Study Of The Health Care Demand And Multi-health Insurance Schemes In China

Nowadays "universal health care" is the aim of the public health insurance program in China, that is, to ensure equity, able to pay and basic health care available to all residents in the rural and urban. China has been making great efforts on the road of universal coverage of public health insurance since the reform.China is currently in the midst of a period of transforming its health-care system. Three main types of medical insurance plan operated in China:Urban Employee Medical Insurance (UEMI), Urban Resident Medical Insurance (URME) and New Cooperative Insurance (NCMI). However, public health insurance’s universal coverage does not mean "universal health care". Because based on the universal coverage,"universal health care" requires health care be adequate, able to pay and equity available to all residents in the rural and urban. This means people with same equal needs for health care have equal utilization; different levels of ill health have appropriately different levels of utilization, whatever their occupations, income, education and other socio-demographic characteristics. And on the other hand, with public health insurance, people should be protected from the financial risks and impoverishment of illness. Currently, multi health insurance schemes are targeted to people with different income and occupations and the basic benefit package varies widely in different schemes across the rural and urban. With regard to NCMI, as a result of limited funding, coverage is typically shallow. Many services are not, or only partially, covered, deductibles are high, ceilings are low, and coinsurance rates are high. Regarding to the UEMI, the expanded coverage to private sector employees and pools its risk at the municipal level, which provides more stable financing. With regard to the URMI, it is a voluntary program aimed at providing health insurance to primary and secondary school students, very young children, and other unemployed urban residents. The goal of URMI is to eliminate medical impoverishment. On average, the URMBI policy covers not half of related inpatient medical costs and some outpatient services for chronic or fatal diseases. The GIS is the best public health insurance available in China in terms of generosity. The questions are arouse that how about the effect of multi-health insurance schemes on the health care utilization and financial protection for all residents in rural and urban.Within this background, this thesis is based on economics, economics of insurance, economics of health and health care and econometrics. The thesis established the theory of demand health and health insurance. Then different types of health insurance system in the world and the health care utilization consequences were examined respectively. Finally, the thesis empirically studied the effect of various types of health insurance on the individual health care demands.Based on the literature review of the effect of health insurance on the health care utilization, the paper employed data from the2008China Health and Retirement Longitudinal Study (CHARLS), to estimates various types of health insurance on the health care demand of people over45years old. The various types of health insurance refers to UEMI, URME, NCMI, Government Medical Insurance (GMI), private health insurance and others. The health care utilization is indicated by the following index:whether to care, the choice of various types of care, Medical care expenditure and out-of-pocket expenditure.The main results are as follows. Individual heterogeneity, i.e. health status, socio-demographic characteristics, accounts significantly for much of the variation in the health care utilization. After controlling for individual heterogeneity, various types of health insurance have a significant impact on the health care demand. First, compared to NCMI, all kinds of health insurance are positively related to the probability of care, particularly, private health insurance is44%more likely to care and UEMI is12%more like to care. Second, people who cared, no evidence showed that health insurance is significantly related to the choice of treat themselves, outpatient or inpatient, both treat themselves and outpatient or inpatient. The exception is, compared to treat themselves, adults with UEMI are8%less likely to choose both treat themselves and outpatient or inpatient than adults with NCMI. Third, with regard to the probability of Medical care expenditure zero above, compared with NCMI, private health insurance incurred a33%higher probability and UEMI incurred a9higher probability. With regard to the Medical care expenditure, URMI has a59%more expenditure (1844RMB, with average Medical care expenditure equals3111RMB); while GMI has a125%higher expenditure (3895RMB). The health care demand elasticity of income is0.127. Fourth, with respect to the probability of OOP zero above, individual with OOP accounts for98%of the sample size. No evidence suggests that health insurance is significantly related to the probability of OOP zero above as a large majority of people have occurred OOP. The exception is people with private health insurance are2%lower to have OOP than people with NCMI. Regarding to OOP, compared to NCMI, people covered by URMI have a26%higher OOP (533RMB, with average of OOP is2022RMB in the sample); while people with private health insurance have a56%lower OOP (1131RMB). With regard to the share of OOP in Medical care expenditure, compared to NCMI, people covered by UEMI and GMI both have a8%lower share of OOP.The findings suggest that multi-health insurance schemes significantly have an impact on the health care utilization and financial protection for residents in rural and urban. In terms of generosity, the GIS is the best public health insurance and increases the Medical care expenditure and decreases the OOP financial burden. However, on the contrary, NCMI with many services only partially covered, higher deductibles, lower ceilings and high coinsurance rates, incurs a lower expenditure and a higher share of OOP, and this is almost true to URMI. And the impact of the UEMI is in the medium. Greater attention to the policies and interventions that may reduce the difference of basic benefit package to promote the equality of public health services to move towards universal coverage is warranted.