Financial protection effects of private health insurance: experimental evidence from Chinese households with resident basic medical insurance.
Financial protection effects of private health insurance: experimental evidence from Chinese households with resident basic medical insurance.
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DOI：
10.1186/s12939-021-01468-5
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发表时间：
2021-05-17
影响因子：
4.8
通讯作者：
Fu XZ
中科院分区：
文献类型：
--
作者：
Fu XZ
在基本医疗保险实现全民覆盖后，中国政府将发展私人医疗保险提上了议事日程，以进一步加强金融风险防范。本文旨在评估在居民基本医疗保险（RBMI）的基础上，公共健康保险为参保家庭提供的经济保障水平。我们采用了2015年至2017年中国家庭金融调查（CHFS）收集的平衡面板数据。采用灾难性卫生支出（CHE）和因卫生支出而导致的损失来衡量财政保护效果。随机效应面板逻辑回归模型进行识别与家庭的CHE和RBMI覆盖的家庭之间的排斥的相关因素。在稳健性检验中，采用倾向评分匹配（PSM）方法解决了内隐问题。2015年至2017年，所有抽样家庭的CHE发病率从12. 96%上升至14. 68%，而所有抽样家庭的发病率从5. 43%略降至5. 32%。2015年，RBMI + PHI的CHE发病率和病死率分别为4.53%和0.72%，均低于单独RBMI的CHE发病率和病死率。2017年也观察到了类似的现象。回归分析还显示，与仅患有RBMI的家庭相比，患有RBMI + PHI的家庭发生CHE（边际效应：-0.054，95%CI：-0.075至-0.034）和抑郁（边际效应：-0.049，95%CI：-0.069至-0.028）的可能性显著降低。采用PSM方法消除了自选择对估计结果的影响后，估计结果仍具有较好的稳健性。在全民基本医疗保险覆盖的背景下，2015年和2017年中国RBMI家庭的CHE发病率和死亡率仍然相当高。在RBMI的基础上，个人住房保险对降低家庭金融风险起到了积极的作用。在线版本包含补充材料，可通过10.1186/s12939-021-01468-5获得。
After achieving universal basic medical insurance coverage, Chinese government put the development of private health insurance (PHI) on its agenda to further strengthen financial risk protection. This paper aims to assess the level of financial protection that PHI provides for its insured households on the basis of resident basic medical insurance (RBMI). We employed balanced panel data collected between 2015 and 2017 from the China Household Finance Survey (CHFS). Catastrophic health expenditure (CHE) and impoverishment due to health spending were applied to measure the financial protection effects. Random effects panel logistic regression model was performed to identify the factors associated with CHE and impoverishment among households covered by RBMI. In the robustness test, the method of propensity score matching (PSM) was employed to solve the problem of endogeneity. From 2015 to 2017, the CHE incidence increased from 12.96 to 14.68 % for all sampled households, while the impoverishment rate decreased slightly from 5.43 to 5.32 % for all sampled households. In 2015, the CHE incidence and impoverishment rate under RBMI + PHI were 4.53 and 0.72 %, respectively, which were lower than those under RBMI alone. A similar phenomenon was observed in 2017. Regression analysis also showed that the households with RBMI + PHI were significantly less likely to experience CHE (marginal effect: -0.054, 95 %CI: -0.075 to -0.034) and impoverishment (marginal effect: -0.049, 95 %CI: -0.069 to -0.028) compared to those with RBMI alone. The results were still robust after using PSM method to eliminate the effects of self-selection on the estimation results. In the context of universal basic medical insurance coverage, the CHE incidence and impoverishment rate of Chinese households with RBMI were still considerably high in 2015 and 2017. PHI played a positive role in decreasing household financial risk on the basis of RBMI. The online version contains supplementary material available at 10.1186/s12939-021-01468-5.
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