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

Research output: Contribution to journalArticlepeer-review

Mingming Xu, Wei Yang

Original languageEnglish
Pages (from-to)1013-1022
Number of pages10
JournalHealth policy and planning
Issue number7
Published1 Aug 2021

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

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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.

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