Extending Health Insurance to the Rural Population : An Impact Evaluation of China's New Cooperative Medical Scheme
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.
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dig-okr-1098672022024-08-08T17:01:42Z Extending Health Insurance to the Rural Population : An Impact Evaluation of China's New Cooperative Medical Scheme Jun, Gao Wagstaff, Adam Ling, Xu Lindelow, Magnus Juncheng, Qian ADVERSE SELECTION AGE STRUCTURE AGRICULTURE CITIES COST CONTROL COST-SHARING ARRANGEMENTS DELIVERY SYSTEM DEVELOPMENT RESEARCH GROUP DISTRICTS ECONOMIC DEVELOPMENT ECONOMIES OF SCALE EDUCATIONAL ATTAINMENT EXPENDITURES FAMILIES FEE-FOR-SERVICE GENDER HEALTH CARE HEALTH CARE PROVIDERS HEALTH EXPENDITURES HEALTH INSURANCE HEALTH INSURANCE PROGRAM HEALTH INSURANCE SCHEME HEALTH SERVICES HEALTH SPENDING HEALTH STATUS HEALTH SYSTEM HOSPITALS HOUSEHOLD EXPENDITURE HOUSEHOLD INCOME HOUSEHOLD LEVEL HOUSEHOLD SIZE HOUSEHOLD SURVEY HOUSEHOLDS INCOME DISTRIBUTION INCOME GROUPS INFORMAL SECTOR INFORMAL SECTOR WORKERS INSURERS LOCAL GOVERNMENTS MEDICAL SERVICES MEDICAL SYSTEM MORAL HAZARD MORTALITY NATIONAL HEALTH NATIONAL HEALTH SERVICE OCCUPANCY OUTPATIENT CARE POCKET PAYMENTS POLICY RESEARCH POOR HOUSEHOLDS POSITIVE SPILLOVERS PUBLIC HEALTH PUBLIC HEALTH INSURANCE QUALITY CONTROL RURAL AREAS RURAL HOUSEHOLDS RURAL POPULATION SAFETY SOCIAL HEALTH INSURANCE STANDARD ERRORS VILLAGES WORKERS 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. 2012-06-05T21:29:55Z 2012-06-05T21:29:55Z 2007-03 http://documents.worldbank.org/curated/en/2007/03/7410304/extending-health-insurance-rural-population-impact-evaluation-chinas-new-cooperative-medical-scheme https://hdl.handle.net/10986/7202 English Policy Research Working Paper; No. 4150 CC BY 3.0 IGO http://creativecommons.org/licenses/by/3.0/igo/ World Bank application/pdf text/plain World Bank, Washington, DC |
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Banco Mundial |
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Estados Unidos |
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US |
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Bibliográfico |
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En linea |
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biblioteca |
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America del Norte |
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Biblioteca del Banco Mundial |
| language |
English |
| topic |
ADVERSE SELECTION AGE STRUCTURE AGRICULTURE CITIES COST CONTROL COST-SHARING ARRANGEMENTS DELIVERY SYSTEM DEVELOPMENT RESEARCH GROUP DISTRICTS ECONOMIC DEVELOPMENT ECONOMIES OF SCALE EDUCATIONAL ATTAINMENT EXPENDITURES FAMILIES FEE-FOR-SERVICE GENDER HEALTH CARE HEALTH CARE PROVIDERS HEALTH EXPENDITURES HEALTH INSURANCE HEALTH INSURANCE PROGRAM HEALTH INSURANCE SCHEME HEALTH SERVICES HEALTH SPENDING HEALTH STATUS HEALTH SYSTEM HOSPITALS HOUSEHOLD EXPENDITURE HOUSEHOLD INCOME HOUSEHOLD LEVEL HOUSEHOLD SIZE HOUSEHOLD SURVEY HOUSEHOLDS INCOME DISTRIBUTION INCOME GROUPS INFORMAL SECTOR INFORMAL SECTOR WORKERS INSURERS LOCAL GOVERNMENTS MEDICAL SERVICES MEDICAL SYSTEM MORAL HAZARD MORTALITY NATIONAL HEALTH NATIONAL HEALTH SERVICE OCCUPANCY OUTPATIENT CARE POCKET PAYMENTS POLICY RESEARCH POOR HOUSEHOLDS POSITIVE SPILLOVERS PUBLIC HEALTH PUBLIC HEALTH INSURANCE QUALITY CONTROL RURAL AREAS RURAL HOUSEHOLDS RURAL POPULATION SAFETY SOCIAL HEALTH INSURANCE STANDARD ERRORS VILLAGES WORKERS ADVERSE SELECTION AGE STRUCTURE AGRICULTURE CITIES COST CONTROL COST-SHARING ARRANGEMENTS DELIVERY SYSTEM DEVELOPMENT RESEARCH GROUP DISTRICTS ECONOMIC DEVELOPMENT ECONOMIES OF SCALE EDUCATIONAL ATTAINMENT EXPENDITURES FAMILIES FEE-FOR-SERVICE GENDER HEALTH CARE HEALTH CARE PROVIDERS HEALTH EXPENDITURES HEALTH INSURANCE HEALTH INSURANCE PROGRAM HEALTH INSURANCE SCHEME HEALTH SERVICES HEALTH SPENDING HEALTH STATUS HEALTH SYSTEM HOSPITALS HOUSEHOLD EXPENDITURE HOUSEHOLD INCOME HOUSEHOLD LEVEL HOUSEHOLD SIZE HOUSEHOLD SURVEY HOUSEHOLDS INCOME DISTRIBUTION INCOME GROUPS INFORMAL SECTOR INFORMAL SECTOR WORKERS INSURERS LOCAL GOVERNMENTS MEDICAL SERVICES MEDICAL SYSTEM MORAL HAZARD MORTALITY NATIONAL HEALTH NATIONAL HEALTH SERVICE OCCUPANCY OUTPATIENT CARE POCKET PAYMENTS POLICY RESEARCH POOR HOUSEHOLDS POSITIVE SPILLOVERS PUBLIC HEALTH PUBLIC HEALTH INSURANCE QUALITY CONTROL RURAL AREAS RURAL HOUSEHOLDS RURAL POPULATION SAFETY SOCIAL HEALTH INSURANCE STANDARD ERRORS VILLAGES WORKERS |
| spellingShingle |
ADVERSE SELECTION AGE STRUCTURE AGRICULTURE CITIES COST CONTROL COST-SHARING ARRANGEMENTS DELIVERY SYSTEM DEVELOPMENT RESEARCH GROUP DISTRICTS ECONOMIC DEVELOPMENT ECONOMIES OF SCALE EDUCATIONAL ATTAINMENT EXPENDITURES FAMILIES FEE-FOR-SERVICE GENDER HEALTH CARE HEALTH CARE PROVIDERS HEALTH EXPENDITURES HEALTH INSURANCE HEALTH INSURANCE PROGRAM HEALTH INSURANCE SCHEME HEALTH SERVICES HEALTH SPENDING HEALTH STATUS HEALTH SYSTEM HOSPITALS HOUSEHOLD EXPENDITURE HOUSEHOLD INCOME HOUSEHOLD LEVEL HOUSEHOLD SIZE HOUSEHOLD SURVEY HOUSEHOLDS INCOME DISTRIBUTION INCOME GROUPS INFORMAL SECTOR INFORMAL SECTOR WORKERS INSURERS LOCAL GOVERNMENTS MEDICAL SERVICES MEDICAL SYSTEM MORAL HAZARD MORTALITY NATIONAL HEALTH NATIONAL HEALTH SERVICE OCCUPANCY OUTPATIENT CARE POCKET PAYMENTS POLICY RESEARCH POOR HOUSEHOLDS POSITIVE SPILLOVERS PUBLIC HEALTH PUBLIC HEALTH INSURANCE QUALITY CONTROL RURAL AREAS RURAL HOUSEHOLDS RURAL POPULATION SAFETY SOCIAL HEALTH INSURANCE STANDARD ERRORS VILLAGES WORKERS ADVERSE SELECTION AGE STRUCTURE AGRICULTURE CITIES COST CONTROL COST-SHARING ARRANGEMENTS DELIVERY SYSTEM DEVELOPMENT RESEARCH GROUP DISTRICTS ECONOMIC DEVELOPMENT ECONOMIES OF SCALE EDUCATIONAL ATTAINMENT EXPENDITURES FAMILIES FEE-FOR-SERVICE GENDER HEALTH CARE HEALTH CARE PROVIDERS HEALTH EXPENDITURES HEALTH INSURANCE HEALTH INSURANCE PROGRAM HEALTH INSURANCE SCHEME HEALTH SERVICES HEALTH SPENDING HEALTH STATUS HEALTH SYSTEM HOSPITALS HOUSEHOLD EXPENDITURE HOUSEHOLD INCOME HOUSEHOLD LEVEL HOUSEHOLD SIZE HOUSEHOLD SURVEY HOUSEHOLDS INCOME DISTRIBUTION INCOME GROUPS INFORMAL SECTOR INFORMAL SECTOR WORKERS INSURERS LOCAL GOVERNMENTS MEDICAL SERVICES MEDICAL SYSTEM MORAL HAZARD MORTALITY NATIONAL HEALTH NATIONAL HEALTH SERVICE OCCUPANCY OUTPATIENT CARE POCKET PAYMENTS POLICY RESEARCH POOR HOUSEHOLDS POSITIVE SPILLOVERS PUBLIC HEALTH PUBLIC HEALTH INSURANCE QUALITY CONTROL RURAL AREAS RURAL HOUSEHOLDS RURAL POPULATION SAFETY SOCIAL HEALTH INSURANCE STANDARD ERRORS VILLAGES WORKERS Jun, Gao Wagstaff, Adam Ling, Xu Lindelow, Magnus Juncheng, Qian Extending Health Insurance to the Rural Population : An Impact Evaluation of China's New Cooperative Medical Scheme |
| description |
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. |
| topic_facet |
ADVERSE SELECTION AGE STRUCTURE AGRICULTURE CITIES COST CONTROL COST-SHARING ARRANGEMENTS DELIVERY SYSTEM DEVELOPMENT RESEARCH GROUP DISTRICTS ECONOMIC DEVELOPMENT ECONOMIES OF SCALE EDUCATIONAL ATTAINMENT EXPENDITURES FAMILIES FEE-FOR-SERVICE GENDER HEALTH CARE HEALTH CARE PROVIDERS HEALTH EXPENDITURES HEALTH INSURANCE HEALTH INSURANCE PROGRAM HEALTH INSURANCE SCHEME HEALTH SERVICES HEALTH SPENDING HEALTH STATUS HEALTH SYSTEM HOSPITALS HOUSEHOLD EXPENDITURE HOUSEHOLD INCOME HOUSEHOLD LEVEL HOUSEHOLD SIZE HOUSEHOLD SURVEY HOUSEHOLDS INCOME DISTRIBUTION INCOME GROUPS INFORMAL SECTOR INFORMAL SECTOR WORKERS INSURERS LOCAL GOVERNMENTS MEDICAL SERVICES MEDICAL SYSTEM MORAL HAZARD MORTALITY NATIONAL HEALTH NATIONAL HEALTH SERVICE OCCUPANCY OUTPATIENT CARE POCKET PAYMENTS POLICY RESEARCH POOR HOUSEHOLDS POSITIVE SPILLOVERS PUBLIC HEALTH PUBLIC HEALTH INSURANCE QUALITY CONTROL RURAL AREAS RURAL HOUSEHOLDS RURAL POPULATION SAFETY SOCIAL HEALTH INSURANCE STANDARD ERRORS VILLAGES WORKERS |
| author |
Jun, Gao Wagstaff, Adam Ling, Xu Lindelow, Magnus Juncheng, Qian |
| author_facet |
Jun, Gao Wagstaff, Adam Ling, Xu Lindelow, Magnus Juncheng, Qian |
| author_sort |
Jun, Gao |
| title |
Extending Health Insurance to the Rural Population : An Impact Evaluation of China's New Cooperative Medical Scheme |
| title_short |
Extending Health Insurance to the Rural Population : An Impact Evaluation of China's New Cooperative Medical Scheme |
| title_full |
Extending Health Insurance to the Rural Population : An Impact Evaluation of China's New Cooperative Medical Scheme |
| title_fullStr |
Extending Health Insurance to the Rural Population : An Impact Evaluation of China's New Cooperative Medical Scheme |
| title_full_unstemmed |
Extending Health Insurance to the Rural Population : An Impact Evaluation of China's New Cooperative Medical Scheme |
| title_sort |
extending health insurance to the rural population : an impact evaluation of china's new cooperative medical scheme |
| publisher |
World Bank, Washington, DC |
| publishDate |
2007-03 |
| url |
http://documents.worldbank.org/curated/en/2007/03/7410304/extending-health-insurance-rural-population-impact-evaluation-chinas-new-cooperative-medical-scheme https://hdl.handle.net/10986/7202 |
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| _version_ |
1807157420468731904 |