IDEAS home Printed from https://ideas.repec.org/
MyIDEAS: Log in (now much improved!) to save this article

Adverse selection in a voluntary Rural Mutual Health Care health insurance scheme in China

Listed author(s):
  • Wang, Hong
  • Zhang, Licheng
  • Yip, Winnie
  • Hsiao, William
Registered author(s):

    This study examines adverse selection in a subsidized voluntary health insurance scheme, the Rural Mutual Health Care (RMHC) scheme, in a poor rural area of China. The study was made possible by a unique longitudinal data set: the total sample includes 3492 rural residents from 1020 households. Logistic regression was employed for the data analysis. The results show that although this subsidized scheme achieved a considerable high enrollment rate of 71% of rural residents, adverse selection still exists. In general, individuals with worse health status are more likely to enroll in RMHC than individuals with better health status. Although the household is set as the enrollment unit for the RMHC for the purpose of reducing adverse selection, nearly 1/3 of enrolled households are actually only partially enrolled. Furthermore, we found that adverse selection mainly occurs in partially enrolled households. The non-enrolled individuals in partially enrolled households have the best health status, while the enrolled individuals in partially enrolled households have the worst health status. Pre-RMHC, medical expenditure for enrolled individuals in partially enrolled households was 206.6 yuan per capita per year, which is 1.7 times as much as the pre-RMHC medical expenditure for non-enrolled individuals in partially enrolled households. The study also reveals that the pre-enrolled medical expenditure per capita per year of enrolled individuals was 9.6% higher than the pre-enrolled medical expenditure of all residents, including both enrolled and non-enrolled individuals. In conclusion, although the subsidized RMHC scheme reached a very high enrollment rate and the household is set as the enrollment unit for the purpose of reducing adverse selection, adverse selection still exists, especially within partially enrolled households. Voluntary RMHC will not be financially sustainable if the adverse selection is not fully taken into account.

    If you experience problems downloading a file, check if you have the proper application to view it first. In case of further problems read the IDEAS help page. Note that these files are not on the IDEAS site. Please be patient as the files may be large.

    File URL: http://www.sciencedirect.com/science/article/pii/S0277-9536(06)00141-9
    Download Restriction: Full text for ScienceDirect subscribers only

    As the access to this document is restricted, you may want to look for a different version under "Related research" (further below) or search for a different version of it.

    Article provided by Elsevier in its journal Social Science & Medicine.

    Volume (Year): 63 (2006)
    Issue (Month): 5 (September)
    Pages: 1236-1245

    as
    in new window

    Handle: RePEc:eee:socmed:v:63:y:2006:i:5:p:1236-1245
    Contact details of provider: Web page: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description

    Order Information: Postal: http://www.elsevier.com/wps/find/supportfaq.cws_home/regional
    Web: http://www.elsevier.com/orderme/journalorderform.cws_home/315/journalorderform1/orderooc/id=654&ref=654_01_ooc_1&version=01

    References listed on IDEAS
    Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.:

    as
    in new window

    1. Ilayperuma Simon, Kosali, 2005. "Adverse selection in health insurance markets? Evidence from state small-group health insurance reforms," Journal of Public Economics, Elsevier, vol. 89(9-10), pages 1865-1877, September.
    2. Bruce D. Meyer & James X. Sullivan, 2003. "Measuring the Well-Being of the Poor Using Income and Consumption," NBER Working Papers 9760, National Bureau of Economic Research, Inc.
    3. Finkelstein, Amy, 2004. "Minimum standards, insurance regulation and adverse selection: evidence from the Medigap market," Journal of Public Economics, Elsevier, vol. 88(12), pages 2515-2547, December.
    4. Jack, William, 2002. "Equilibrium in competitive insurance markets with ex ante adverse selection and ex post moral hazard," Journal of Public Economics, Elsevier, vol. 84(2), pages 251-278, May.
    5. Cutler, David M. & Zeckhauser, Richard J., 2000. "The anatomy of health insurance," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 11, pages 563-643 Elsevier.
    6. Liu, Yuanli & Hsiao, William C. L. & Li, Qing & Liu, Xingzhu & Ren, Minghui, 1995. "Transformation of China's rural health care financing," Social Science & Medicine, Elsevier, vol. 41(8), pages 1085-1093, October.
    7. Savage, Elizabeth & Wright, Donald J., 2003. "Moral hazard and adverse selection in Australian private hospitals: 1989-1990," Journal of Health Economics, Elsevier, vol. 22(3), pages 331-359, May.
    8. Bloom, Gerald & Xingyuan, Gu, 1997. "Health sector reform: Lessons from China," Social Science & Medicine, Elsevier, vol. 45(3), pages 351-360, August.
    9. Carrin, Guy & Ron, Aviva & Hui, Yang & Hong, Wang & Tuohong, Zhang & Licheng, Zhang & Shuo, Zhang & Yide, Ye & Jiaying, Chen & Qicheng, Jiang & Zhaoyang, Zhang & Jun, Yu & Xuesheng, Li, 1999. "The reform of the rural cooperative medical system in the People's Republic of China: interim experience in 14 pilot counties," Social Science & Medicine, Elsevier, vol. 48(7), pages 961-972, April.
    10. Michael Rothschild & Joseph Stiglitz, 1976. "Equilibrium in Competitive Insurance Markets: An Essay on the Economics of Imperfect Information," The Quarterly Journal of Economics, Oxford University Press, vol. 90(4), pages 629-649.
    11. Claudio Sapelli & Bernardita Vial, 2001. "Self Selection and Moral Hazard in Chilean Health Insurance," Documentos de Trabajo 195, Instituto de Economia. Pontificia Universidad Católica de Chile..
    12. Dror, David M. & Soriano, Elmer S. & Lorenzo, Marilyn E. & Sarol, Jesus Jr. & Azcuna, Rosebelle S. & Koren, Ruth, 2005. "Field based evidence of enhanced healthcare utilization among persons insured by micro health insurance units in Philippines," Health Policy, Elsevier, vol. 73(3), pages 263-271, September.
    13. Arhin, Dyna C., 1994. "The health card insurance scheme in Burundi: A social asset or a non-viable venture?," Social Science & Medicine, Elsevier, vol. 39(6), pages 861-870, September.
    14. Ahuja, Rajeev & Jutting, Johannes Paul, 2003. "Design Of Incentives In Community Based Health Insurance Schemes," Discussion Papers 18744, University of Bonn, Center for Development Research (ZEF).
    15. Noterman, Jean-Pierre & Criel, Bart & Kegels, Guy & Isu, Katulanya, 1995. "A prepayment scheme for hospital care in the Masisi district in Zaire: A critical evaluation," Social Science & Medicine, Elsevier, vol. 40(7), pages 919-930, April.
    Full references (including those not matched with items on IDEAS)

    This item is not listed on Wikipedia, on a reading list or among the top items on IDEAS.

    When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:63:y:2006:i:5:p:1236-1245. See general information about how to correct material in RePEc.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Dana Niculescu)

    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 references are entirely missing, you can add them using this form.

    If the full references list an item that is present in RePEc, but the system did not link 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 profile, as there may be some citations waiting for confirmation.

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

    This information is provided to you by IDEAS at the Research Division of the Federal Reserve Bank of St. Louis using RePEc data.