Extending Health Insurance to the Rural Population : An Impact Evaluation of China's New Cooperative Medical Scheme

Wagstaff, Adam ; Lindelow, Magnus ; Jun, Gao ; Ling, Xu ; Juncheng, Qian

World Bank, Washington, DC

关键词: ADVERSE SELECTION;    AGE STRUCTURE;    AGRICULTURE;    CITIES;    COST CONTROL;   

DOI  :  10.1596/1813-9450-4150
RP-ID  :  WPS4150

学科分类：社会科学、人文和艺术（综合）

来源: World Bank Open Knowledge Repository

【 摘 要 】

In 2003, after over 20 years of minimalhealth insurance coverage in rural areas, China launched aheavily subsidized voluntary health insurance program forrural residents. The authors use program and householdsurvey data, as well as health facility census data, toanalyze factors affecting enrollment into the program and toestimate its impact on households and health facilities.They obtain estimates by combiningdifferences-in-differences with matching methods. Theauthors find some evidence of lower enrollment rates amongpoor households, holding other factors constant, and higherenrollment rates among households with chronically sickmembers. The household and facility data point to the schemesignificantly increasing both outpatient and inpatientutilization (by 20-30 percent), but they find no impact onutilization in the poorest decile. For the sample as awhole, the authors find no statistically significant effectson average out-of-pocket spending, but they do findsome-albeit weak-evidence of increased catastrophic healthspending. For the poorest decile, by contrast, they findthat the scheme increased average out-of-pocket spending butreduced the incidence of catastrophic health spending. Theyfind evidence that the program has increased ownership ofexpensive equipment among central township health centersbut had no impact on cost per case.