IDEAS home Printed from https://ideas.repec.org/a/eee/ecanpo/v78y2023icp937-953.html
   My bibliography  Save this article

The effect of public insurance policy on the private insurance market: New evidence from a quasi-experiment in China

Author

Listed:
  • Chen, Hua
  • Ding, Yugang
  • Wang, Xiangnan
  • Yang, Yifei

Abstract

Analyzing the net social welfare of a public health insurance policy necessitates an accurate estimation of its impact on the private health insurance market. This paper presents new evidence of the effect of public health insurance on private health insurance market by exploiting a quasi-experiment of Urban Resident Basic Medical Insurance (URBMI) in China. Our findings indicate that the implementation of URBMI has no significant effect on the aggregated private health insurance market. However, upon dividing the private health insurance market into medical and illness insurance markets, we observe a significant crowding-out effect of URBMI on the former but not the latter. This finding may help explain the mixed results in the literature, which typically lumps all segments of private health insurance markets together. In terms of the possible channels, we find that the crowding-out effect of public health insurance on private health insurance is through lowering the cost of health services, raising the accessibility to health services or reducing health risks.

Suggested Citation

  • Chen, Hua & Ding, Yugang & Wang, Xiangnan & Yang, Yifei, 2023. "The effect of public insurance policy on the private insurance market: New evidence from a quasi-experiment in China," Economic Analysis and Policy, Elsevier, vol. 78(C), pages 937-953.
  • Handle: RePEc:eee:ecanpo:v:78:y:2023:i:c:p:937-953
    DOI: 10.1016/j.eap.2023.04.031
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0313592623000802
    Download Restriction: Full text for ScienceDirect subscribers only

    File URL: https://libkey.io/10.1016/j.eap.2023.04.031?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Ellis, Cameron M. & Esson, Meghan I., 2021. "Crowd-Out and Emergency Department Utilization," Journal of Health Economics, Elsevier, vol. 80(C).
    2. Darius Lakdawalla & Wesley Yin, 2015. "Insurers’ Negotiating Leverage and the External Effects of Medicare Part D," The Review of Economics and Statistics, MIT Press, vol. 97(2), pages 314-331, May.
    3. Shore-Sheppard Lara D., 2008. "Stemming the Tide? The Effect of Expanding Medicaid Eligibility On Health Insurance Coverage," The B.E. Journal of Economic Analysis & Policy, De Gruyter, vol. 8(2), pages 1-35, July.
    4. Mark Duggan & Fiona Scott Morton, 2010. "The Effect of Medicare Part D on Pharmaceutical Prices and Utilization," American Economic Review, American Economic Association, vol. 100(1), pages 590-607, March.
    5. Richard H. Thaler, 2017. "Behavioral Economics," Journal of Political Economy, University of Chicago Press, vol. 125(6), pages 1799-1805.
    6. Gao, Qiuming & Wang, Derek, 2021. "Hospital efficiency and equity in health care delivery: A study based in China," Socio-Economic Planning Sciences, Elsevier, vol. 76(C).
    7. Jeffrey R. Brown & Amy Finkelstein, 2008. "The Interaction of Public and Private Insurance: Medicaid and the Long-Term Care Insurance Market," American Economic Review, American Economic Association, vol. 98(3), pages 1083-1102, June.
    8. Daniele Fabbri & Chiara Monfardini, 2016. "Opt Out or Top Up? Voluntary Health Care Insurance and the Public vs. Private Substitution," Oxford Bulletin of Economics and Statistics, Department of Economics, University of Oxford, vol. 78(1), pages 75-93, February.
    9. Annamaria Lusardi & Olivia S. Mitchell, 2014. "The Economic Importance of Financial Literacy: Theory and Evidence," Journal of Economic Literature, American Economic Association, vol. 52(1), pages 5-44, March.
    10. Cardon, James H & Hendel, Igal, 2001. "Asymmetric Information in Health Insurance: Evidence from the National Medical Expenditure Survey," RAND Journal of Economics, The RAND Corporation, vol. 32(3), pages 408-427, Autumn.
    11. Salm, Martin & Wübker, Ansgar, 2020. "Sources of regional variation in healthcare utilization in Germany," Journal of Health Economics, Elsevier, vol. 69(C).
    12. 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.
    13. David M. Cutler & Jonathan Gruber, 1996. "Does Public Insurance Crowd out Private Insurance?," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 111(2), pages 391-430.
    14. Karen Eggleston & Li Ling & Meng Qingyue & Magnus Lindelow & Adam Wagstaff, 2008. "Health service delivery in China: a literature review," Health Economics, John Wiley & Sons, Ltd., vol. 17(2), pages 149-165, February.
    15. Andrew E. Clark & Paul Frijters & Michael A. Shields, 2008. "Relative Income, Happiness, and Utility: An Explanation for the Easterlin Paradox and Other Puzzles," Journal of Economic Literature, American Economic Association, vol. 46(1), pages 95-144, March.
    16. Melissa Dell & Benjamin F. Jones & Benjamin A. Olken, 2012. "Temperature Shocks and Economic Growth: Evidence from the Last Half Century," American Economic Journal: Macroeconomics, American Economic Association, vol. 4(3), pages 66-95, July.
    17. Michael Anderson & Carlos Dobkin & Tal Gross, 2012. "The Effect of Health Insurance Coverage on the Use of Medical Services," American Economic Journal: Economic Policy, American Economic Association, vol. 4(1), pages 1-27, February.
    18. Richard H. Thaler, 2018. "From Cashews to Nudges: The Evolution of Behavioral Economics," American Economic Review, American Economic Association, vol. 108(6), pages 1265-1287, June.
    19. Jeffrey M Wooldridge, 2010. "Econometric Analysis of Cross Section and Panel Data," MIT Press Books, The MIT Press, edition 2, volume 1, number 0262232588, December.
    20. Li, Xiaoxue & Tian, Liu, 2020. "The effect of non-employment-based health insurance program on firm's offering of health insurance: Evidence from the social health insurance system in China," Journal of Comparative Economics, Elsevier, vol. 48(4), pages 997-1010.
    21. David Card & Carlos Dobkin & Nicole Maestas, 2008. "The Impact of Nearly Universal Insurance Coverage on Health Care Utilization: Evidence from Medicare," American Economic Review, American Economic Association, vol. 98(5), pages 2242-2258, December.
    22. Ham, John C. & Shore-Sheppard, Lara, 2005. "The effect of Medicaid expansions for low-income children on Medicaid participation and private insurance coverage: evidence from the SIPP," Journal of Public Economics, Elsevier, vol. 89(1), pages 57-83, January.
    23. Huang, Xian & Wu, Bingxiao, 2020. "Impact of urban-rural health insurance integration on health care: Evidence from rural China," China Economic Review, Elsevier, vol. 64(C).
    24. Xiaohui Hou & Jing Zhang, 2017. "The effects of public health insurance expansion on private health insurance in urban China," International Journal of Health Economics and Management, Springer, vol. 17(3), pages 359-375, September.
    25. Leemore Dafny, 2019. "Does It Matter if Your Health Insurer Is For Profit? Effects of Ownership on Premiums, Insurance Coverage, and Medical Spending," American Economic Journal: Economic Policy, American Economic Association, vol. 11(1), pages 222-265, February.
    26. DeLeire, Thomas & Chappel, Andre & Finegold, Kenneth & Gee, Emily, 2017. "Do individuals respond to cost-sharing subsidies in their selections of marketplace health insurance plans?," Journal of Health Economics, Elsevier, vol. 56(C), pages 71-86.
    27. Gruber, Jonathan & Simon, Kosali, 2008. "Crowd-out 10 years later: Have recent public insurance expansions crowded out private health insurance?," Journal of Health Economics, Elsevier, vol. 27(2), pages 201-217, March.
    28. Abdullah Al Mamun & Muhammad Khalilur Rahman & Uma Thevi Munikrishnan & P. Yukthamarani Permarupan, 2021. "Predicting the Intention and Purchase of Health Insurance Among Malaysian Working Adults," SAGE Open, , vol. 11(4), pages 21582440211, November.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Thomas Buchmueller & John C. Ham & Lara D. Shore-Sheppard, 2015. "The Medicaid Program," NBER Chapters, in: Economics of Means-Tested Transfer Programs in the United States, Volume 1, pages 21-136, National Bureau of Economic Research, Inc.
    2. Cristian Pardo & Whitney Schott, 2012. "Public versus private: evidence on health insurance selection," International Journal of Health Economics and Management, Springer, vol. 12(1), pages 39-61, March.
    3. Phillip B. Levine & Robin McKnight & Samantha Heep, 2011. "How Effective Are Public Policies to Increase Health Insurance Coverage among Young Adults?," American Economic Journal: Economic Policy, American Economic Association, vol. 3(1), pages 129-156, February.
    4. Ellis, Cameron M. & Esson, Meghan I., 2021. "Crowd-Out and Emergency Department Utilization," Journal of Health Economics, Elsevier, vol. 80(C).
    5. Raj Chetty & Amy Finkelstein, 2012. "Social Insurance: Connecting Theory to Data," NBER Working Papers 18433, National Bureau of Economic Research, Inc.
    6. Phillip B. Levine & Robin McKnight & Samantha Heep, 2009. "Public Policy, Health Insurance and the Transition to Adulthood," NBER Working Papers 15114, National Bureau of Economic Research, Inc.
    7. Wagner, Kathryn L., 2016. "Shock, but no shift: Hospitals' responses to changes in patient insurance mix," Journal of Health Economics, Elsevier, vol. 49(C), pages 46-58.
    8. John C. Ham & Serkan Ozbeklik & Lara D. Shore-Sheppard, 2014. "Estimating Heterogeneous Takeup and Crowd-Out Responses to Existing Medicaid Income Limits and their Nonmarginal Expansions," Journal of Human Resources, University of Wisconsin Press, vol. 49(4), pages 872-905.
    9. Hamersma, Sarah & Kim, Matthew, 2013. "Participation and crowd out: Assessing the effects of parental Medicaid expansions," Journal of Health Economics, Elsevier, vol. 32(1), pages 160-171.
    10. Wagner, Kathryn L., 2015. "Medicaid expansions for the working age disabled: Revisiting the crowd-out of private health insurance," Journal of Health Economics, Elsevier, vol. 40(C), pages 69-82.
    11. Sarah Hamersma & Matthew Kim & Brenden Timpe, 2019. "The Effect Of Parental Medicaid Expansions On Children'S Health Insurance Coverage," Contemporary Economic Policy, Western Economic Association International, vol. 37(2), pages 297-311, April.
    12. Li, Xiaoxue & Tian, Liu, 2020. "The effect of non-employment-based health insurance program on firm's offering of health insurance: Evidence from the social health insurance system in China," Journal of Comparative Economics, Elsevier, vol. 48(4), pages 997-1010.
    13. Witman, Allison, 2015. "Public health insurance and disparate eligibility of spouses: The Medicare eligibility gap," Journal of Health Economics, Elsevier, vol. 40(C), pages 10-25.
    14. Koch, Thomas G., 2013. "Using RD design to understand heterogeneity in health insurance crowd-out," Journal of Health Economics, Elsevier, vol. 32(3), pages 599-611.
    15. Andrei Barbos & Yi Deng, 2015. "The Impact Of A Public Option In The U.S. Health Insurance Market," Economic Inquiry, Western Economic Association International, vol. 53(1), pages 508-521, January.
    16. Bronchetti, Erin Todd, 2014. "Public insurance expansions and the health of immigrant and native children," Journal of Public Economics, Elsevier, vol. 120(C), pages 205-219.
    17. Dhaval Dave & Sandra L. Decker & Robert Kaestner & Kosali I. Simon, 2015. "The Effect of Medicaid Expansions in the Late 1980s and Early 1990s on the Labor Supply of Pregnant Women," American Journal of Health Economics, MIT Press, vol. 1(2), pages 165-193, Spring.
    18. Craig Garthwaite & Tal Gross & Matthew J. Notowidigdo, 2014. "Public Health Insurance, Labor Supply, and Employment Lock," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 129(2), pages 653-696.
    19. Marianne P. Bitler & Madeline Zavodny, 2014. "Medicaid: A Review of the Literature," NBER Working Papers 20169, National Bureau of Economic Research, Inc.
    20. Mark Duggan & Atul Gupta & Emilie Jackson, 2022. "The Impact of the Affordable Care Act: Evidence from California's Hospital Sector," American Economic Journal: Economic Policy, American Economic Association, vol. 14(1), pages 111-151, February.

    More about this item

    Keywords

    Health insurance; Crowding-out effect; Quasi experiment; Staggered difference-in-differences; China;
    All these keywords.

    JEL classification:

    • H43 - Public Economics - - Publicly Provided Goods - - - Project Evaluation; Social Discount Rate
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • G22 - Financial Economics - - Financial Institutions and Services - - - Insurance; Insurance Companies; Actuarial Studies

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:ecanpo:v:78:y:2023:i:c:p:937-953. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.journals.elsevier.com/economic-analysis-and-policy .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.