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Health Insurance Benefit Design and Healthcare Utilization in Northern Rural China

Author

Listed:
  • Hong Wang
  • Yu Liu
  • Yan Zhu
  • Lei Xue
  • Martha Dale
  • Heather Sipsma
  • Elizabeth Bradley
Abstract
Background: Poverty due to illness has become a substantial social problem in rural China since the collapse of the rural Cooperative Medical System in the early 1980s. Although the Chinese government introduced the New Rural Cooperative Medical Schemes (NRCMS) in 2003, the associations between different health insurance benefit package designs and healthcare utilization remain largely unknown. Accordingly, we sought to examine the impact of health insurance benefit design on health care utilization. Methods and Findings: We conducted a cross-sectional study using data from a household survey of 15,698 members of 4,209 randomly-selected households in 7 provinces, which were representative of the provinces along the north side of the Yellow River. Interviews were conducted face-to-face and in Mandarin. Our analytic sample included 9,762 respondents from 2,642 households. In each household, respondents indicated the type of health insurance benefit that the household had (coverage for inpatient care only or coverage for both inpatient and outpatient care) and the number of outpatient visits in the 30 days preceding the interview and the number of hospitalizations in the 365 days preceding the household interview. People who had both outpatient and inpatient coverage compared with inpatient coverage only had significantly more village-level outpatient visits, township-level outpatient visits, and total outpatient visits. Furthermore, the increased utilization of township and village-level outpatient care was experienced disproportionately by people who were poorer, whereas the increased inpatient utilization overall and at the county level was experienced disproportionately by people who were richer. Conclusion: The evidence from this study indicates that the design of health insurance benefits is an important policy tool that can affect the health services utilization and socioeconomic equity in service use at different levels. Without careful design, health insurance may not benefit those who are most in need of financial protection from health services expenses.

Suggested Citation

  • Hong Wang & Yu Liu & Yan Zhu & Lei Xue & Martha Dale & Heather Sipsma & Elizabeth Bradley, 2012. "Health Insurance Benefit Design and Healthcare Utilization in Northern Rural China," PLOS ONE, Public Library of Science, vol. 7(11), pages 1-7, November.
    • Handle: RePEc:plo:pone00:0050395
    DOI: 10.1371/journal.pone.0050395
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    References listed on IDEAS

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    1. 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.
    2. 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.
    3. Adam Wagstaff, 2012. "Benefit‐incidence analysis: are government health expenditures more pro‐rich than we think?," Health Economics, John Wiley & Sons, Ltd., vol. 21(4), pages 351-366, April.
    4. Wagstaff, Adam & Yu, Shengchao, 2007. "Do health sector reforms have their intended impacts?: The World Bank's Health VIII project in Gansu province, China," Journal of Health Economics, Elsevier, vol. 26(3), pages 505-535, May.
    5. 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.
    6. Hongmei Yi & Linxiu Zhang & Kim Singer & Scott Rozelle & Scott Atlas, 2009. "Health insurance and catastrophic illness: a report on the New Cooperative Medical System in rural China," Health Economics, John Wiley & Sons, Ltd., vol. 18(S2), pages 119-127, July.
    7. 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.
    8. You, Xuedan & Kobayashi, Yasuki, 2009. "The new cooperative medical scheme in China," Health Policy, Elsevier, vol. 91(1), pages 1-9, June.
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    Cited by:

    1. Kim, Sujin & Kwon, Soonman, 2014. "Has the National Health Insurance improved the inequality in the use of tertiary-care hospitals in Korea?," Health Policy, Elsevier, vol. 118(3), pages 377-385.
    2. 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.
    3. Yun Liu & Qingxia Kong & Shasha Yuan & Joris van de Klundert, 2018. "Factors influencing choice of health system access level in China: A systematic review," PLOS ONE, Public Library of Science, vol. 13(8), pages 1-21, August.

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