IDEAS home Printed from https://ideas.repec.org/a/eee/pubeco/v226y2023ics0047272723001810.html
   My bibliography  Save this article

The largest insurance program in history: Saving one million lives per year in China

Author

Listed:
  • Gruber, Jonathan
  • Lin, Mengyun
  • Yi, Junjian

Abstract

The New Cooperative Medical Scheme (NCMS), rolled out in China from 2003–2008, provided insurance to 800 million rural Chinese. We combine aggregate mortality data with individual survey data, and identify the impact of the NCMS from program rollout and heterogeneity across areas in their rural share. We find that there was a significant decline in aggregate mortality, with the program saving more than one million lives per year at its peak, and explaining 78% of the entire increase in life expectancy in China over this period. We confirm these mortality effects using micro-data on mortality, other health outcomes, and utilization.

Suggested Citation

  • Gruber, Jonathan & Lin, Mengyun & Yi, Junjian, 2023. "The largest insurance program in history: Saving one million lives per year in China," Journal of Public Economics, Elsevier, vol. 226(C).
  • Handle: RePEc:eee:pubeco:v:226:y:2023:i:c:s0047272723001810
    DOI: 10.1016/j.jpubeco.2023.104999
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0047272723001810
    Download Restriction: Full text for ScienceDirect subscribers only

    File URL: https://libkey.io/10.1016/j.jpubeco.2023.104999?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Jonathan Gruber & Nathaniel Hendren & Robert M. Townsend, 2014. "The Great Equalizer: Health Care Access and Infant Mortality in Thailand," American Economic Journal: Applied Economics, American Economic Association, vol. 6(1), pages 91-107, January.
    2. Long, Qian & Klemetti, Reija & Wang, Yang & Tao, Fangbiao & Yan, Hong & Hemminki, Elina, 2012. "High caesarean section rate in rural China: Is it related to health insurance (New Co-operative Medical Scheme)?," Social Science & Medicine, Elsevier, vol. 75(4), pages 733-737.
    3. Xiaoyun Sun & Sukhan Jackson & Gordon Carmichael & Adrian C. Sleigh, 2009. "Catastrophic medical payment and financial protection in rural China: evidence from the New Cooperative Medical Scheme in Shandong Province," Health Economics, John Wiley & Sons, Ltd., vol. 18(1), pages 103-119, January.
    4. Lingguo Cheng & Hong Liu & Ye Zhang & Ke Shen & Yi Zeng, 2015. "The Impact of Health Insurance on Health Outcomes and Spending of the Elderly: Evidence from China's New Cooperative Medical Scheme," Health Economics, John Wiley & Sons, Ltd., vol. 24(6), pages 672-691, June.
    5. Emily Oster, 2019. "Unobservable Selection and Coefficient Stability: Theory and Evidence," Journal of Business & Economic Statistics, Taylor & Francis Journals, vol. 37(2), pages 187-204, April.
    6. Sarah Miller & Norman Johnson & Laura R Wherry, 2021. "Medicaid and Mortality: New Evidence From Linked Survey and Administrative Data," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 136(3), pages 1783-1829.
    7. Cl'ement de Chaisemartin & Xavier D'Haultfoeuille, 2020. "Difference-in-Differences Estimators of Intertemporal Treatment Effects," Papers 2007.04267, arXiv.org, revised Nov 2023.
    8. Chen, Yuyu & Jin, Ginger Zhe, 2012. "Does health insurance coverage lead to better health and educational outcomes? Evidence from rural China," Journal of Health Economics, Elsevier, vol. 31(1), pages 1-14.
    9. James Hammitt & Ying Zhou, 2006. "The Economic Value of Air-Pollution-Related Health Risks in China: A Contingent Valuation Study," Environmental & Resource Economics, Springer;European Association of Environmental and Resource Economists, vol. 33(3), pages 399-423, March.
    10. Liu, Kai, 2016. "Insuring against health shocks: Health insurance and household choices," Journal of Health Economics, Elsevier, vol. 46(C), pages 16-32.
    11. Clément de Chaisemartin & Xavier D’Haultfœuille, 2023. "Two-way fixed effects and differences-in-differences with heterogeneous treatment effects: a survey," The Econometrics Journal, Royal Economic Society, vol. 26(3), pages 1-30.
    12. Litvack, Jennie I. & Bodart, Claude, 1993. "User fees plus quality equals improved access to health care: Results of a field experiment in Cameroon," Social Science & Medicine, Elsevier, vol. 37(3), pages 369-383, August.
    13. Wei Huang & Chuanchuan Zhang, 2021. "The Power of Social Pensions: Evidence from China's New Rural Pension Scheme," American Economic Journal: Applied Economics, American Economic Association, vol. 13(2), pages 179-205, April.
    14. Carine Milcent, 2018. "Health Reform in China: From Violence To Digital Healthcare," Post-Print halshs-01960389, HAL.
    15. Pablo Martínez‐Camblor & Todd A. MacKenzie & Douglas O. Staiger & Phillip P. Goodney & A. James O’Malley, 2019. "An instrumental variable procedure for estimating Cox models with non‐proportional hazards in the presence of unmeasured confounding," Journal of the Royal Statistical Society Series C, Royal Statistical Society, vol. 68(4), pages 985-1005, August.
    16. Jeffrey M. Wooldridge, 2015. "Control Function Methods in Applied Econometrics," Journal of Human Resources, University of Wisconsin Press, vol. 50(2), pages 420-445.
    17. Bilge Erten & Jessica Leight, 2021. "Exporting Out of Agriculture: The Impact of WTO Accession on Structural Transformation in China," The Review of Economics and Statistics, MIT Press, vol. 103(2), pages 364-380, May.
    18. Hua Wang & Jie He, 2014. "Estimating the Economic Value of Statistical Life in China: A Study of the Willingness to Pay for Cancer Prevention," Frontiers of Economics in China-Selected Publications from Chinese Universities, Higher Education Press, vol. 9(2), pages 183-215, June.
    19. Zombré, David & De Allegri, Manuela & Ridde, Valéry, 2017. "Immediate and sustained effects of user fee exemption on healthcare utilization among children under five in Burkina Faso: A controlled interrupted time-series analysis," Social Science & Medicine, Elsevier, vol. 179(C), pages 27-35.
    20. David Neumark & J. M. Ian Salas & William Wascher, 2014. "Revisiting the Minimum Wage—Employment Debate: Throwing Out the Baby with the Bathwater?," ILR Review, Cornell University, ILR School, vol. 67(3_suppl), pages 608-648, May.
    21. Leila Agha & Dan Zeltzer, 2022. "Drug Diffusion through Peer Networks: The Influence of Industry Payments," American Economic Journal: Economic Policy, American Economic Association, vol. 14(2), pages 1-33, May.
    22. Gertler, Paul & Locay, Luis & Sanderson, Warren, 1987. "Are user fees regressive? : The welfare implications of health care financing proposals in Peru," Journal of Econometrics, Elsevier, vol. 36(1-2), pages 67-88.
    23. Huang, Wei & Liu, Hong, 2023. "Early childhood exposure to health insurance and adolescent outcomes: Evidence from rural China," Journal of Development Economics, Elsevier, vol. 160(C).
    24. Xiaoyan Lei & Wanchuan Lin, 2009. "The New Cooperative Medical Scheme in rural China: does more coverage mean more service and better health?," Health Economics, John Wiley & Sons, Ltd., vol. 18(S2), pages 25-46, July.
    25. Sun, Liyang & Abraham, Sarah, 2021. "Estimating dynamic treatment effects in event studies with heterogeneous treatment effects," Journal of Econometrics, Elsevier, vol. 225(2), pages 175-199.
    26. Gruber, Jonathan, 1994. "The Incidence of Mandated Maternity Benefits," American Economic Review, American Economic Association, vol. 84(3), pages 622-641, June.
    27. Justin Wolfers, 2006. "Did Unilateral Divorce Laws Raise Divorce Rates? A Reconciliation and New Results," American Economic Review, American Economic Association, vol. 96(5), pages 1802-1820, December.
    28. Jacob Goldin & Ithai Z Lurie & Janet McCubbin, 2021. "Health Insurance and Mortality: Experimental Evidence from Taxpayer Outreach," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 136(1), pages 1-49.
    29. Andrew Goodman-Bacon, 2021. "The Long-Run Effects of Childhood Insurance Coverage: Medicaid Implementation, Adult Health, and Labor Market Outcomes," American Economic Review, American Economic Association, vol. 111(8), pages 2550-2593, August.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Lin, Lin & Zai, Xianhua, 2022. "The Power of Public Insurance With Limited Benefits: Evidence from China's New Cooperative Medical Scheme," GLO Discussion Paper Series 1180, Global Labor Organization (GLO).
    2. Lin Lin & Xianhua Zai, 2022. "The role of supply responses in public insurance expansion: evidence from China's New Cooperative Medical Scheme," MPIDR Working Papers WP-2022-025, Max Planck Institute for Demographic Research, Rostock, Germany.
    3. Guanfu Fang & Xin Li & Tianyu Tang, 2024. "Growing up without health insurance: Evidence from rural China," Health Economics, John Wiley & Sons, Ltd., vol. 33(2), pages 363-390, February.
    4. Chan, Marc K. & Zeng, Guohua, 2018. "Unintended consequences of supply-side cost control? Evidence from China's new cooperative medical scheme," Journal of Health Economics, Elsevier, vol. 61(C), pages 27-46.
    5. Jinjing Wu & Shelby Deaton & Boshen Jiao & Zohn Rosen & Peter A Muennig, 2018. "The cost-effectiveness analysis of the New Rural Cooperative Medical Scheme in China," PLOS ONE, Public Library of Science, vol. 13(12), pages 1-13, December.
    6. Roth, Jonathan & Sant’Anna, Pedro H.C. & Bilinski, Alyssa & Poe, John, 2023. "What’s trending in difference-in-differences? A synthesis of the recent econometrics literature," Journal of Econometrics, Elsevier, vol. 235(2), pages 2218-2244.
    7. Huang, Wei & Liu, Hong, 2023. "Early childhood exposure to health insurance and adolescent outcomes: Evidence from rural China," Journal of Development Economics, Elsevier, vol. 160(C).
    8. Li, Xue & Smyth, Russell & Yao, Yao, 2023. "Extreme temperatures and out-of-pocket medical expenditure: Evidence from China," China Economic Review, Elsevier, vol. 77(C).
    9. Liu, Hong & Zhao, Zhong, 2014. "Does health insurance matter? Evidence from China’s urban resident basic medical insurance," Journal of Comparative Economics, Elsevier, vol. 42(4), pages 1007-1020.
    10. Bagnoli, Lisa, 2019. "Does health insurance improve health for all? Heterogeneous effects on children in Ghana," World Development, Elsevier, vol. 124(C), pages 1-1.
    11. Chen, Yi & Shi, Julie & Zhuang, Castiel Chen, 2019. "Income-dependent impacts of health insurance on medical expenditures: Theory and evidence from China," China Economic Review, Elsevier, vol. 53(C), pages 290-310.
    12. Gunes, Pinar Mine & Tsaneva, Magda, 2022. "The Effect of Brazil's Family Health Program on Cognitive Skills," IZA Discussion Papers 15784, Institute of Labor Economics (IZA).
    13. Abe Dunn & Joshua D. Gottlieb & Adam Shapiro & Daniel J. Sonnenstuhl & Pietro Tebaldi, 2021. "A Denial a Day Keeps the Doctor Away," NBER Working Papers 29010, National Bureau of Economic Research, Inc.
    14. Anaka Aiyar & Naveen Sunder, 2024. "Health insurance and child mortality: Evidence from India," Health Economics, John Wiley & Sons, Ltd., vol. 33(5), pages 870-893, May.
    15. Jessica Ya Sun, 2020. "Welfare consequences of access to health insurance for rural households: Evidence from the New Cooperative Medical Scheme in China," Health Economics, John Wiley & Sons, Ltd., vol. 29(3), pages 337-352, March.
    16. Fei Xie & Xiaoqing Jiang & Fang Yuan & Xiaoyun Chen & Zhaokang Yuan & Yuanan Lu, 2018. "Impact of the New Cooperative Medical Scheme on the Rural Residents’ Hospitalization Medical Expenses: A Five-Year Survey Study for the Jiangxi Province in China," IJERPH, MDPI, vol. 15(7), pages 1-11, June.
    17. Goodman-Bacon, Andrew, 2021. "Difference-in-differences with variation in treatment timing," Journal of Econometrics, Elsevier, vol. 225(2), pages 254-277.
    18. Palmer, Michael & Mitra, Sophie & Mont, Daniel & Groce, Nora, 2015. "The impact of health insurance for children under age 6 in Vietnam: A regression discontinuity approach," Social Science & Medicine, Elsevier, vol. 145(C), pages 217-226.
    19. Bairoliya, Neha & Miller, Ray, 2021. "Social insurance, demographics, and rural-urban migration in China," Regional Science and Urban Economics, Elsevier, vol. 91(C).
    20. Yiqiu, Wang & Maria, Porter & Songqing, Jin, 2016. "Estimating Effects of Health Insurance Coverage on Medical Service Utilization and Health in Rural China," 2016 Annual Meeting, July 31-August 2, Boston, Massachusetts 235470, Agricultural and Applied Economics Association.

    More about this item

    Keywords

    Public health insurance; Health outcomes; Mortality rate; Life expectancy; New cooperative medical scheme;
    All these keywords.

    JEL classification:

    • I10 - Health, Education, and Welfare - - Health - - - General
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:pubeco:v:226:y:2023:i:c:s0047272723001810. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/locate/inca/505578 .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.