Income-dependent impacts of health insurance on medical expenditures: Theory and evidence from China

Chen, Yi; Shi, Julie; Zhuang, Castiel Chen

doi:10.1016/j.chieco.2018.10.002

Cited by 24 publications

(13 citation statements)

References 45 publications

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“…The NRCMS reduced barriers to the use of the health services, thereby decreasing households' OOP payment, affecting households with disabled members, households with elementary and junior high level education, and the households with two or less people. However, in some respects, it was still not efficient in reducing the overall risk of households falling into poverty [34]. We, thus, diagnosed the critical reasons for the failure of the NRCMS:…”

Section: Discussionmentioning

confidence: 98%

Targeting vulnerable groups of health poverty alleviation in rural China— what is the role of the New Rural Cooperative Medical Scheme for the middle age and elderly population?

Wang

et al. 2020

Int J Equity Health

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Background In light of the health poverty alleviation policy, we explore whether the New Rural Cooperative Medical System (NRCMS) has effectively reduced the economic burden of medical expenses on rural middle-aged and elderly people and other impoverished vulnerable groups. The study aims to provide evidence that can be used to improve the medical insurance system. Methods Data were obtained from the 2015 China Health and Retirement Longitudinal Study (CHARLS). The method of calculating the catastrophic health expenditure (CHE) and impoverishment by medical expense (IME) was adopted from the World Health Organization (WHO). The treatment effect model was used to identify the determinants of CHE for rural middle-aged and elderly people. Results The incidence of CHE in rural China for middle-aged and elderly people is 21.8%, and the IME is 8.0%. The households that had enrolled in the NRCMS suffered higher CHE (21.9%) and IME (8.0%), than those that had not enrolled (CHE: 20.6% and IME: 7.7%). The NRCMS did not provide sufficient economic protection from CHE for households with three or more chronic diseases, inpatients, or households with members aged over 65 years. Key risk factors for the CHE included education levels, households with inpatients, households with members aged over 65 years, and households with disabilities. Conclusions Although the NRCMS has reduced barriers to the usage of household health services by reducing people’s out-of-pocket payments, it has not effectively reduced the risk of these households falling into poverty. Our research identifies the characteristics of vulnerable groups that the NRCMS does not provide enough support for, and which puts them at a greater risk of falling into poverty due to health impoverishment.

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Section: Discussionmentioning

confidence: 98%

Targeting vulnerable groups of health poverty alleviation in rural China— what is the role of the New Rural Cooperative Medical Scheme for the middle age and elderly population?

Wang

et al. 2020

Int J Equity Health

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“…To account for unobserved confounding variables, we use an IV approach. Following previous literature on impact evaluation of the NRCMS [ 9 , 23 , 30 ], insurance availability at the county level is used to derive an instrument for individual enrolment into the NRCMS. This is considered an appropriate IV because it satisfies the two requirements of validity: (1) there is a high correlation between the county NRCMS status and household insurance enrolment status, as shown in Tables 1 , 2 where the coefficients of county NRMCS status in the first-stage regression are very large, and as we show later, these pass standard thresholds for detecting weak instruments; (2) the roll-out of the NRCMS across counties and over time can be treated as good as random conditional on community characteristics.…”

Section: Methodsmentioning

confidence: 99%

“…In earlier years, the NRCMS primarily focused on inpatient care for the purpose of protecting people from catastrophic diseases [ 22 ], and the programme in all counties covered a specific proportion of inpatient care. As the budget increased, the insurance benefits were also expanded to outpatient services and primary care [ 23 ]. Meanwhile a combination of deductibles, co-payments and spending caps are used to control the total health expenditure.…”

Section: Institutional Backgroundmentioning

confidence: 99%

The impact of social health insurance on rural populations

2021

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Improving health outcomes of rural populations in low- and middle-income countries represents a significant challenge. A key part of this is ensuring access to health services and protecting households from financial risk caused by unaffordable medical care. In 2003, China introduced a heavily subsidised voluntary social health insurance programme that aimed to provide 800 million rural residents with access to health services and curb medical impoverishment. This paper provides new evidence on the impact of the scheme on health care utilisation and medical expenditure. Given the voluntary nature of the insurance enrolment, we exploit the uneven roll-out of the programme across rural counties as a natural experiment to explore causal inference. We find little effect of the insurance on the use of formal medical care and out-of-pocket health payments. However, there is evidence that it directed people away from informal health care towards village clinics, especially among patients with lower income. The insurance has also led to a reduction in the use of city hospitals among the rich. The shift to village clinics from informal care and higher-level hospitals suggests that the NRCMS has the potential to improve efficiency within the health care system and help patients to obtain less costly primary care. However, the poor quality of primary care and insufficient insurance coverage for outpatient services remains a concern.

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“…More attention should be paid to the PHI market and purchasing behavior in China. Systematic research on health insurance has shown that more attention was paid to SBMI than to PHI—for example, the impact of the NCMS on the reduction of out-of-pocket medical expenditures, thereby improving financial protection [ 13 , 14 , 15 ], and the role played by other schemes such as UEBMI in containing health expenditures [ 16 ]; the role of SBMI in lowering catastrophic health expenditures and increasing outpatient expenditure reimbursement [ 1 , 2 , 3 , 17 , 18 ]. Studies on PHI have mainly focused on the way in which the expansion of SBMI has affected the development of PHI [ 19 ].…”

Section: Introductionmentioning

confidence: 99%

What Are the Determinants of the Decision to Purchase Private Health Insurance in China?

Wan

Peng

Shi

et al. 2020

IJERPH

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The objective of this study was to assess the determinants of the decision to purchase private health insurance (PHI) in China. Nationally representative data from the fourth wave of the China Household Finance Survey from 2017 were used, and the dataset comprised 105,691 individuals aged 18 years or older. The Andersen health services utilization model was used to inform the research. Chi-square tests and logistic regression analyses were used to estimate the decision to purchase PHI. The proportion of the sample that had PHI was small, at 5.06%, but coverage for social basic medical insurance (SBMI) was 90.64%. Among PHI holders, the overwhelming majority (87.40%) also had SBMI. Logistic regression analysis demonstrated that predisposing factors (age, education, marital status, household size), enabling factors (household income, SBMI status, geographical factors, household medical expense, and medical debt), and needs-based factors (health status) were statistically significant determinants of the decision to purchase PHI. This study suggests that the socio-economic circumstances of households play a crucial role in the decision to acquire PHI. The findings may be used by the insurance industry to inform actions to enhance PHI coverage and by policy decision-makers that seek to improve equality in access to PHI.

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Income-dependent impacts of health insurance on medical expenditures: Theory and evidence from China

Cited by 24 publications

References 45 publications

Targeting vulnerable groups of health poverty alleviation in rural China— what is the role of the New Rural Cooperative Medical Scheme for the middle age and elderly population?

Targeting vulnerable groups of health poverty alleviation in rural China— what is the role of the New Rural Cooperative Medical Scheme for the middle age and elderly population?

The impact of social health insurance on rural populations

What Are the Determinants of the Decision to Purchase Private Health Insurance in China?

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