The collapse of China's Cooperative Medical System (CMS) in 1978 resulted in the lack of an organized financing scheme for health care, adversely affecting rural farmers' access to health care, especially among the poor. The Chinese government recently announced a policy to re-establish some forms of community-based insurance (CBI). Many existing schemes involve low premiums but high co-payments. We hypothesized that such benefit design leads to unequal distribution of the "net benefits" (NB)--benefits net of payment--because even though low premiums are more affordable to poor farmers, high co-payments may have a significant deterrent effect on the poor in the use of services in CBI. To test this hypothesis empirically, we estimated the probability of farmers joining a re-established CBI using logistic regression, and the utilization of health care services for those who joined the scheme using the two-part model. Based on the estimations, we predicted the distribution of NB among those who joined the CBI and for the entire population in the community. Our data came from a household survey of 4160 members of 1173 households conducted in six villages in Fengshan Township, Guizhou Province, China. Three principal findings emerged from this study. First, income is an important factor influencing farmers' decision to join a CBI despite the premium representing a very small fraction of household income. Secondly, both income and health status influence enrollees' utilization of health services: richer/sicker participants obtain greater NB from the CBI than poorer/healthier members, meaning that the poorer/healthier participants subsidize the rich/sick. Thirdly, wealthy farmers benefit the most from the CBI with low premium and high co-payment features at every level of health status. In conclusion, policy recommendations related to the improvement of the benefit distribution of CBI schemes are made based on the results from this study.

No abstract

No abstract

Despite widespread efforts to expand health insurance in developing countries, there is scant evidence as to whether doing so actually improves people's health. This paper aims to fill this gap by evaluating the impact of Rural Mutual Health Care (RMHC), a community-based health insurance scheme, on enrollees' health outcomes. RMHC is a social experiment that was conducted in one of China's western provinces from 2003 to 2006. The RMHC experiment adopted a pre-post treatment-control study design. This study used panel data collected in 2002, 1 year prior to the intervention, and followed up in 2005, 2 years after the intervention, both in the intervention and control sites. We measured health status using both a 5-point Categorical Rating Scale and the EQ-5D instruments. The estimation method used here is difference-in-difference combined propensity score matching. The results show that RMHC has a positive effect on the health status of participants. Among the five dimensions of EQ-5D, RMHC significantly reduces pain/discomfort and anxiety/depression for the general population, and has a positive impact on mobility and usual activity for those over 55-years old. Our study provides useful policy information on the development of health insurance in developing countries, and also identifies areas where further research is needed.

No abstract