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Impacts of the type of social health insurance on health service utilisation and expenditures: implications for a unified system in China

Published online by Cambridge University Press:  08 May 2018

Si Ying Tan ,
Xun Wu  and
Wei Yang
Si Ying Tan*
Affiliation:
Lee Kuan Yew School of Public Policy, National University of Singapore, Singapore
Xun Wu
Affiliation:
Lee Kuan Yew School of Public Policy, National University of Singapore, Singapore Division of Social Science and Division of Environment, Hong Kong University of Science and Technology, Hong Kong, China
Wei Yang
Affiliation:
Department of Global Health and Social Medicine, King’s College London, London, UK
*
*Correspondence to: Si Ying Tan, Lee Kuan Yew School of Public Policy, National University of Singapore, 469C Bukit Timah Road, Oei Tiong Ham Building, Singapore 259772. Email: s.tan14@u.nus.edu
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Abstract

While moving towards unified social health insurance (SHI) is often a politically popular policy reform in countries where rapid expansion in health insurance coverage has given rise to the segmentation of SHI systems as different SHI schemes were rolled out to serve different populations, the potential impacts of reform on service utilisation and health costs have not been systematically studied. Using data from the Chinese Health and Retirement Longitudinal Study (CHARLS), we compared the mean costs incurred for both inpatient and outpatient care under different health insurance schemes, and the impact of different SHI schemes on treatment utilisation and health care costs using a two-part model. Our results show that Urban Employee Medical Insurance, which offers the most generous benefits, incurs the highest total costs prior to reimbursement when compared to other SHI schemes. Our analysis also shows that utilisation of SHI did not show significant reduction in out-of-pocket payments for outpatients. We argue that, unless effective measures are introduced to deal with perverse provider payment incentives, the move towards a unified system with more generous benefits may usher in a new wave of cost escalation for health care systems in China.

Type
Articles
Information
Health Economics, Policy and Law , Volume 14 , Issue 4 , October 2019 , pp. 468 - 486
Copyright
© Cambridge University Press 2018 

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