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Examining the association between social health insurance participation and patients' out-of-pocket payments in China: The role of institutional arrangement

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  • Liu, Kai
  • Wu, Qiaobing
  • Liu, Junqiang

Abstract

Previous work on the relationship between social health insurance (SHI) participation and patients' out-of-pocket payments (OOP) in China has overlooked the mediating mechanisms of the institutional arrangement. This study establishes a conceptual framework involving the reimbursement, behavior management and purchasing mechanisms to elaborate on the institutional arrangement of SHI in China. Using structural equation modeling, data on 1645 hospitalized patients obtained from a nationally representative survey in China are analyzed. The results show that the behavior management and purchasing mechanisms of SHI perform poorly, undermining the function of the reimbursement mechanism and mitigating the association between SHI participation and OOP. As a result, SHI participation has a weak negative or even no significant association with the OOP of hospitalized patients. This seems to contradict the principles of SHI, which aims to reduce people's OOP and enhance their wellbeing. These findings are expected to provide valuable insights to the ongoing healthcare reform process in China.

Suggested Citation

  • Liu, Kai & Wu, Qiaobing & Liu, Junqiang, 2014. "Examining the association between social health insurance participation and patients' out-of-pocket payments in China: The role of institutional arrangement," Social Science & Medicine, Elsevier, vol. 113(C), pages 95-103.
    • Handle: RePEc:eee:socmed:v:113:y:2014:i:c:p:95-103
    DOI: 10.1016/j.socscimed.2014.05.011
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    1. Zhang, Xiaobo & Kanbur, Ravi, 2005. "Spatial inequality in education and health care in China," China Economic Review, Elsevier, vol. 16(2), pages 189-204.
    2. Gerdtham, Ulf-G. & Jonsson, Bengt, 2000. "International comparisons of health expenditure: Theory, data and econometric analysis," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 1, pages 11-53, Elsevier.
    3. Wagstaff, Adam & Lindelow, Magnus & Jun, Gao & Ling, Xu & Juncheng, Qian, 2009. "Extending health insurance to the rural population: An impact evaluation of China's new cooperative medical scheme," Journal of Health Economics, Elsevier, vol. 28(1), pages 1-19, January.
    4. William C. Hsiao & R. Paul Shaw, 2007. "Social Health Insurance for Developing Nations," World Bank Publications - Books, The World Bank Group, number 6860.
    5. Adam Wagstaff, 2010. "Social health insurance reexamined," Health Economics, John Wiley & Sons, Ltd., vol. 19(5), pages 503-517, May.
    6. 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.
    7. Xu, Weiwei & van de Ven, Wynand P.M.M., 2009. "Purchasing health care in China: Competing or non-competing third-party purchasers?," Health Policy, Elsevier, vol. 92(2-3), pages 305-312, October.
    8. Karen Eggleston & Li Ling & Meng Qingyue & Magnus Lindelow & Adam Wagstaff, 2008. "Health service delivery in China: a literature review," Health Economics, John Wiley & Sons, Ltd., vol. 17(2), pages 149-165, February.
    9. Yip, Winnie & Hsiao, William C., 2009. "Non-evidence-based policy: How effective is China's new cooperative medical scheme in reducing medical impoverishment?," Social Science & Medicine, Elsevier, vol. 68(2), pages 201-209, January.
    10. Liu, Dan & Tsegai, Daniel W., 2011. "The New Cooperative Medical Scheme (NCMS) and its implications for access to health care and medical expenditure: Evidence from rural China," Discussion Papers 116746, University of Bonn, Center for Development Research (ZEF).
    11. 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.
    12. Wagstaff, Adam & Lindelow, Magnus, 2008. "Can insurance increase financial risk?: The curious case of health insurance in China," Journal of Health Economics, Elsevier, vol. 27(4), pages 990-1005, July.
    13. Gu, Danan & Dupre, Matthew E. & Warner, David F. & Zeng, Yi, 2009. "Changing health status and health expectancies among older adults in China: Gender differences from 1992 to 2002," Social Science & Medicine, Elsevier, vol. 68(12), pages 2170-2179, June.
    14. repec:wly:soecon:v:82:2:y:2015:p:361-384 is not listed on IDEAS
    Full references (including those not matched with items on IDEAS)

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    2. Ben Westmore, 2017. "Sharing the Benefits of China’s Growth by Providing Opportunities to All," Journal of International Commerce, Economics and Policy (JICEP), World Scientific Publishing Co. Pte. Ltd., vol. 8(03), pages 1-33, October.
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    5. Eduardo J. Gómez, 2016. "Confronting Health Inequalities in the BRICS: Political Institutions, Foreign Policy Aspirations and State-civil Societal Relationships," Global Policy, London School of Economics and Political Science, vol. 7(4), pages 500-509, November.
    6. Xiaoyu Wang & Chunan Wang, 2020. "How Does Health Status Affect Marginal Utility of Consumption? Evidence from China," IJERPH, MDPI, vol. 17(7), pages 1-20, March.
    7. Darius Erlangga & Marc Suhrcke & Shehzad Ali & Karen Bloor, 2019. "The impact of public health insurance on health care utilisation, financial protection and health status in low- and middle-income countries: A systematic review," PLOS ONE, Public Library of Science, vol. 14(8), pages 1-20, August.

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