Comparative Analysis of the Health Effects of China's Different Social Health Insurance Schemes on Insured People Based on Consumer Incentives

中國不同社會醫療保險制度安排對居民健康效應比較研究——基於消費者激勵

Student thesis: Doctoral Thesis

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Author(s)

Detail(s)

Awarding Institution
Supervisors/Advisors
  • Ruiping FAN (Supervisor)
  • Ying MAO (External person) (Supervisor)
  • Ying MAO (External person) (External Supervisor)
Award date10 Aug 2020

Abstract

Health insurance expansion is a critical step toward universal health coverage. Following decades of reform, China has achieved universal population coverage of social health insurance (SHI) schemes. The difficulty and high cost of visiting a doctor have been significantly alleviated among Chinese residents. In recent years, people’s health need has changed dramatically given that their living standards constantly improve and the population continues to age. Specifically, their health need has been developed from single and passive medical treatment to active health promotion and comprehensive health security. Consequently, SHI schemes, which only focus on the reimbursement of medical expenditure, cannot satisfy people’s ever increasing health need. As such, evaluating the health effects of the current arrangements of China’s SHI schemes on insured people is necessary to explore the reform orientation of the SHI system, develop a fair and highly sustainable universal SHI system, and promote transformation from a treatment-centered to a health-centered health care system in contemporary China. This issue is a significant livelihood issue of achieving “health for all”.

This study stands at the viewpoint of demanders for health, namely, individual consumers of health-related productions in the health care market. This study constructs a theoretical framework for the health effects of China’s SHI schemes on insured people based on consumer incentives and comprehensively elaborates the impact of SHI on people’s health outcomes with its underlying mechanism. On the basis of the three-wave panel data from the China Health and Retirement Longitudinal Study, this study takes the middle-aged and elderly people as the analytical sample. The three main SHI schemes in mainland China, including one employment-based SHI scheme (i.e., Urban Employees’ Basic Medical Insurance [UEBMI]), and two non-employment-based SHI schemes (i.e., Urban Residents’ Basic Medical Insurance [URBMI]) and New Rural Cooperative Medical Scheme [NRCMS]), are considered as core independent variables. Individual health outcomes are considered as dependent variables. Individual health-related behavior (i.e., preventive care behavior pre-illness and medical care consumption post-illness) are considered as mediating variables. Through panel regressions and mediating effect regressions, the overall health effects of the three different SHI schemes on insured people and the specific health effects based on ex-ante and ex-post consumer incentives are examined comparatively and empirically. On the basis of the analytical findings, policy recommendations are put forward to optimize China’s current SHI system.

The main findings of this study include the following four aspects. First, based on consumer incentives in the health care market, this study constructs an up-to-date theoretical analytical framework of the health effects of China’s SHI schemes on insured people by combining pre-illness prevention and post-illness treatment. Second, this study verifies the positive overall health effects of China’s three main SHI schemes on insured people and finds that the overall health effects of employment-based UEBMI were more significant than those of non-employment-based URBMI and NRCMS. Third, this study verifies the positive health effects of China’s three main SHI schemes on insured people based on ex-ante consumer incentives and finds that the SHI schemes improved the physical health status of insured chronic disease sufferers through their incentive effects on the use of preventive care services pre-illness. Fourth, through mediating effect regressions, this study verifies the positive health effects of China’s three main SHI schemes on insured people based on ex-post consumer incentives and finds that the SHI schemes improved the physical health status of insured outpatients and inpatients through their incentive effects on medical service utilization and medical care spending post-illness.