IDEAS home Printed from https://ideas.repec.org/a/wly/hlthec/v33y2024i2p363-390.html
   My bibliography  Save this article

Growing up without health insurance: Evidence from rural China

Author

Listed:
  • Guanfu Fang
  • Xin Li
  • Tianyu Tang

Abstract

This paper examines the long‐term effects of health insurance on children's educational attainment in a developing country. Utilizing the county‐by‐county rollout of the New Rural Cooperative Medical Scheme in rural China, we find that exposure to the health insurance program in early life leads to improved educational attainment in adulthood. Empirical tests suggest that a short‐term increase in health care utilization is unlikely to be a potential channel. We provide some evidence for the channel that health insurance reduces household financial burdens and increases household expenditure on children's nutrition.

Suggested Citation

  • Guanfu Fang & Xin Li & Tianyu Tang, 2024. "Growing up without health insurance: Evidence from rural China," Health Economics, John Wiley & Sons, Ltd., vol. 33(2), pages 363-390, February.
    • Handle: RePEc:wly:hlthec:v:33:y:2024:i:2:p:363-390
    DOI: 10.1002/hec.4778
    as

    Download full text from publisher

    File URL: https://doi.org/10.1002/hec.4778
    Download Restriction: no
    File URL: https://libkey.io/10.1002/hec.4778?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
    ---><---

    References listed on IDEAS

    as
    1. 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.
    2. Bianchi, Nicola & Lu, Yi & Song, Hong, 2022. "The effect of computer-assisted learning on students’ long-term development," Journal of Development Economics, Elsevier, vol. 158(C).
    3. Joseph G. Altonji & Todd E. Elder & Christopher R. Taber, 2005. "Selection on Observed and Unobserved Variables: Assessing the Effectiveness of Catholic Schools," Journal of Political Economy, University of Chicago Press, vol. 113(1), pages 151-184, February.
    4. Clément de Chaisemartin & Xavier D'Haultfœuille, 2020. "Two-Way Fixed Effects Estimators with Heterogeneous Treatment Effects," American Economic Review, American Economic Association, vol. 110(9), pages 2964-2996, September.
    5. Hongmei Yi & Linxiu Zhang & Kim Singer & Scott Rozelle & Scott Atlas, 2009. "Health insurance and catastrophic illness: a report on the New Cooperative Medical System in rural China," Health Economics, John Wiley & Sons, Ltd., vol. 18(S2), pages 119-127, July.
    6. Douglas Almond & Janet Currie & Valentina Duque, 2018. "Childhood Circumstances and Adult Outcomes: Act II," Journal of Economic Literature, American Economic Association, vol. 56(4), pages 1360-1446, December.
    7. Orazem, Peter F. & King, Elizabeth M., 2008. "Schooling in Developing Countries: The Roles of Supply, Demand and Government Policy," Handbook of Development Economics, in: T. Paul Schultz & John A. Strauss (ed.), Handbook of Development Economics, edition 1, volume 4, chapter 55, pages 3475-3559, Elsevier.
    8. Xiaoyun Sun & Sukhan Jackson & Gordon Carmichael & Adrian C. Sleigh, 2009. "Catastrophic medical payment and financial protection in rural China: evidence from the New Cooperative Medical Scheme in Shandong Province," Health Economics, John Wiley & Sons, Ltd., vol. 18(1), pages 103-119, January.
    9. Liu, Zhiqiang, 2005. "Institution and inequality: the hukou system in China," Journal of Comparative Economics, Elsevier, vol. 33(1), pages 133-157, March.
    10. Lu, Yi & Shi, Julie & Yang, Wanyu, 2019. "Expenditure response to health insurance policies: Evidence from kinks in rural China," Journal of Public Economics, Elsevier, vol. 178(C).
    11. Emily Oster, 2019. "Unobservable Selection and Coefficient Stability: Theory and Evidence," Journal of Business & Economic Statistics, Taylor & Francis Journals, vol. 37(2), pages 187-204, April.
    12. Bratti, Massimiliano & Mendola, Mariapia, 2014. "Parental health and child schooling," Journal of Health Economics, Elsevier, vol. 35(C), pages 94-108.
    13. Chyi, Hau & Zhou, Bo, 2014. "The effects of tuition reforms on school enrollment in rural China," Economics of Education Review, Elsevier, vol. 38(C), pages 104-123.
    14. Li, Hongbin & Liu, Pak Wai & Zhang, Junsen, 2012. "Estimating returns to education using twins in urban China," Journal of Development Economics, Elsevier, vol. 97(2), pages 494-504.
    15. 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.
    16. Bharadwaj, Prashant & Johnsen, Julian V. & Løken, Katrine V., 2014. "Smoking bans, maternal smoking and birth outcomes," Journal of Public Economics, Elsevier, vol. 115(C), pages 72-93.
    17. Borgschulte, Mark & Vogler, Jacob, 2020. "Did the ACA Medicaid expansion save lives?," Journal of Health Economics, Elsevier, vol. 72(C).
    18. Marianne Bertrand & Esther Duflo & Sendhil Mullainathan, 2004. "How Much Should We Trust Differences-In-Differences Estimates?," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 119(1), pages 249-275.
    19. Zhang, Junsen & Zhao, Yaohui & Park, Albert & Song, Xiaoqing, 2005. "Economic returns to schooling in urban China, 1988 to 2001," Journal of Comparative Economics, Elsevier, vol. 33(4), pages 730-752, December.
    20. Liu, Kai, 2016. "Insuring against health shocks: Health insurance and household choices," Journal of Health Economics, Elsevier, vol. 46(C), pages 16-32.
    21. Xiao, Yun & Li, Li & Zhao, Liqiu, 2017. "Education on the cheap: The long-run effects of a free compulsory education reform in rural china," Journal of Comparative Economics, Elsevier, vol. 45(3), pages 544-562.
    22. Yi, Hongmei & Song, Yingquan & Liu, Chengfang & Huang, Xiaoting & Zhang, Linxiu & Bai, Yunli & Ren, Baoping & Shi, Yaojiang & Loyalka, Prashant & Chu, James & Rozelle, Scott, 2015. "Giving kids a head start: The impact and mechanisms of early commitment of financial aid on poor students in rural China," Journal of Development Economics, Elsevier, vol. 113(C), pages 1-15.
    23. Laura R. Wherry & Bruce D. Meyer, 2016. "Saving Teens: Using a Policy Discontinuity to Estimate the Effects of Medicaid Eligibility," Journal of Human Resources, University of Wisconsin Press, vol. 51(3), pages 556-588.
    24. Sarah R. Cohodes & Daniel S. Grossman & Samuel A. Kleiner & Michael F. Lovenheim, 2016. "The Effect of Child Health Insurance Access on Schooling: Evidence from Public Insurance Expansions," Journal of Human Resources, University of Wisconsin Press, vol. 51(3), pages 727-759.
    25. Sun, Ang & Yao, Yang, 2010. "Health shocks and children's school attainments in rural China," Economics of Education Review, Elsevier, vol. 29(3), pages 375-382, June.
    26. Can Tang & Liqiu Zhao & Zhong Zhao, 2019. "Free Education Helps Combat Child Labor? The Effect of a Free Compulsory Education Reform in Rural China," Working Papers 2019-036, Human Capital and Economic Opportunity Working Group.
    27. Junxia Zeng & Xiaopeng Pang & Linxiu Zhang & Alexis Medina & Scott Rozelle, 2014. "Gender Inequality In Education In China: A Meta-Regression Analysis," Contemporary Economic Policy, Western Economic Association International, vol. 32(2), pages 474-491, April.
    28. Prashant Bharadwaj & Katrine Vellesen L?ken & Christopher Neilson, 2013. "Early Life Health Interventions and Academic Achievement," American Economic Review, American Economic Association, vol. 103(5), pages 1862-1891, August.
    29. Callaway, Brantly & Sant’Anna, Pedro H.C., 2021. "Difference-in-Differences with multiple time periods," Journal of Econometrics, Elsevier, vol. 225(2), pages 200-230.
    30. Hoyt Bleakley, 2007. "Disease and Development: Evidence from Hookworm Eradication in the American South," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 122(1), pages 73-117.
    31. Woode, Maame Esi, 2017. "Parental health shocks and schooling: The impact of mutual health insurance in Rwanda," Social Science & Medicine, Elsevier, vol. 173(C), pages 35-47.
    32. Chen, Yi & Shi, Julie & Zhuang, Castiel Chen, 2019. "Income-dependent impacts of health insurance on medical expenditures: Theory and evidence from China," China Economic Review, Elsevier, vol. 53(C), pages 290-310.
    33. 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.
    34. Alam, Shamma Adeeb, 2015. "Parental health shocks, child labor and educational outcomes: Evidence from Tanzania," Journal of Health Economics, Elsevier, vol. 44(C), pages 161-175.
    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. Huang, Wei & Liu, Hong, 2023. "Early childhood exposure to health insurance and adolescent outcomes: Evidence from rural China," Journal of Development Economics, Elsevier, vol. 160(C).
    2. Fang, Guanfu & Zhu, Ying, 2022. "Long-term impacts of school nutrition: Evidence from China’s school meal reform," World Development, Elsevier, vol. 153(C).
    3. Phuong Huu Khiem & Yu-Chen Kuo, 2022. "Health insurance reform impact on children’s educational attainment: evidence from Vietnam," Review of Economics of the Household, Springer, vol. 20(4), pages 1255-1285, December.
    4. Alex Hollingsworth & Krzysztof Karbownik & Melissa A. Thomasson & Anthony Wray, 2022. "The Gift of a Lifetime: The Hospital, Modern Medicine, and Mortality," NBER Working Papers 30663, National Bureau of Economic Research, Inc.
    5. Can Tang & Liqiu Zhao & Zhong Zhao, 2020. "Does free education help combat child labor? The effect of a free compulsory education reform in rural China," Journal of Population Economics, Springer;European Society for Population Economics, vol. 33(2), pages 601-631, April.
    6. Douglas Almond & Janet Currie & Valentina Duque, 2018. "Childhood Circumstances and Adult Outcomes: Act II," Journal of Economic Literature, American Economic Association, vol. 56(4), pages 1360-1446, December.
    7. Xiao, Yun & Li, Li & Zhao, Liqiu, 2017. "Education on the cheap: The long-run effects of a free compulsory education reform in rural china," Journal of Comparative Economics, Elsevier, vol. 45(3), pages 544-562.
    8. Lingguo Cheng & Hong Liu & Ye Zhang & Ke Shen & Yi Zeng, 2015. "The Impact of Health Insurance on Health Outcomes and Spending of the Elderly: Evidence from China's New Cooperative Medical Scheme," Health Economics, John Wiley & Sons, Ltd., vol. 24(6), pages 672-691, June.
    9. Tang, Can & Zhao, Liqiu & Zhao, Zhong, 2019. "Free Education Helps Combat Child Labor? The Effect of a Free Compulsory Education Reform in Rural China," IZA Discussion Papers 12374, Institute of Labor Economics (IZA).
    10. Fang Guanfu & Chen Yu, 2021. "Sibling Rivalry: Evidence from China’s Compulsory Schooling Reform," The B.E. Journal of Economic Analysis & Policy, De Gruyter, vol. 21(2), pages 611-656, April.
    11. Andrew Goodman-Bacon, 2016. "The Long-Run Effects of Childhood Insurance Coverage: Medicaid Implementation, Adult Health, and Labor Market Outcomes," NBER Working Papers 22899, National Bureau of Economic Research, Inc.
    12. Silvia Mendolia & Nga Nguyen & Oleg Yerokhin, 2019. "The impact of parental illness on children’s schooling and labour force participation: evidence from Vietnam," Review of Economics of the Household, Springer, vol. 17(2), pages 469-492, June.
    13. Stefan Bauernschuster & Michael Grimm & Cathy M. Hajo, 2023. "The Impact of Margaret Sanger’s Birth Control Clinics on Early 20th Century U.S. Fertility and Mortality," CESifo Working Paper Series 10421, CESifo.
    14. Ashley C. Bradford & Johanna Catherine Maclean, 2024. "Evictions and psychiatric treatment," Journal of Policy Analysis and Management, John Wiley & Sons, Ltd., vol. 43(1), pages 87-125, January.
    15. Lin, Lin & Zai, Xianhua, 2022. "The Power of Public Insurance With Limited Benefits: Evidence from China's New Cooperative Medical Scheme," GLO Discussion Paper Series 1180, Global Labor Organization (GLO).
    16. Chloe N. East & Sarah Miller & Marianne Page & Laura R. Wherry, 2023. "Multigenerational Impacts of Childhood Access to the Safety Net: Early Life Exposure to Medicaid and the Next Generation's Health," American Economic Review, American Economic Association, vol. 113(1), pages 98-135, January.
    17. Cristian Bortes & Mattias Strandh & Karina Nilsson, 2020. "Parental Illness and Young People’s Education," Child Indicators Research, Springer;The International Society of Child Indicators (ISCI), vol. 13(6), pages 2069-2091, December.
    18. Lim, Sung Soo, 2020. "Parental chronic illness and child education: Evidence from children in Indonesia," International Journal of Educational Development, Elsevier, vol. 73(C).
    19. 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.
    20. Jinjing Wu & Shelby Deaton & Boshen Jiao & Zohn Rosen & Peter A Muennig, 2018. "The cost-effectiveness analysis of the New Rural Cooperative Medical Scheme in China," PLOS ONE, Public Library of Science, vol. 13(12), pages 1-13, December.

    More about this item

    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:wly:hlthec:v:33:y:2024:i:2:p:363-390. 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: Wiley Content Delivery (email available below). General contact details of provider: http://www3.interscience.wiley.com/cgi-bin/jhome/5749 .

    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.