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Can National Health Insurance Programs Improve Health Outcomes?—Re-Examining the Case of the New Cooperative Medical Scheme in Rural China


  • Chu, Xueling
  • Chen, Qihui
  • Fang, Xiangming


In 2003, China launched a new health insurance system - the New Cooperative Medicine Scheme (NCMS) in its rural areas, where more than 87 percent of China’ rural residents were not covered by any health insurance programs. By the end of 2009, the NCMS had expanded to cover 95 percent of China’s rural residents. Previous research has yielded conflicting results regarding the effects of the NCMS in rural China, but the conflicting results may be due to estimation biases. This paper uses a triple-difference method, which takes into account rural residents’ unobserved heterogeneity, to re-evaluate the impacts of the NCMS on rural residents’ health outcomes, including hypertension, diabetes, heart disease, apoplexy and born fracture. Using a longitudinal sample drawn from the China Health and Nutrition Survey, our tripledifference method indicates that the NCMS significantly reduces the incidence of diabetes, heart disease, apoplexy for rural residents over age 55. Our results also suggest that the commonlyadopted impact evaluation method, the double-difference method, is likely to underestimate the health impacts of the NCMS.

Suggested Citation

  • Chu, Xueling & Chen, Qihui & Fang, Xiangming, 2013. "Can National Health Insurance Programs Improve Health Outcomes?—Re-Examining the Case of the New Cooperative Medical Scheme in Rural China," 2013 Annual Meeting, August 4-6, 2013, Washington, D.C. 150488, Agricultural and Applied Economics Association.
  • Handle: RePEc:ags:aaea13:150488

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    References listed on IDEAS

    1. Adam Wagstaff, 2010. "Estimating health insurance impacts under unobserved heterogeneity: the case of Vietnam's health care fund for the poor," Health Economics, John Wiley & Sons, Ltd., vol. 19(2), pages 189-208.
    2. Wagstaff, Adam & Lindelow, Magnus & Jun, Gao & Ling, Xu & Juncheng, Qian, 2009. "Extending health insurance to the rural population: An impact evaluation of China's new cooperative medical scheme," Journal of Health Economics, Elsevier, vol. 28(1), pages 1-19, January.
    3. Likwang Chen & Winnie Yip & Ming-Cheng Chang & Hui-Sheng Lin & Shyh-Dye Lee & Ya-Ling Chiu & Yu-Hsuan Lin, 2007. "The effects of Taiwan's National Health Insurance on access and health status of the elderly," Health Economics, John Wiley & Sons, Ltd., vol. 16(3), pages 223-242.
    4. 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.
    5. 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.
    6. Fabrice Etilé & Carine Milcent, 2006. "Income-related reporting heterogeneity in self-assessed health: evidence from France," Health Economics, John Wiley & Sons, Ltd., vol. 15(9), pages 965-981.
    7. Yip, Winnie & Hsiao, William, 2009. "China's health care reform: A tentative assessment," China Economic Review, Elsevier, vol. 20(4), pages 613-619, December.
    8. Johar, Meliyanni, 2009. "The impact of the Indonesian health card program: A matching estimator approach," Journal of Health Economics, Elsevier, vol. 28(1), pages 35-53, January.
    9. Antonio Trujillo & Jorge Portillo & John Vernon, 2005. "The Impact of Subsidized Health Insurance for the Poor: Evaluating the Colombian Experience Using Propensity Score Matching," International Journal of Health Economics and Management, Springer, vol. 5(3), pages 211-239, September.
    10. You, Xuedan & Kobayashi, Yasuki, 2009. "The new cooperative medical scheme in China," Health Policy, Elsevier, vol. 91(1), pages 1-9, June.
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