The impact of rural mutual health care on health status: evaluation of a social experiment in rural China

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.

Does health insurance coverage lead to better health and educational outcomes? Evidence from rural China

“…Wang et al (2009) do find some positive effects of health insurance coverage on self-reported health status, but the insurance program they studied is different from the NCMS and arguably more comprehensive in outpatient care and could offer more help to deal with non-catastrophic health risk. Since our studied area is much poorer than most areas of China, we suspect that the NCMS does not improve the three studied outcomes in other areas either.…”

“…More specifically, Wang et al (2009) and Wagstaff et al (2009) propose estimators similar to ATE P-NE . 19 This is still biased because insurance participants are a selected group and the distribution of Z ip could be systematically different from Z i NE even if the two sets of counties are overall comparable.…”

Social security health insurance for the informal sector in Nicaragua: a randomized evaluation

“…Barros found, as we did, a substitution of visits to service providers and a reduction in out of pocket expenditures. See also Wang et al (2009). Other studies have evaluated the effects of health insurance in Columbia and have also found increased utilization and reduced out-of pocket expenditure (Giedion et al, 2007).…”

The Impact of Health Insurance Schemes for the Informal Sector in Low- and Middle-Income Countries: A Systematic Review

“…2 (August 2013) Mensah et al (2010) show lower levels of infant death, although these levels are not statistically significant. Wang et al (2009) use EQ-5D, a standardized index value instrument for use as a measure of a wide range of health conditions, to report on a community-based health insurance program in China. They find that the scheme had positive effects on health status for all insured people and for the poor.…”