Health insurance and consumption: Evidence from China’s New Cooperative Medical Scheme

We exploit a quasi-natural experiment arising from the introduction of a health insurance program in rural China to examine how the insurance coverage affects household consumption. Results show that, on average, the health insurance coverage increases nonmedical-related consumption by more than 5%. This insurance effect is observed even in households with no out-of-pocket medical spending. In addition, the insurance effect is stronger in households with worse self-reported health status. These results are consistent with the precautionary savings argument. The insurance effect also varies by household experience with the program. In particular, the effect is significant only in villages where some households have actually obtained reimbursement from the insurance program. The program within these villages stimulates less consumption among new participants than among households that have participated in the program for more than a year.     

医疗保险与消费:来自新型农村合作医疗的证据

本文利用农村引入新型农村合作医疗这一政策变化来研究医疗保险的获得对农村居民消费的影响。结果表明,新农合使得非医疗支出类的家庭消费增加了约5.6个百分点。这一正向作用随医疗保险保障水平的提高而增强,而且在没有医疗支出的家庭中仍然存在。同时,新农合对消费的正向影响在收入较低或健康状况较差的家庭中更强。这些结果都与医疗保险减少了预防性储蓄的假说相一致。另外本文发现,新农合的效果随农户在这个项目中的经历而变化。实际上只有在那些有村民获得保险补偿的村子,保险对消费的正向影响才显著,而且在这些村子中,新农合对新加入农户的消费的影响明显小于对参合一年以上农户的消费的影响。     

医疗保险与城乡反贫困:1989-2006

文章利用中国健康与营养调查(CHNS)数据,估计了1989-2006年医疗保险对中国城乡家庭的反贫困效应。结果发现:发生灾难性卫生支出的城乡家庭比例较高,最穷的群体其医疗费用超过收入的比例增加,医疗保险对减少收入不平等只起到微弱作用。TIP贫困曲线表明,近几年,医疗保险补偿后,城乡患病家庭的贫困并没有减轻,医疗保险在减少贫困上的作用很小。分析贫困特征的多元回归模型显示,家庭成员数量、教育程度、抚养比率、参保人数等都影响了贫困,而条件多元回归模型则显示,医疗保险对贫困的变动没有影响。     

Supplementary private health insurance and health care utilization of people aged 50+

Does supplementary private health insurance (PHI) coverage influence health care utilization in countries where the coverage ratio with public health insurance is high? I estimate this effect using the Survey of Health, Ageing and Retirement in Europe. Handling the potential endogeneity of supplementary insurance coverage and the large fraction of zero observations in the utilization models influences the empirical results. I show that the effect of PHI coverage on inpatient and outpatient care utilization is not trivial even in countries with generous public health funding. The main finding is that supplementary PHI coverage increases dental care utilization, but decreases the visits to general practitioners. Private insurance is estimated to have little and insignificant influence on the utilization of inpatient care and outpatient specialist care. The magnitude of the effect of supplementary PHI on health care utilization varies with the characteristics of the health care systems.     

DOES CHINA'S RURAL COOPERATIVE MEDICAL SYSTEM ACHIEVE ITS GOALS? EVIDENCE FROM THE CHINA HEALTH SURVEILLANCE BASELINE SURVEY IN 2001

The Chinese government is in the process of providing health insurance to the uninsured rural population by expanding the rural Cooperative Medical System (CMS) to every rural county. Using the China Health Surveillance Baseline Survey in 2001, we conducted a case study on two CMS pilot programs and investigated whether or not enrolling in these CMS pilot programs has led to an increase in health care utilization and a decrease in the likelihood of catastrophic health spending for rural residents. Matched data sets are produced using propensity score and the instrumental variable (IV) method is used. We have found that the CMS pilot programs have had a significant and positive effect on the probability of seeking medical care and the number of visits. However, the CMS programs did not seem to have had a significant impact on households' out‐of‐pocket health expenditure and on reducing catastrophic spending. The findings generated from the matched data are consistent with those obtained from the full set of data and those obtained from the IV method. (JEL I18)     

Do Consumers Purchase Too Much Health Insurance? The Role of Market Power in Health‐Care Markets

Several authors have suggested that consumers purchase too much health insurance in private markets. We readdress this issue within a model that combines excess health‐care demand due to health insurance with market power due to monopolistic production of health‐care services. We evaluate the market equilibrium in terms of consumer welfare and social welfare. The consumer welfare criterion suggests that in the market equilibrium consumers in fact purchase too much health insurance coverage. The social welfare criterion, in contrast, suggests that because profits of the health‐care industry are properly accounted for, consumers should purchase more insurance coverage than they choose to do in the market equilibrium.     

中国城镇社会医疗保障改革的理论探索

With its transition to a market-oriented economy, China has gone through significant changes in health care delivery and financing systems in the last three decades. Since 1998, a new public health insurance program for urban employees, called Basic Medical Insurance Program (BMI), has been established. One theme of this reform was to control medical service over-consumption with new cost containment methods. This paper attempts to evaluate the effects of the reformed public health insurance on health care utilization, with in-depth theoretical investigation. We formulate a health care demand model based on the structure of health care delivery and health insurance systems in China. It is assumed in the model that physicians have pure monopoly power in determining patients’ health care utilization. The major inference is that the insurance co-payment mechanism cannot reduce medical service over-utilization effectively without any efforts to control physicians’ behavior. Meanwhile, we use the calibrated simulation to demonstrate our hypothesis in the theoretical model. The main implication is that physicians’ incentive to over utilize medical services for their own benefits is significant and severe in China.      

Tax subsidies,the rational demand for insurance and the health care crisis

An individual's optimal insurance coverage depends on balancing his gain through avoiding risk against his loss through the distortion of demand. The U.S. tax system subsidizes the purchase of excessive health insurance by excluding employer premium payments from employees' taxable incomes and by permitting the deduction of a portion of individual premiums. The current operational model of demand for health insurance shows that the tax subsidy does substantially increase insurance coverage. Since much of the rise in health care costs can be attributed to the growth of insurance, the tax subsidy is responsible for much of what is widely perceived as a health care crisis.     

中国城镇医疗体制改革前后的医疗融资比较

The health financing schemes is the foundation for the nation’s health care system, and the health insurance is a main one of some options for financing health care. This article compares two health care financing schemes in urban areas before and after the health reform, and targets at the impacts facing coverage groups, the financing methods, decision-making power or financial management (i.e. the distribution of responsibility and rights between the central government and local governments), payment arrangement and cost containment of health care financing mechanisms. Prior to reform, the equal access and universal coverage of health care services were implemented through the employment-based health insurance in a state-controlled economy with guaranteed full employment and central control in general. The decentralization reforms of fiscal system and tax sharing reforms disrupts the past economic foundation, the rebuilding health insurance system which still benefits the employed bring the limited coverage. The next trend is to make transition from health insurance covering only part of the employed population to what are in effect national health services covering the whole population in urban areas.      

Income-related inequalities of health and health care utilization

By utilizing the China Health and Nutrition Survey (CHNS) data, this paper examines the extent of deviations in terms of horizontal equity in the field of China’s health and medical community, i.e., that those in equal demand ought to be treated equally, and computes the contribution of income in health inequality and utilization inequality of health care. The main conclusions are: There is pro-rich inequality in health and utilization of health care; income contribution to inequality of health care utilization accounts for 0.13–0.2; insurance also enlarges the inequality of health care utilization; health inequality in rural area is larger than that of in urban area; and both rural and urban health inequality are increasing. From 1991 to 2006, income changes in urban districts and rural area account for 7.08% and 13.38% respectively of raising inequality of rural and urban health.     

The effect of non-employment-based health insurance program on firm's offering of health insurance: Evidence from the social health insurance system in China

To achieve universal health insurance coverage, many developing countries have established a segmented health insurance system, which contains separate programs for workers with formal employment and residents without formal employment. A potential concern with such a segmented system is that the establishment of a non-employment-based insurance program may generate a disincentive for firms to provide health insurance benefits to workers. In this study, we empirically examine this crowd-out effect of a non-employment-based insurance program, the Urban Residents Basic Medical Insurance (URBMI), in China. Exploiting city-by-year variations in the roll-out process of the program and utilizing a unique administrative dataset on Chinese firms, we find that the enactment of URBMI reduced a firm's offering of an employment-based health insurance program by a statistically significant 0.94-1.29 percentage point. This crowd-out effect was stronger among domestic private firms, new firms, and firms that are individual-owned.     

Efficiency of health care delivery systems: effects of health insurance coverage

Health insurance expansions may increase the demand for care-creating incentives for health systems to increase input consumption. The possibility remains that added capacity and personnel will have little effect on health outcomes, decreasing the technical efficiency of health care delivery systems. We estimate that a 1 percentage point increase in health insurance coverage decreases the technical efficiency of health care delivery by 1.3 percentage points, translating into approximately 50 billion dollars in additional health expenditures. This finding uncovers a previously unexplored consequence of changes in health insurance on the supply side of health care markets suggesting one avenue through which health care costs growth may occur.     

The impact of health insurance on job location choice: Evidence from rural China

Many health insurance programs contain certain portability constraints. It is common that enrollees are eligible for greater reimbursement when they received services at selected local facilities. We investigate the impact of this portability constraint on residents' choice of job location. Using a unique, nationwide survey data set in China, we find that provision of health insurance decreases the probability of working in non-local regions for the rural residents by 2.4%. The results are mainly driven by the residence lock-in effect. That is, the insurance program discourages rural residents from working outside their registered areas of residence and, especially, in other provinces. The pullback effect, that is, the effect of the health insurance program attracting migrant workers who had worked outside back to regions close to their hometowns, is not found to be significant.     

Analysis on demand‐ and supply‐side responses during the expansion of health insurance coverage in Vietnam: Challenges and policy implications toward universal health coverage

This study examines how the demand and supply of healthcare services have responded to the expansion of health insurance coverage in Vietnam by using biyearly provincial panel data from 2006 to 2014. The results of our analysis indicate significant progress towards universal health coverage (UHC) in Vietnam, with the expansion of health insurance coverage being accompanied by increases in admissions and inpatient days. However, some concerns remain. Our findings show a positive response of supply capacity only in terms of doctors and nurses at higher‐level hospitals (provincial hospitals), and none in other relevant aspects. Moreover, we find no positive response of the number of outpatient visits. Another concern is the issue of financial protection. The decline in out‐of‐pocket payments is not significant throughout our observation period, suggesting that lowering the cost of healthcare is not straightforward and that the expansion of health insurance coverage alone cannot achieve this. We believe that the Vietnamese experience has valuable implications for other emerging and developing countries, considering that the expansion of health insurance coverage is likely to increase utilization of healthcare services significantly and that the supply side needs to be prepared for the increase.     

我国城镇卫生筹资公平性研究——基于医疗保健支出累进度的测算

文章利用1995-2006年城镇家庭收支调查数据,测算了我国医疗保健个人现金支出的累进度指数,包括Kakwani指数和Suits指数,并采用可支配收入、消费性支出和非食品消费支出衡量支付能力,分别计算相应的累进度指数.研究结果表明:城镇职工基本医疗保险推行以来,我国个人现金卫生累退程度不断增加,这主要归咎于医疗保险覆盖不广泛以及分布不公平.这一结论对进一步改革我国社会医疗保险制度有着重要的政策含义.     

农村三代家庭中子女外出务工对老年人经济支持的影响研究

劳动力外流在积极推动农村经济发展的同时也给老年人的家庭养老带来了极大的挑战.本文利用深圳市外来农村流动人口调查数据,从子女角度分析了中国农村子女外出务工三代家庭中老年人的经济支持.结果显示:首先,农村老年人与其外出务工子女三代家庭的代际支持符合合作群体模型:经济支持主要由子女流向老年父母,最有需要的老年父母获得更多的经济支持;众多老年父母给留守未成年孙子女提供了同住和生活照料帮助,老年父母也因此获得了更多的经济支持.其次,外出务工子女的城市化程度并没有影响其提供的经济支持.最后,文章指出了研究结果对完善农村养老保障制度和促进剩余劳动力外流的启示.     

新型农村社会养老保险参保率影响因素实证研究:村域社会资本理论视角

基于对河南省某县47个村域的调查,实证检验了村域社会资本对新型农村社会养老保险参保率的影响。因子分析发现,村域社会资本分为村域信任、村域互惠、村域规范和村域互动四个因子。回归分析发现,村域信任和村域互动对参保率具有正效应,村域互惠没有通过显著性检验,村域规范对参保率的正效应缺乏稳定性。对解释新型农村社会养老保险参保率的差异提供了一个新的理论视角。     

Employee cost-sharing and the welfare effects of flexible spending accounts

Flexible Spending Accounts (FSAs) subsidize out-of-pocket health expenses not covered by employer-provided health insurance, making health care cheaper ex post, but also reducing the incentive to insure. We use a cross section of firm-level data to show that FSAs are indeed associated with reduced insurance coverage, and to evaluate the welfare consequences of this shift. Correcting for selection effects we find that FSAs are associated with insurance contracts that have coinsurance rates about 7 percentage points higher, relative to a sample average coinsurance rate of 17%. Meanwhile, coinsurance rates net of the subsidy are approximately unchanged, providing evidence that FSAs are only welfare neutral if we ignore distributional considerations and the deadweight loss of the taxes necessary to finance the subsidy. These results also suggest that FSAs may explain a significant fraction of the shift in health care costs to employees that has occurred in recent years.     

Adverse Selection and the Decline in Private Health Insurance Coverage in Australia: 1989–95

The decline in private health insurance coverage over the period 1989–95 is analysed using the ABS National Health Surveys. Individuals' health status and health risk behaviours are found to be significant determinants of their decision to purchase private health insurance. At a point in time, the pool of the insured is very heterogeneous, with a mix of both good and bad health risks. It is found that the decline in insurance coverage over the period 1989–95 coincided with an increase in the degree of 'adverse selection' within the insured population.