Extending Health Insurance to the Rural Population: An Impact Evaluation of China's New Cooperative Medical Scheme
World Bank, Development Research Group, Public Services Team and East Asia and Pacific Region, Human Development Sector Department, 2007 - Child development - 39 pages
Abstract: In 2003, after over 20 years of minimal health insurance coverage in rural areas, China launched a heavily subsidized voluntary health insurance program for rural residents. The authors use program and household survey data, as well as health facility census data, to analyze factors affecting enrollment into the program and to estimate its impact on households and health facilities. They obtain estimates by combining differences-in-differences with matching methods. The authors find some evidence of lower enrollment rates among poor households, holding other factors constant, and higher enrollment rates among households with chronically sick members. The household and facility data point to the scheme significantly increasing both outpatient and inpatient utilization (by 20-30 percent), but they find no impact on utilization in the poorest decile. For the sample as a whole, the authors find no statistically significant effects on average out-of-pocket spending, but they do find some-albeit weak-evidence of increased catastrophic health spending. For the poorest decile, by contrast, they find that the scheme increased average out-of-pocket spending but reduced the incidence of catastrophic health spending. They find evidence that the program has increased ownership of expensive equipment among central township health centers but had no impact on cost per case.
What people are saying - Write a review
We haven't found any reviews in the usual places.
Other editions - View all
adverse selection Catastrophic payments catastrophic spending category is East central THCs changes in outcomes China omitted category closest facility category Colombia common support county-level cities Descriptive statistics difference Distance to closest enroll in NCMS expenditures February 2007 February GDP per capita GIS or LIS health facilities health insurance health insurance program health spending household enrolled Household per capita households living illiterate or semi-literate impact evaluation incidence of catastrophic income inpatient kernel weights last 12 months living in NCMS matching methods moral hazard NCMS counties NCMS households NCMS pilot counties non-enrolled households non-NCMS counties out-of-pocket payments out-of-pocket spending outpatient expenses Outpatient visit poorest decile probit professional worker propensity score provinces regression reimbursement Research Working Paper revenues rural wage laborer safety net payments sample scheme Share of household standard errors subsidized survey t-stat Table 11 township health centers treated untreated variables Village clinic Wagstaff World Bank