Who will drop out of voluntary social health insurance? Evidence from the New Cooperative Medical Scheme in China. Issue 7 (8th May 2021)

• Record Type: Journal Article
• Authors: Xu, Mingming; Yang, Wei
• Is Part Of: Health policy and planning. Volume 36:Issue 7(2021)
• Page Start: 1013
• Page End: 1022
• Publication Date: 2021-05-08
• Subjects: Public voluntary health insurance -- drop out -- the New Cooperative Medical Scheme -- China; Medical policy -- Developing countries -- Periodicals; Public health -- Developing countries -- Periodicals; Health planning -- Developing countries -- Periodicals; 362.1091724
• DOI: 10.1093/heapol/czab017
• Languages: English
• ISSNs: 0268-1080

Abstract

Abstract: Although public voluntary health insurance (VHI) has been adopted in many low- and middle-income 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.