Abstract
Background: Social health insurance (SHI) in China has reached 95% coverage and facilitated progress toward Universal Health Coverage (UHC). However, elderly populations are currently under-represented, amplifying regional disparities and threatening progress toward UHC. Some households seek commercial health insurance (CHI) to complement SHI. This study is the first to investigate the effect of ageing and education on demand for CHI by region in China. Methods: Drawing on 2011 to 2018 data for 31 out of 34 provinces from the China Insurance Yearbook and Statistic Yearbook, fixed effects models were built for national and regional multivariate regression analyses. The analysis included CHI demand as the dependent variable, education level and elderly dependency ratio as independent variables, and disposable income per capita, SHI coverage, as well as health expenditure per capita as control variables.Results: Findings from the national analysis indicate a significant positive relationship between CHI demand and education level (17.3, p=0.01), elderly dependency ratio (24.1, p<0.001), disposable income per capita (179.5, p=0.04), and health expenditure per capita (0.12, p<0.001). However, no significant association is found between SHI coverage and CHI demand. In the regional analysis, a significant positive between education level and CHI demand is only found for the Eastern region (29.1, p<0.05). Similarly, a significant positive relationship between the elderly dependency ratio and CHI demand is observed for the Eastern (25.9, p<0.05) and Central regions (18.5, p<0.05). Of the three control variables investigated, disposable income per capita is not found to have an effect on CHI demand in any of the three regions. Conclusions: Results from this study build on existing evidence and draw attention to regional disparities in China, particularly in terms of education, and the resulting effect on CHI demand. Findings support calls for more elderly-oriented public health policy and insurance reform in China.
A National and Regional Analysis of the Effects of Ageing and Education on Demand for Commercial Health Insurance in China.
