Empirical Study on the Impact of Urban and Rural Resident Basic Medical Insurance on Children's Educational Outcomes

This paper employs data from the 2016 and 2018 China Family Panel Studies (CFPS) to study the impact of participation in Urban and Rural Resident Basic Medical Insurance (URRBMI) on children's educational outcomes by using the logit model, double selection Lasso model, and propensity score matching. It is found that participating in URRBMI has no significant effect on children's Chinese performance, but has a significant negative effect on children's mathematics performance. The negative effect is more obvious for children who participating in the New Cooperative Medical Scheme (NCMS). The paper also studies the channel effects of participation in URRBMI on children's educational outcomes trough two different ways. It is noticed that both channel effects are not significant, that is, participation in URRBMI neither improves children's health nor changes household education expenditures.

Urban-rural differences in healthcare utilization among beneficiaries in China’s new cooperative medical scheme

Background The New Cooperative Medical Scheme (NCMS) is a voluntary social health insurance program launched in 2002 for rural Chinese residents where 80% of people were without health insurance of any kind. Over time, several concerns about this program have been raised related to healthcare utilization disparities for NCMS participants in urban versus rural regions. Our study uses 2015 national survey data to evaluate the extent of these urban and rural disparities among NCMS beneficiaries. Methods Data for our study are based on the Chinese Health and Retirement Longitudinal Study (CHARLS) for 2015. Our 12,190-patient sample are urban and rural patients insured by NCMS. We use logistic regression analyses to compare the extent of disparities for urban and rural residence of NCMS beneficiaries in (1) whether individuals received any inpatient or outpatient care during 2015 and (2) for those individuals that did receive care, the extent of the variation in the number of inpatient and outpatient visits among each group. Results Our regression results reveal that for urban and rural NCMS patients in 2015, there were no significant differences in inpatient or outpatient utilization for either of the dependent variables – 1) whether or not the patient had a visit during the last year, or 2) for those that had a visit, the number of visits they had. Patient characteristics: age, sex, employment, health status, chronic conditions, and per capita annual expenditures – all had significant impacts on whether or not there was an inpatient or outpatient visit but less influence on the number of inpatient or outpatient visits. Conclusions For both access to inpatient and outpatient facilities and the level of utilization of these facilities, our results reveal that both urban and rural NCMS patients have similar levels of resource utilization. These results from 2015 indicate that utilization angst about urban and rural disparities in NCMS patients do not appear to be a significant concern.

The impact of health insurance on poverty among rural older adults: an evidence from nine counties of western China

Background Older adults are more prone to various diseases. Health insurance becomes effective mechanism to relieve financial burden when the insured is sick. In China, most older adults live in the countryside, and New Rural Cooperative Medical Scheme is a kind of health insurance system in rural areas. The relationship between New Rural Cooperative Medical Scheme and financial burden due to health expenditure of older adults in China was investigated. This paper aims at the impact of New Rural Cooperative Medical Scheme on the poverty among rural older adults. Methods This study employs Probit model and Tobit model to assess the impact of New Rural Cooperative Medical Scheme on alleviating poverty among rural older adults based on a survey in nine representative counties in western China. Results The findings show that diseases have significantly negative impact on rural elderly poverty. New Rural Cooperative Medical Scheme has impact on alleviating of the health-payment poverty due to catastrophic health expenditure, but the impact is limited. The impact of health insurance on poverty alleviation is greater for men, older adults aged between 60 to 69 and households in in economically poorer area than their counterparts. Conclusions This study show the relationship between New Rural Cooperative Medical Scheme and catastrophic health expenditure of older adults in China. The results draw policy attention to introduce different reimbursement expense ratios for different groups to alleviate them from poverty based on more comprehensive insurance packages.

Effectiveness of primary care gatekeeping: difference-in-differences evaluation of a pilot scheme in China

IntroductionThis paper evaluates the effectiveness of a gatekeeping pilot in shifting resources and patient visits from hospitals to primary care facilities under the Chinese New Rural Cooperative Medical Scheme.MethodsWe applied a difference-in-differences regression analysis using claims data from a pilot district in northern China. The study covered 200 685 enrollees in 17 townships in 2012 and followed-up the townships over 12 year-quarters until the end of 2014.ResultsThe gatekeeping pilot led to significantly more patients visiting primary care facilities (55.3%, p=0.001), but there was little evidence of increased ambulatory spending on primary care (1.6%, p=0.884). The pilot reduced hospital visits by 23.9% (p=0.048) and ambulatory spending at the hospitals by 22.4% (p=0.011).ConclusionsThis first impact evaluation of gatekeeping outside high-income countries found that gatekeeping policy did not seem to have expanded the care provided by primary care facilities, despite an increased volume of claimed visits. Although claimed patient visits and expenditure at hospitals reduced, we suspect this may have been because patients found it either cumbersome or difficult to obtain reimbursement for their care.

NRCMS and Rural Household Credit Availability in China: Evidence From CFPS

Background: The Chinese government has, in seeking to enable farmers to obtain and use safe and affordable formal financial services, implemented Inclusive Finance. But disease burden, poor health and other factors have made it difficult for farmers to obtain formal credit servicesMethods: This paper draws on 2010 China family survey (CFPS) data to explore how the New Rural Cooperative Medical Scheme (NRCMS) affected rural households’ credit availability. Results:The results show that, as a public health insurance system sustained by the participation of government investment participation, the NRCMS provides good ‘collateral’ and significantly enhances farmers’ credit availability level. Conclusions: Our study suggests the positive impacts is mainly reflected in the economic effect of the NRCMS. This raises the question of how to make better use of the NRCMS’ mortgage function, promote inclusive finance and provide more financial services for farmers that will promote their income. This serves to confirm and underline the importance of relevant policies.JEL Classifications: I18; G50; O16