Does health insurance matter? Evidence from China’s urban resident basic medical insurance

Hong, Liu; Zhao, Zhong

doi:10.1016/j.jce.2014.02.003

Cited by 113 publications

(96 citation statements)

References 33 publications

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“…These findings are consistent with those of Liu and Zhao (2014), who investigate the effects of the URBMI provision and find that the high-income group is less responsive to price changes. The results show that the increased cost sharing of the UEBMI has stronger negative impacts for low-income and middle-income groups: the two groups' probabilities of utilizing the outpatient care decrease 23.4 and 6.5 percentage points, and their outpatient spending declines by 63.5 and 41.4%, respectively.…”

Section: Heterogeneous Effects Of Urban Employee Basic Medical Insurancesupporting

confidence: 89%

“…We denote an individual by i, the residential province by s, and the year by t. Following the literature (Chen et al, 2007;Aron-Dine et al, 2013;Liu and Zhao, 2014), the baseline DID model takes the following form: To evaluate whether reform has resulted in expectable achievements, we must investigate whether the reform has reduced the overuse of medical resources.…”

Section: Identification Strategymentioning

confidence: 99%

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The Impacts of China's Urban Employee Basic Medical Insurance on Healthcare Expenditures and Health Outcomes

Huang

Gan

2015

Health Econ.

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At the end of 1998, China launched a government-run mandatory insurance program, the urban employee basic medical insurance (UEBMI), to replace the previous medical insurance system. Using the UEBMI reform in China as a natural experiment, this study identifies variations in patient cost sharing that were imposed by the UEBMI reform and examines their effects on the demand for healthcare services. Using data from the 1991-2006 waves of the China Health and Nutrition Survey, we find that increased cost sharing is associated with decreased outpatient medical care utilization and expenditures but not with decreased inpatient care utilization and expenditures. Patients from low-income and middle-income households or with less severe medical conditions are more sensitive to prices. We observe little impact on patient's health, as measured by self-reported health status. Copyright © 2015 John Wiley & Sons, Ltd.

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Section: Heterogeneous Effects Of Urban Employee Basic Medical Insurancesupporting

confidence: 89%

Section: Identification Strategymentioning

confidence: 99%

The Impacts of China's Urban Employee Basic Medical Insurance on Healthcare Expenditures and Health Outcomes

Huang

Gan

2015

Health Econ.

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“…Less studied are the urban insurance plans, though early and isolated evidence suggests slight decreases in both total expenditures (35) and drug expenditures (96). Although some studies show no impact of health insurance coverage on OOP expenses in either Urban or Rural Resident health insurance (38,42), some evidence indicates reduced overall OOP expenses in both Rural Resident insurance enrollees (2,13,25) and Urban Employee insurance enrollees (34). This mixed evidence is likely due to differences in study samples with different insurance types and inpatient/outpatient variation.…”

Section: Impact Of Insurance On Patientsmentioning

confidence: 99%

“…Although some studies show no significant increases in utilization of outpatient services for certain subpopulations, such as the elderly (34), or decreased usage during the initial implementation in the 1990s (26), the balance of research shows increases in outpatient utilization. Outpatient visits increased by 3.6 percentage points for Rural Resident Insurance enrollees (57) and by 7-13 percentage points for Urban Resident Insurance enrollees (38), and the probability of outpatient treatment increased by 12.6% for Urban Employee Insurance enrollees (34). Additionally, more generous insurance plans, including immediate cost-sharing at higher levels, increased outpatient visits (24,68,95).…”

Section: Access and Utilizationmentioning

confidence: 99%

China's Health Reform Update

Liu

Vortherms

Hong

2017

Annu. Rev. Public Health

220

215

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China experienced both economic and epistemological transitions within the past few decades, greatly increasing demand for accessible and affordable health care. These shifts put significant pressure on the existing outdated, highly centralized bureaucratic system. Adjusting to growing demands, the government has pursued a new round of health reforms since the late 2000s; the main goals are to reform health care financing, essential drug policies, and public hospitals. Health care financing reform led to universal basic medical insurance, whereas the public hospital reform required more complex measures ranging from changes in regulatory, operational, and service delivery settings to personnel management. This article reviews these major policy changes and the literature-based evidence of the effects of reforms on cost, access, and quality of care. It then highlights the outlook for future reforms. We argue that a better understanding of the unintended consequences of reform policies and of how practitioners' and patients' interests can be better aligned is essential for reforms to succeed.

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“…However, Huang and Gan (2015) applied DID model using the China Health and Nutrition Survey (CHNS) data set from 1991-2006, and found that the probability of utilizing out-patient care and outpatient expenditures both declines due to the UEBMI reform, but insignificant and smaller for the inpatient. For the URBMI, Liu and Zhao (2014) explored the fixed effects approach with instrumental variable correction, used the CHNS data from 2006-2009, and found URBMI has significantly increased the utilization of formal medical services, but not reduced OOP health expense. While Huang and Gan (2012) demonstrated the outpatient total medical expense significantly declines 28.6%-30.6%, but insignificant in OOP healthcare spending.…”

Section: Impact Of Healthcare On Medical Expenditurementioning

confidence: 99%

Impact of healthcare insurance on medical expense in China: new evidence from meta-analysis

et al. 2017

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This paper is aimed to make sense of the real effect of implement of social healthcare insurance on one's medical expense in China. Due to previous studies drew various and inconsistent conclusions on this issue, this works intend to apply meta-analysis to the problem. For 31 related studies, we first implement an advanced conditional Dirichlet-based Bayesian semi-parametric model specific to meta-analysis, and come to a primary conclusion that healthcare possesses little probability reducing one's medical expense in China. Further, the authors conduct random effects meta-regression and find that heterogeneity exists among the observed effect sizes. Mixed effects model shows that the age variation may is actually the heterogeneity source. The coefficients for Nonold and Old are respectively 0.29 and 0.54, implying that when researching on the medical expense for the elderly, it is more likely to conclude the medical insurance could increase medical spending. The coefficients for IV and OLS are both National Center for Mathematics and Interdisciplinary Sciences, CAS, Beijing, China remarkably negative at 90% confidence level. This suggests when directly using Instrument Variable (IV) approach and OLS method to assess the implementation effect for the healthcare insurance, it is inclined to result in the reduced impact on medical expense. We deduce this is because this two methods can't solve the sample-selection bias when compared with the Two-part model and difference-in-difference (DID) model. Based on the results and discussion, we finally propose suggests for the government.

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Does health insurance matter? Evidence from China’s urban resident basic medical insurance

Cited by 113 publications

References 33 publications

The Impacts of China's Urban Employee Basic Medical Insurance on Healthcare Expenditures and Health Outcomes

The Impacts of China's Urban Employee Basic Medical Insurance on Healthcare Expenditures and Health Outcomes

China's Health Reform Update

Impact of healthcare insurance on medical expense in China: new evidence from meta-analysis

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