Nothing Special   »   [go: up one dir, main page]
IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v170y2016icp124-132.html
   My bibliography  Save this article

Insurance coverage and socioeconomic differences in patient choice between private and public health care providers in China

Author

Listed:
  • Wang, Qing
  • Zhang, Donglan
  • Hou, Zhiyuan
Abstract
The private health care sector has become an increasingly important complement to China's health care system. During the health care reform in 2009, China's central government established multiple initiatives to relax constraints on the growth of the private health care sector. However, private health services have not been growing as rapidly as private health care facilities. Using data from the China Health and Retirement Longitudinal Study collected between 2011 and 2013, this study investigated patient choice between private and public providers for outpatient care and estimated its relationship with health insurance and socioeconomic status (SES). The Heckman sample selection model was applied to address the problem of selection bias caused by a lack of awareness of provider ownership. We found that 82.1% of the outpatient care users were aware of their provider's ownership, and 23.8% chose private health care providers. Although patients with health insurance and higher SES were more likely to be aware of their provider's ownership, they preferred public providers over private providers. For example, having Urban Employee Basic Medical Insurance was associated with a 16.5% lower probability of choosing private providers than no health insurance. Respondents with the highest level of household expenditure had a 7.5% lower probability of choosing private providers than those with the lowest level of expenditure. The probability of choosing private providers were significantly lower by 4.0% among respondents with an education level of junior high school and above than those with no formal education. For private providers to play an effective role in the health care system, policies that have constrained the growth of the private sector should be changed, and more effort should be directed toward equalizing health insurance coverage for both types of providers.

Suggested Citation

  • Wang, Qing & Zhang, Donglan & Hou, Zhiyuan, 2016. "Insurance coverage and socioeconomic differences in patient choice between private and public health care providers in China," Social Science & Medicine, Elsevier, vol. 170(C), pages 124-132.
    • Handle: RePEc:eee:socmed:v:170:y:2016:i:c:p:124-132
    DOI: 10.1016/j.socscimed.2016.10.016
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277953616305846
    Download Restriction: Full text for ScienceDirect subscribers only
    File URL: https://libkey.io/10.1016/j.socscimed.2016.10.016?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. Søgaard, Rikke & Pedersen, Morten Saaby & Bech, Mickael, 2013. "To what extent does employer-paid health insurance reduce the use of public hospitals?," Health Policy, Elsevier, vol. 113(1), pages 61-68.
    2. Heckman, James, 2013. "Sample selection bias as a specification error," Applied Econometrics, Russian Presidential Academy of National Economy and Public Administration (RANEPA), vol. 31(3), pages 129-137.
    3. Pan, Jay & Qin, Xuezheng & Li, Qian & Messina, Joseph P. & Delamater, Paul L., 2015. "Does hospital competition improve health care delivery in China?," China Economic Review, Elsevier, vol. 33(C), pages 179-199.
    4. Judy Xu & Gordon Liu & Guoying Deng & Lin Li & Xianjun Xiong & Kisalaya Basu, 2015. "A Comparison of Outpatient Healthcare Expenditures Between Public and Private Medical Institutions in Urban China: An Instrumental Variable Approach," Health Economics, John Wiley & Sons, Ltd., vol. 24(3), pages 270-279, March.
    5. Gronau, Reuben, 1974. "Wage Comparisons-A Selectivity Bias," Journal of Political Economy, University of Chicago Press, vol. 82(6), pages 1119-1143, Nov.-Dec..
    6. Lewis, H Gregg, 1974. "Comments on Selectivity Biases in Wage Comparisons," Journal of Political Economy, University of Chicago Press, vol. 82(6), pages 1145-1155, Nov.-Dec..
    7. Srivastava, P & Zhao, X, 2008. "Impact of Private Health Insurance on the Choice of Public versus Private Hospital Services," Health, Econometrics and Data Group (HEDG) Working Papers 08/17, HEDG, c/o Department of Economics, University of York.
    8. Sandra L. Decker & Jalpa A. Doshi & Amy E. Knaup & Daniel Polsky, 2012. "Health Service Use Among The Previously Uninsured: Is Subsidized Health Insurance Enough?," Health Economics, John Wiley & Sons, Ltd., vol. 21(10), pages 1155-1168, October.
    9. Liu, Yuanli & Berman, Peter & Yip, Winnie & Liang, Haocai & Meng, Qingyue & Qu, Jiangbin & Li, Zhonghe, 2006. "Health care in China: The role of non-government providers," Health Policy, Elsevier, vol. 77(2), pages 212-220, July.
    10. Qian, Dongfu & Lucas, Henry & Chen, Jiaying & Xu, Ling & Zhang, Yaoguang, 2010. "Determinants of the use of different types of health care provider in urban China: A tracer illness study of URTI," Health Policy, Elsevier, vol. 98(2-3), pages 227-235, December.
    11. Lei, Xiaoyan & Sun, Xiaoting & Strauss, John & Zhang, Peng & Zhao, Yaohui, 2014. "Depressive symptoms and SES among the mid-aged and elderly in China: Evidence from the China Health and Retirement Longitudinal Study national baseline," Social Science & Medicine, Elsevier, vol. 120(C), pages 224-232.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Xuefeng Li & Li Deng & Han Yang & Hui Wang, 2020. "Effect of socioeconomic status on the healthcare-seeking behavior of migrant workers in China," PLOS ONE, Public Library of Science, vol. 15(8), pages 1-15, August.
    2. Runguo Wu & Niying Li & Angelo Ercia, 2020. "The Effects of Private Health Insurance on Universal Health Coverage Objectives in China: A Systematic Literature Review," IJERPH, MDPI, vol. 17(6), pages 1-21, March.
    3. Xinxin Peng & Xiaolei Tang & Yijun Chen & Jinghua Zhang, 2021. "Ranking the Healthcare Resource Factors for Public Satisfaction with Health System in China—Based on the Grey Relational Analysis Models," IJERPH, MDPI, vol. 18(3), pages 1-13, January.
    4. Yanbing Zeng & Yuanyuan Wan & Zhipeng Yuan & Ya Fang, 2021. "Healthcare-Seeking Behavior among Chinese Older Adults: Patterns and Predictive Factors," IJERPH, MDPI, vol. 18(6), pages 1-18, March.
    5. Arsen P. Davitadze, 2024. "Modeling Consumer Choice between Public and Private Health Care in Russia," Journal of Applied Economic Research, Graduate School of Economics and Management, Ural Federal University, vol. 23(2), pages 499-521.
    6. Jiangjun Wan & Yutong Zhao & Kaili Zhang & Chunchi Ma & Haiying Sun & Ziming Wang & Hongyu Wu & Mingjie Li & Lingqing Zhang & Xiaohong Tang & Ying Cao & Li Tang & Jinxiu Yang, 2022. "Healthy Community-Life Circle Planning Combining Objective Measurement and Subjective Evaluation: Theoretical and Empirical Research," IJERPH, MDPI, vol. 19(9), pages 1-25, April.

    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. Verbeek, M.J.C.M. & Nijman, T.E., 1992. "Incomplete panels and selection bias : A survey," Discussion Paper 1992-7, Tilburg University, Center for Economic Research.
    2. James J. Heckman, 2008. "Econometric Causality," International Statistical Review, International Statistical Institute, vol. 76(1), pages 1-27, April.
    3. Yiu Por (Vincent) Chen, 2016. "Fiscal Decentralization, Rural Industrialization and Undocumented Labour Mobility in Rural China, 1982–87," Regional Studies, Taylor & Francis Journals, vol. 50(9), pages 1469-1482, September.
    4. Ben-Halima, B. & Chusseau, N. & Hellier, J., 2014. "Skill premia and intergenerational education mobility: The French case," Economics of Education Review, Elsevier, vol. 39(C), pages 50-64.
    5. B. Ben Halima & N. Chusseau & J. Hellier, 2013. "Skill Premia and Intergenerational Skill Transmission: The French Case," Working Papers 285, ECINEQ, Society for the Study of Economic Inequality.
    6. Andrew J. Hogan & Luisa Franzini & James R. Boex, 2000. "Estimating the cost of primary care training in ambulatory settings," Health Economics, John Wiley & Sons, Ltd., vol. 9(8), pages 715-726, December.
    7. Alan Benson & Danielle Li & Kelly Shue, 2019. "Promotions and the Peter Principle," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 134(4), pages 2085-2134.
    8. Torres, Miguel Matos & Clegg, L. Jeremy & Varum, Celeste Amorim, 2016. "The missing link between awareness and use in the uptake of pro-internationalization incentives," International Business Review, Elsevier, vol. 25(2), pages 495-510.
    9. Wojtyś, Małgorzata & Marra, Giampiero & Radice, Rosalba, 2018. "Copula based generalized additive models for location, scale and shape with non-random sample selection," Computational Statistics & Data Analysis, Elsevier, vol. 127(C), pages 1-14.
    10. María Arrazola & José de Hevia, 2016. "The Gender Wage Gap in Offered, Observed, and Reservation Wages for Spain," Feminist Economics, Taylor & Francis Journals, vol. 22(4), pages 101-128, October.
    11. Zhewen Pan, 2023. "On semiparametric estimation of the intercept of the sample selection model: a kernel approach," Papers 2302.05089, arXiv.org.
    12. Peng, Fei & Kang, Lili & Jiang, Jun, 2011. "Selection and institutional shareholder activism in Chinese acquisitions," MPRA Paper 38701, University Library of Munich, Germany.
    13. Yves Guillotin & Patrick Sevestre, 1994. "Estimations de fonctions de gains sur données de panel : endogéneité du capital humain et effets de la sélection," Économie et Prévision, Programme National Persée, vol. 116(5), pages 119-135.
    14. Marra Giampiero & Radice Rosalba, 2017. "A joint regression modeling framework for analyzing bivariate binary data in R," Dependence Modeling, De Gruyter, vol. 5(1), pages 268-294, December.
    15. Schafgans, Marcia M. A., 2000. "Gender wage differences in Malaysia: parametric and semiparametric estimation," Journal of Development Economics, Elsevier, vol. 63(2), pages 351-378, December.
    16. Marra, Giampiero & Wyszynski, Karol, 2016. "Semi-parametric copula sample selection models for count responses," Computational Statistics & Data Analysis, Elsevier, vol. 104(C), pages 110-129.
    17. Fedderke, Johannes W. & Chen, Tinghua, 2023. "Generalizing the “Masterpiece Effect” in fine art pricing: Quantile Hedonic regression results for the South African fine art market, 2009–2021," Economic Modelling, Elsevier, vol. 124(C).
    18. Bengt Muthen & Karl G. Jöreskog, 1983. "Selectivity Problems in Quasi-Experimental Studies," Evaluation Review, , vol. 7(2), pages 139-174, April.
    19. Boucher, Michel, 1984. "Les Canadiens français dans la ligue nationale de hockey : une analyse statistique," L'Actualité Economique, Société Canadienne de Science Economique, vol. 60(3), pages 308-325, septembre.
    20. James J. Heckman, 2005. "Micro Data, Heterogeneity and the Evaluation of Public Policy Part 2," The American Economist, Sage Publications, vol. 49(1), pages 16-44, March.

    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:socmed:v:170:y:2016:i:c:p:124-132. 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/wps/find/journaldescription.cws_home/315/description#description .

    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.