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The impact of tax-subsidized health insurance on health and out-of-pocket burden in China

Author

Listed:
  • Feiyan Yang

    (Southwestern University of Finance and Economics)

  • Li Wei

    (Renmin University of China)

Abstract

To achieve a tiered healthcare system in China, the government has beefed up efforts to encourage people to embrace private health insurance. One of the steps is to introduce tax-subsidized health insurance (TSHI) in 2015. This paper assesses whether TSHI is successful in improving health and easing financial burden. Using unique data from the Domestic TSHI Consumers Evaluation Survey in 2019 and Propensity Score Matching method, we find that TSHI has been effective in improving participants’ health status, but not in lowering out-of-pocket (OOP) burden. Besides, TSHI can increase the utilization of both inpatient and outpatient care, which provides a possible explanation for beneficial health effect. From an internal perspective, TSHI has the potential to reduce disparities in health and access to healthcare services. Our results provide implications on modifying the benefit design of TSHI to better complement basic medical insurance system and on reforming the current tax incentive policy to reach out a large number of low-income people.

Suggested Citation

  • Feiyan Yang & Li Wei, 2023. "The impact of tax-subsidized health insurance on health and out-of-pocket burden in China," The Geneva Papers on Risk and Insurance - Issues and Practice, Palgrave Macmillan;The Geneva Association, vol. 48(1), pages 194-246, January.
    • Handle: RePEc:pal:gpprii:v:48:y:2023:i:1:d:10.1057_s41288-022-00276-4
    DOI: 10.1057/s41288-022-00276-4
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    1. Michel Grignon & Marc Perronnin & John N. Lavis, 2008. "Does free complementary health insurance help the poor to access health care? Evidence from France," Health Economics, John Wiley & Sons, Ltd., vol. 17(2), pages 203-219, February.
    2. Bagnoli, Lisa, 2019. "Does health insurance improve health for all? Heterogeneous effects on children in Ghana," World Development, Elsevier, vol. 124(C), pages 1-1.
    3. Patrick Hullegie & Tobias J. Klein, 2010. "The effect of private health insurance on medical care utilization and self‐assessed health in Germany," Health Economics, John Wiley & Sons, Ltd., vol. 19(9), pages 1048-1062, September.
    4. Arthur Lewbel, 2012. "Using Heteroscedasticity to Identify and Estimate Mismeasured and Endogenous Regressor Models," Journal of Business & Economic Statistics, Taylor & Francis Journals, vol. 30(1), pages 67-80.
    5. Diana Cheung & Jean-Pierre Laffargue & Ysaline Padieu, 2016. "Insurance of Household Risks and the Rebalancing of the Chinese Economy: Health Insurance, Health Expenses and Household Savings," Université Paris1 Panthéon-Sorbonne (Post-Print and Working Papers) hal-01450749, HAL.
    6. Chuanchuan Zhang & Xiaoyan Lei & John Strauss & Yaohui Zhao, 2017. "Health Insurance and Health Care among the Mid‐Aged and Older Chinese: Evidence from the National Baseline Survey of CHARLS," Health Economics, John Wiley & Sons, Ltd., vol. 26(4), pages 431-449, April.
    7. Chen, Yuyu & Jin, Ginger Zhe, 2012. "Does health insurance coverage lead to better health and educational outcomes? Evidence from rural China," Journal of Health Economics, Elsevier, vol. 31(1), pages 1-14.
    8. Gary V. Engelhardt & Jonathan Gruber, 2011. "Medicare Part D and the Financial Protection of the Elderly," American Economic Journal: Economic Policy, American Economic Association, vol. 3(4), pages 77-102, November.
    9. Janet Currie & Jonathan Gruber, 1996. "Health Insurance Eligibility, Utilization of Medical Care, and Child Health," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 111(2), pages 431-466.
    10. Martin Feldstein & Jonathan Gruber, 1995. "A Major Risk Approach to Health Insurance Reform," NBER Chapters, in: Tax Policy and the Economy, Volume 9, pages 103-130, National Bureau of Economic Research, Inc.
    11. David Card & Carlos Dobkin & Nicole Maestas, 2009. "Does Medicare Save Lives?," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 124(2), pages 597-636.
    12. Joseph J. Doyle Jr., 2005. "Health Insurance, Treatment and Outcomes: Using Auto Accidents as Health Shocks," NBER Working Papers 11099, National Bureau of Economic Research, Inc.
    13. Hitoshi Shigeoka, 2014. "The Effect of Patient Cost Sharing on Utilization, Health, and Risk Protection," American Economic Review, American Economic Association, vol. 104(7), pages 2152-2184, July.
    14. Goldman D. P. & Bhattacharya J. & McCaffrey D. F. & Duan N. & Leibowitz A. A. & Joyce G. F. & Morton S. C., 2001. "Effect of Insurance on Mortality in an HIV-Positive Population in Care," Journal of the American Statistical Association, American Statistical Association, vol. 96, pages 883-894, September.
    15. Amy Finkelstein & Sarah Taubman & Bill Wright & Mira Bernstein & Jonathan Gruber & Joseph P. Newhouse & Heidi Allen & Katherine Baicker, 2012. "The Oregon Health Insurance Experiment: Evidence from the First Year," The Quarterly Journal of Economics, Oxford University Press, vol. 127(3), pages 1057-1106.
    16. Zhiyuan Hou & Ellen Van de Poel & Eddy Van Doorslaer & Baorong Yu & Qingyue Meng, 2014. "Effects Of Ncms On Access To Care And Financial Protection In China," Health Economics, John Wiley & Sons, Ltd., vol. 23(8), pages 917-934, August.
    17. J. Guan & JdD Tena, 2018. "Do Social Medical Insurance Schemes Improve Children's Health in China?," Working Paper CRENoS 201807, Centre for North South Economic Research, University of Cagliari and Sassari, Sardinia.
    18. Grossman, Michael, 1972. "On the Concept of Health Capital and the Demand for Health," Journal of Political Economy, University of Chicago Press, vol. 80(2), pages 223-255, March-Apr.
    19. Douglas Holtz-Eakin & Harvey S. Rosen (ed.), 2004. "Public Policy and the Economics of Entrepreneurship," MIT Press Books, The MIT Press, edition 1, volume 1, number 0262083299, December.
    20. He, Huajing & Nolen, Patrick J., 2019. "The effect of health insurance reform: Evidence from China," China Economic Review, Elsevier, vol. 53(C), pages 168-179.
    21. Xiaoyan Lei & Wanchuan Lin, 2009. "The New Cooperative Medical Scheme in rural China: does more coverage mean more service and better health?," Health Economics, John Wiley & Sons, Ltd., vol. 18(S2), pages 25-46, July.
    22. Wagstaff, Adam & Lindelow, Magnus, 2008. "Can insurance increase financial risk?: The curious case of health insurance in China," Journal of Health Economics, Elsevier, vol. 27(4), pages 990-1005, July.
    23. Finkelstein, Amy & McKnight, Robin, 2008. "What did Medicare do? The initial impact of Medicare on mortality and out of pocket medical spending," Journal of Public Economics, Elsevier, vol. 92(7), pages 1644-1668, July.
    24. Zhang, Anwen & Nikoloski, Zlatko & Mossialos, Elias, 2017. "Does health insurance reduce out-of-pocket expenditure? Heterogeneity among China's middle-aged and elderly," Social Science & Medicine, Elsevier, vol. 190(C), pages 11-19.
    25. Gary V. Engelhardt & Jonathan Gruber, 2011. "Does Medicare Part D Protect the Elderly from Financial Risk?," Issues in Brief ib2011-8, Center for Retirement Research, revised Jun 2011.
    26. Liu, Hong & Zhao, Zhong, 2014. "Does health insurance matter? Evidence from China’s urban resident basic medical insurance," Journal of Comparative Economics, Elsevier, vol. 42(4), pages 1007-1020.
    27. Andrew Goodman-Bacon, 2018. "Public Insurance and Mortality: Evidence from Medicaid Implementation," Journal of Political Economy, University of Chicago Press, vol. 126(1), pages 216-262.
    28. Diana Cheung & Jean-Pierre Laffargue & Ysaline Padieu, 2016. "Insurance of Household Risks and the Rebalancing of the Chinese Economy: Health Insurance, Health Expenses and Household Savings," Pacific Economic Review, Wiley Blackwell, vol. 21(3), pages 381-412, August.
    29. Currie, Janet & Gruber, Jonathan, 1996. "Saving Babies: The Efficacy and Cost of Recent Changes in the Medicaid Eligibility of Pregnant Women," Journal of Political Economy, University of Chicago Press, vol. 104(6), pages 1263-1296, December.
    30. Diana Cheung & Jean-Pierre Laffargue & Ysaline Padieu, 2016. "Insurance of Household Risks and the Rebalancing of the Chinese Economy: Health Insurance, Health Expenses and Household Savings," Post-Print hal-01450749, HAL.
    31. Ye Li & Qunhong Wu & Chaojie Liu & Zheng Kang & Xin Xie & Hui Yin & Mingli Jiao & Guoxiang Liu & Yanhua Hao & Ning Ning, 2014. "Catastrophic Health Expenditure and Rural Household Impoverishment in China: What Role Does the New Cooperative Health Insurance Scheme Play?," PLOS ONE, Public Library of Science, vol. 9(4), pages 1-9, April.
    32. Hanratty, Maria J, 1996. "Canadian National Health Insurance and Infant Health," American Economic Review, American Economic Association, vol. 86(1), pages 276-284, March.
    33. Hullegie, P.G.J. & Klein, T.J., 2010. "The effect of private health insurance on medical care utilization and self-assessed health in Germany," Other publications TiSEM 5ca37b31-1d1b-4fa7-9f91-6, Tilburg University, School of Economics and Management.
    34. Joseph J. Doyle, 2005. "Health Insurance, Treatment and Outcomes: Using Auto Accidents as Health Shocks," The Review of Economics and Statistics, MIT Press, vol. 87(2), pages 256-270, May.
    35. Lichtenberg Frank R., 2002. "The Effects of Medicare on Health Care Utilization and Outcomes," Forum for Health Economics & Policy, De Gruyter, vol. 5(1), pages 1-29, January.
    36. Currie, Janet & Decker, Sandra & Lin, Wanchuan, 2008. "Has public health insurance for older children reduced disparities in access to care and health outcomes?," Journal of Health Economics, Elsevier, vol. 27(6), pages 1567-1581, December.
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