Aging in Asia Findings from New and Emerging Data Initiatives (2012) / Chapter Skim
Currently Skimming:
14 Healthcare and Insurance Among the Elderly in China: Evidence from the CHARLS Pilot--John Strauss, Hao Hong, Xiaoyan Lei, Lin Li, Albert Park, Li Yang, and Yaohui Zhao
14 Healthcare and Insurance Among the Elderly in China: Evidence from the CHARLS Pilot--John Strauss, Hao Hong, Xiaoyan Lei, Lin Li, Albert Park, Li Yang, and Yaohui Zhao
Pages 342-370
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 342... ...
These are important issues in China now, with many changes instituted recently related to the programs' availability and generosity. In very recent years, there has been a large set of reforms begun regarding health insurance and healthcare, and a growing literature has analyzed these reforms (see, for instance, a recent issue of Health Economics devoted to this topic, Wagstaff et al., 2009)
|
From page 343... ...
In urban areas, coverage has been extended to the nonemployed (e.g., students, children, elderly, those unemployed or out of the labor force) by a new voluntary Urban Resident Basic Medical Insurance Scheme, which was introduced in September 2007 in 79 cities.
|
From page 344... ...
(2009) found lower reimbursement rates for higher medical costs in the five provinces their study covers, which means that major medical bills are not well covered.
|
From page 345... ...
sampling. As noted above, rural counties contain both rural villages and urban neighborhoods, and it is also possible for urban districts to contain rural administrative villages.
|
From page 346... ...
Two insurance schemes dominate urban areas: the Urban Employee Medical Insurance and the Urban Resident Basic Medical 3 Spouses who are under 45 years old are dropped from this analysis. 4 Here we use the sample weights allowing for household nonresponse; see Zhao et al.
|
From page 347... ...
For women, Table 14-2 Panel C shows that having a rural hukou makes it a little more likely that they will have some coverage. Women with an urban hukou are much more likely to have the Urban Resident Basic Medical Insurance, and men almost only have the Urban Employee Medical Insurance.
|
From page 348... ...
(1.3) PANEL B Men Urban Resident New Cooperative Urban Employee Basic Medical Scheme Medical N Medical Insurance Insurance Insurance Other Insurances Without Insurance 268 Urban Hukou 63.0 11.4 7.4 18.3 7.9 (5.8)
|
From page 349... ...
(1.5) PANEL C Women Urban Resident New Cooperative Urban Employee Basic Medical Scheme Medical N Medical Insurance Insurance Insurance Other Insurances Without Insurance 229 Urban Hukou 43.5 21.5 12.6 18.0 12.9 (7.2)
|
From page 350... ...
(2009) , however, do find adverse selection in their analysis of the Urban Resident Basic Medical Insurance, but they do not focus exclusively on the older population.
|
From page 351... ...
P-values are from tests of equality of insurance coverage between people having poor health and nonpoor health, separately for men and women. SOURCE: Authors' calculations using CHARLS pilot data.
|
From page 352... ...
TABLE 14-4 Regression for Having Any Insurance, Men and Women 352 Men Women (1)
|
From page 353... ...
(0.001) Observations 1,262 1,107 1,107 1,233 1,118 1,118 NOTE: Robust standard errors in parentheses, all clustered at community level.
|
From page 354... ...
The two major urban insurance schemes also do not cover migrants. In May 2006, a separate medical insurance pooling fund was set up to cover expenses for migrants, but the effectiveness of this program has not been evaluated to date.
|
From page 355... ...
(2009) find that income has a U-shaped association with having the Urban Resident Basic Medical Insurance, with low- and high-income persons more likely to have it.
|
From page 356... ...
SOURCE: Authors' calculations using CHARLS pilot data.
|
From page 357... ...
(0.000) Observations 1,104 1,104 1,118 1,118 NOTE: Robust standard errors in parentheses, all clustered at community level.
|
From page 358... ...
The CHARLS pilot collected data about some of the characteristics of the insurance, in particular about the premiums paid, as well as, for those who had insurance and who went for inpatient or outpatient services, what fraction of their total costs they anticipated would be reimbursed. For the Urban Resident Basic Medical Insurance, not enough respondents reported their premiums so our sample is too small to report.
|
From page 359... ...
(0.890) Observations 1,104 1,104 1,118 1,118 NOTE: Robust standard errors in parentheses, all clustered at community level.
|
From page 360... ...
The other point to note from Table 14-8 is that in urban Zhejiang, a little more than 10% get their Urban Employee Medical Insurance without any premium. Another important parameter of the new insurance schemes is the reimbursement rate.
|
From page 361... ...
. By hukou status, the reimbursement rates are 58% for urban hukou holders and 28% for rural hukou holders (these are significantly different at the .01 level)
|
From page 362... ...
P-values are from tests of equality of reimbursement rates between rural and urban residents or rural and urban Hukou, separately or jointly for Gansu and Zhejiang provinces. SOURCE: Authors' calculations using CHARLS pilot data.
|
From page 363... ...
, as total costs of inpatient treatment increased, reimbursement rates fell for the NCMS, often to quite low levels, around 10%. If total costs are taken as a proxy of severity of the health problem, then this strongly suggests that the major new rural health insurance scheme is not covering catastrophic illnesses well and is certainly not adequately covering catastrophic health expenditures.
|
From page 364... ...
using data on respondents with any insurance who reported inpatient uti R02177 lization over the past year.22 It is clear that reimbursement rates rise, not fall, as total costs rise. Reimbursement rates rise from 31% to a plateau of Figure 14-1 40% at a total cost of 10,000 Yuan, which is right at the 75th percentile for bitmapped graph, all type replaced the total cost distribution.
|
From page 365... ...
Again, the standard error is much higher in urban Zhejiang than in urban Gansu, suggesting more experimentation in urban Zhejiang.23 If we split the sample by rural and urban hukou, the differences in reimbursement rates become starker (see Table 14-10 Panel B)
|
From page 366... ...
P-values are from tests of equality of reimbursement rates between rural and urban residents or rural and urban Hukou, separately or jointly for Gansu and Zhejiang provinces. SOURCE: Authors' calculations using CHARLS pilot data.
|
From page 367... ...
TABLE 14-11 Regression for the Share of Out-of-Pocket Cost in the Total Cost of the Past Visit for Outpatient Medical Service in the Past Month Men Women (1)
|
From page 368... ...
(0.003) Observations 162 162 162 226 226 226 NOTE: Robust standard errors in parentheses, all clustered at community level.
|
From page 369... ...
Thus, the degree of public subsidy is high. At the moment, in Zhejiang and Gansu, these schemes cover mainly inpatient care, and the reimbursement rates top out at 64% for respondents in Zhejiang having an urban hukou.
|
From page 370... ...
. The Urban Resident Basic Medical Insurance: A land mark reform toward universal coverage in China.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.