Adverse selection in a voluntary Rural Mutual Health Care health insurance scheme in China
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.
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Volume (Year): 63 (2006)
Issue (Month): 5 (September)
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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.:
- 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.
- 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.
- Bloom, Gerald & Xingyuan, Gu, 1997. "Health sector reform: Lessons from China," Social Science & Medicine, Elsevier, vol. 45(3), pages 351-360, August.
- 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.
- 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).
- Sapelli, Claudio & Vial, Bernardita, 2003.
"Self-selection and moral hazard in Chilean health insurance,"
Journal of Health Economics,
Elsevier, vol. 22(3), pages 459-476, May.
- 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..
- 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.
- David M. Cutler & Richard J. Zeckhauser, 1999. "The Anatomy of Health Insurance," NBER Working Papers 7176, National Bureau of Economic Research, Inc.
- 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.
- 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.
- 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.
- Jack, W., 1998. "Equilibrium in Competitive Insurance Markets with Ex Ante Adverse Slection and Ex Post Moral Hazard," Papers 340, Australian National University - Department of Economics.
- 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.
- 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.
- 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.
- 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.
- 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. Full references (including those not matched with items on IDEAS)