دانلود رایگان مقاله انگلیسی تأثیر اصلاحات بیمه درمانی: شواهد از چین - الزویر 2018

Abstract

This paper estimates the impact of a health insurance reform on health outcomes in urban China. Using the China Health and Nutrition Survey we find that this reform increases the rate of health insurance coverage significantly among workers in Non-State Owned Enterprises. The double difference (DD) estimations show that the reform also leads to better health outcomes: workers are less likely to get sick and more likely to use preventive care. Using an instrumental variable (IV) approach to look at the causal effect of health insurance, we find those with health insurance use more preventive care but do not report significantly better health outcomes, an increase in health care utilisation, or an increase in out-of-pocket medical expenditure.

Conclusion

In this paper, we analyse the impact of the UEBMI health insurance reform in China on coverage and health outcomes. The results show that the insurance reform significantly increased health insurance coverage among the target group in urban areas. However, the coverage was only around 30% for all eligible citizens in 2004, which suggests it was still far from reaching its stated goal of helping to achieve universal coverage. Although the insurance programme was meant to be mandatory for all urban employees, during the first five years of the reform, there were some enterprises and individuals who chose not participate. There was poor monitoring of the programme and punishments were not strict enough in the early years of the reform. Therefore, with high worker turnover, employers chose to underinvest in health (Fang & Gavazza 2007). Despite the failure of UEMBI to make health care universal, the DD results show it did play a large part in causing Non-SOE employees to become insured: insurance among the target group increased by more than 50%. The jump in insurance coverage led to an increase in the use of preventative health care and a decrease in the likelihood of being sick. The IV estimates show us that individuals who were newly covered due to UEMBI were less likely to report being sick and that 21% of them used preventative health care. These benefits accrued without causing out-of-pocket medical expenditures or demand on services from formal medical facilities increase. These results show that large, developing countries, like China, can introduce health insurance without appearing to drive up out-of-pocket expenditures or demand for formal services.