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Examining the association between social health insurance participation and patients' out-of-pocket payments in China: The role of institutional arrangement

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  • Liu, Kai
  • Wu, Qiaobing
  • Liu, Junqiang

Abstract

Previous work on the relationship between social health insurance (SHI) participation and patients' out-of-pocket payments (OOP) in China has overlooked the mediating mechanisms of the institutional arrangement. This study establishes a conceptual framework involving the reimbursement, behavior management and purchasing mechanisms to elaborate on the institutional arrangement of SHI in China. Using structural equation modeling, data on 1645 hospitalized patients obtained from a nationally representative survey in China are analyzed. The results show that the behavior management and purchasing mechanisms of SHI perform poorly, undermining the function of the reimbursement mechanism and mitigating the association between SHI participation and OOP. As a result, SHI participation has a weak negative or even no significant association with the OOP of hospitalized patients. This seems to contradict the principles of SHI, which aims to reduce people's OOP and enhance their wellbeing. These findings are expected to provide valuable insights to the ongoing healthcare reform process in China.

Suggested Citation

  • Liu, Kai & Wu, Qiaobing & Liu, Junqiang, 2014. "Examining the association between social health insurance participation and patients' out-of-pocket payments in China: The role of institutional arrangement," Social Science & Medicine, Elsevier, vol. 113(C), pages 95-103.
    • Handle: RePEc:eee:socmed:v:113:y:2014:i:c:p:95-103
    DOI: 10.1016/j.socscimed.2014.05.011
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    2. Eduardo J. Gómez, 2016. "Confronting Health Inequalities in the BRICS: Political Institutions, Foreign Policy Aspirations and State-civil Societal Relationships," Global Policy, London School of Economics and Political Science, vol. 7(4), pages 500-509, November.
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    5. Darius Erlangga & Marc Suhrcke & Shehzad Ali & Karen Bloor, 2019. "The impact of public health insurance on health care utilisation, financial protection and health status in low- and middle-income countries: A systematic review," PLOS ONE, Public Library of Science, vol. 14(8), pages 1-20, August.
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    7. Xiaoyu Wang & Chunan Wang, 2020. "How Does Health Status Affect Marginal Utility of Consumption? Evidence from China," IJERPH, MDPI, vol. 17(7), pages 1-20, March.

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