium-income individuals are the main beneficiaries with reduced OOP expenditure, those faced with very high medical bills are still at risk, owing to limited and shallow coverage in certain aspects. Third, rural migrants hardly benefit from having health insurance, suggesting that institutional barriers are still in place. Fourth, health insurance does not increase patient visits to primary care facilities; hospitals are still the main provider of healthcare. Nonetheless, there is some evidence that patients shift from higher-tier to lower-tier hospitals. Last, OOP spending on pharmaceuticals is reduced for inpatient care but not for outpatient care, suggesting that people rely on inpatient care to obtain reimbursable drugs, putting further pressure on the already overcrowded hospitals. Our findings suggest that China's health insurance system has been effective in boosting healthcare utilization and lowering OOP hospitalization expenditure, but there still remain challenges due to the less generous rural scheme, shallow outpatient care coverage, lack of insurance portability, and an underdeveloped primary healthcare system. (C) 2017 Elsevier Ltd. All rights reserved.."
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Q1: Is this article is about 'human migration mobility': 1 = yes; 0 = no. Answer with a number. Do not give a textual explanation.

Q2: What drivers of migration and mobility does the article study? 0 = 'other', 1 = 'climate', 2 = 'environment', 3 = 'economic', 4 = 'conflict', 5 = 'political', 6 = 'social', 7 = 'family'. Answer with a number or a sequence of numbers separated by commas. Do not give a textual explanation. 

Q3: What is the overall sentiment of the article?:0 = 'neutral', 1 = 'negative', 2 = 'positive'. Answer with a number. Do not give a textual explanation.

Q4: What type of climate or environmental keywords are explicitly mentioned?:  0 = 'none', 1 = 'algal blooms', 2 = 'infestation', 3 = 'infectious diseases', 4 = 'ocean acidification', 5 = 'sea ice', 6 = 'acid rain', 7 = 'drought', 8 = 'cold wave', 9 = 'heat wave', 10 = 'glacial', 11 = 'wildfire', 12 = 'air pollution', 13 = 'biodiversity loss', 14 = 'coastal erosion', 15 = 'land degradation', 16 = 'deforestation', 17 = 'desertification', 18 = 'water pollution', 19 = 'diebacks', 20 = 'permafrost loss', 21 = 'sand mining', 22 = 'sea level rise', 23 = 'earthquake', 24 = 'tsunami', 25 = 'volcanic', 26 = 'flood', 27 = 'avalanche', 28 = 'landslide', 29 = 'downburst', 30 = 'thunderstorm', 31 = 'sandstorm', 32 = 'haze', 33 = 'storm', 34 = 'cyclone', 35 = 'blizzard', 36 = 'hail', 37 = 'snow', 38 = 'tornado', 39 = 'wind', 40 = 'hurricane', 41 = 'typhoon', 42 = 'other'. Answer with a number or a sequence of numbers separated by commas. Do not give a textual explanation. 

Q5: What discipline does the article belong to?: 0 = 'other', 1 = 'social science', 2 = 'natural science', 3 = 'arts and humanities', 4 = 'multidiscipline and interdiscipline'. Answer with a number. Do not give a textual explanation.

Q6: Does the article apply quantitative and/or statistical analysis?: 0 = 'no', 1 = 'yes'. Answer with a number. Do not give a textual explanation.

Use the following template: 

Q1 = [];
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Q6 = [].<|eot_id|><|start_header_id|>assistant<|end_header_id|>Answer:
Q1 = [0];
Q2 = [];
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Q5 = [1];
Q6 = [1].
Does health insurance reduce out-of-pocket expenditure? Heterogeneity among China's middle-aged and elderly
China's recent healthcare reforms aim to provide fair and affordable health services for its huge population. In this paper, we investigate the association between China's health insurance and out-of-pocket (OOP) healthcare expenditure. We further explore the heterogeneity in this association. Using data of 32,387 middle-aged and elderly individuals drawn from the 2011 and 2013 waves of China Health and Retirement Longitudinal Study (CHARLS), we report five findings. First, having health insurance increases the likelihood of utilizing healthcare and reduces inpatient OOP expenditure. Second, healthcare benefits are distributed unevenly: while low- and medium-income individuals are the main beneficiaries with reduced OOP expenditure, those faced with very high medical bills are still at risk, owing to limited and shallow coverage in certain aspects. Third, rural migrants hardly benefit from having health insurance, suggesting that institutional barriers are still in place. Fourth, health insurance does not increase patient visits to primary care facilities; hospitals are still the main provider of healthcare. Nonetheless, there is some evidence that patients shift from higher-tier to lower-tier hospitals. Last, OOP spending on pharmaceuticals is reduced for inpatient care but not for outpatient care, suggesting that people rely on inpatient care to obtain reimbursable drugs, putting further pressure on the already overcrowded hospitals. Our findings suggest that China's health insurance system has been effective in boosting healthcare utilization and lowering OOP hospitalization expenditure, but there still remain challenges due to the less generous rural scheme, shallow outpatient care coverage, lack of insurance portability, and an underdeveloped primary healthcare system. (C) 2017 Elsevier Ltd. All rights reserved.