Measuring the Impact of China's Rural Insurance Scheme on Health: Propensity Score Matching Valuation Using Biomarkers
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Background
Following the breakdown of China's Cooperative Medical Scheme in the early 1980s, the Chinese government established the New Cooperative Medical Scheme (NCMS) in 2003 with the goal of improving health for the country's 800 million mostly uninsured rural residents. Using new data on objective health measures, we seek to analyse the programme's effectiveness in improving health for enrolees. Until now, analysis has focused on self-reported measures of health and recent illness and has provided inconclusive results.
Methods
We used ordinary least squares and logistic analysis on matched cross-sectional data (2009) from the China Health and Nutrition Survey to compare objective health measures (biomarkers) of rural residents who were and were not enrolled in NCMS. We also used individual fixed effects and difference-in-difference analysis (exploiting variation in regional rollout times) on longitudinal data (1997–2009) to evaluate self-reported health and recent sickness/injury.
Findings
By 2009, more than 90% (5734 of 6168) of rural individuals in the sample reported having some kind of insurance. Of these, 79% (4553 of 5734) had NCMS. Our preliminary results indicate that those with NCMS insurance coverage were less likely to have abnormal blood glucose levels (p=0·0004) and abnormal total cholesterol levels (p=0·019) than their counterparts without the insurance scheme. These results are consistent with previous research that finds decreased use of traditional Chinese folk doctors and increased use of preventive care among enrolees.
Interpretation
The NCMS appears to have improved objective indicators of health including blood glucose and total cholesterol levels among rural adults. Long-term effects on the management of chronic health conditions have yet to be demonstrated.
Funding
None.
JOUR
Rokicki, Slawa
Donato, Katherine
2013
The Lancet
381
S2
S127
0140-6736
10.1016/S0140-6736(13)61381-1
2118