Who will drop out of voluntary social health insurance? Evidence from the New Cooperative Medical Scheme in China

TY - JOUR

T1 - Who will drop out of voluntary social health insurance? Evidence from the New Cooperative Medical Scheme in China

AU - Xu, Mingming

AU - Yang, Wei

N1 - Publisher Copyright: © 2021 Oxford University Press. All rights reserved. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

PY - 2021/8/12

Y1 - 2021/8/12

N2 - Although public voluntary health insurance (VHI) has been adopted in many low- and middleincome countries to improve access to care for the population, a common issue with VHI is its high dropout rate. Using the New Cooperative Medical Scheme (NCMS) a public VHI in China as a case study, this article employs a fixed-effects negative binomial regression model combining the difference-in-difference-in-differences approach and multivariate distance matching to examine the factors associated with dropping out and the impact of dropout on outpatient care utilization among middle-aged and older people in rural China. Drawing data from the China Health and Retirement Longitudinal Study, our results showed that healthy people, vulnerable people and people who use less healthcare tended to drop out. Dropout had a significant negative impact on outpatient care utilization, especially for those with worse health statuses and those living in poorer provinces. We also found that the impact of dropout on outpatient utilization was more pronounced at secondary and tertiary hospitals than at primary care clinics. We urge policymakers to rethink the design of the NCMS by waiving premiums for the most vulnerable people.

AB - Although public voluntary health insurance (VHI) has been adopted in many low- and middleincome countries to improve access to care for the population, a common issue with VHI is its high dropout rate. Using the New Cooperative Medical Scheme (NCMS) a public VHI in China as a case study, this article employs a fixed-effects negative binomial regression model combining the difference-in-difference-in-differences approach and multivariate distance matching to examine the factors associated with dropping out and the impact of dropout on outpatient care utilization among middle-aged and older people in rural China. Drawing data from the China Health and Retirement Longitudinal Study, our results showed that healthy people, vulnerable people and people who use less healthcare tended to drop out. Dropout had a significant negative impact on outpatient care utilization, especially for those with worse health statuses and those living in poorer provinces. We also found that the impact of dropout on outpatient utilization was more pronounced at secondary and tertiary hospitals than at primary care clinics. We urge policymakers to rethink the design of the NCMS by waiving premiums for the most vulnerable people.

KW - China

KW - drop out

KW - Public voluntary health insurance

KW - the New Cooperative Medical Scheme

UR - http://www.scopus.com/inward/record.url?scp=85114708301&partnerID=8YFLogxK

U2 - 10.1093/heapol/czab017

DO - 10.1093/heapol/czab017

M3 - Article

AN - SCOPUS:85114708301

SN - 0268-1080

VL - 36

SP - 1013

EP - 1022

JO - Health policy and planning

JF - Health policy and planning

IS - 7

ER -