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Is universal and uniform health insurance better for China? Evidence from the perspective of supply-induced demand

Published online by Cambridge University Press:  06 August 2018

Jianxing Yu ,
Yue Qiu  and
Ziying He
Jianxing Yu
Affiliation:
School of Public Affairs, Zhejiang University, Hangzhou, P.R. China
Yue Qiu
Affiliation:
School of Public Affairs, Zhejiang University, Hangzhou, P.R. China
Ziying He*
Affiliation:
School of Public Affairs, Zhejiang University, Hangzhou, P.R. China
*
*Correspondence to: Ziying He, School of Public Affairs, Zhejiang University, Hangzhou 310058, P.R. China. Email: hzyyzl@zju.edu.cn
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Abstract

China has achieved nearly universal social health insurance (SHI) coverage by implementing three statutory schemes, but gaps and differences in benefit levels are apparent. There is wide agreement that China should merge the three schemes into a universal and uniform SHI. However, data on the medical expenses of all inpatients in 2014 at a public Tier-three hospital suggests that supply-induced demand (SID) is a serious concern and that, under the design of the current schemes, a higher benefit level has a greater impact on the total expenses of insured patients. Thus, if SID is not effectively controlled, a universal and uniform SHI may be more harmful than beneficial in China. Finally, we suggest that China should substitute the existing fee-for-service design with a suite of bundled provider payment methods; furthermore, China should replace its current system of pricing drugs that encourages hospitals and doctors to use costlier medications.

Keywords

health insuranceout of pocketprovider payment methodsupply-induced demanduniversal coverage
Type
Articles
Information
Health Economics, Policy and Law , Volume 15 , Issue 1 , January 2020 , pp. 56 - 71
Copyright
© Cambridge University Press 2018 

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References

Allen, P, Cao, Q Wang, H (2014) Public hospital autonomy in China in an international context. International Journal of Health Planning and Management 29(2): 141–159.Google Scholar
Barham, V Milliken, O (2015) Payment mechanisms and the composition of physician practices: balancing cost-containment, access, and quality of care. Health Economics 24(7): 895–906.Google Scholar
Bloom, G Gu, X (1997) Health sector reform: lessons from China. Social Science and Medicine 45(3): 351–360.Google Scholar
Blumenthal, D Hsiao, W (2015) Lessons from the East—China’s rapidly evolving health care system. New England Journal of Medicine 372(14): 1281–1285.Google Scholar
Carrin, G James, C (2005) Social health insurance: key factors affecting the transition towards universal coverage. International Social Security Review 58(1): 45–64.Google Scholar
Clark, NM (2003) Management of chronic disease by patients. Annual Review of Public Health 24(1): 289–313.Google Scholar
Cheng, L, Liu, H, Zhang, Y, Shen, K Zeng, Y (2015) The impact of health insurance on health outcomes and spending of the elderly: evidence from China’s new cooperative medical scheme. Health Economics 24(6): 672–691.Google Scholar
Coudin, E, Pla, A Samson, A (2015) GP responses to price regulation: evidence from a French nationwide reform. Health Economics 24(9): 1118–1130.Google Scholar
Darimont, B (2009) Social security in contemporary China in T Heberer and G Schubert (eds), Regime Legitimacy in Contemporary China, Oxfordshire, England: Routledge, 199–221.Google Scholar
Dijk, CE, Berg, BD, Verheij, RA, Spreeuwenberg, P, Groenewegen, PP Bakker, DH (2013) Moral hazard and supplier-induced demand: empirical evidence in general practice. Health Economics 22(3): 340–352.Google Scholar
Du, J (2009) Economic reforms and health insurance in China. Social Science and Medicine 69(3): 387–395.Google Scholar
Duckett, J Heilmann, S (2010) Economic crisis and China’s 2009 health reform plan: rebuilding social protection for stability and growth? China Analysis: Studies in China’s Political Economy 80: 1–14.Google Scholar
Eggleston, K, Li, L, Meng, Q, Lindelow, M Wagstaff, A (2008a) Health service delivery in China: a literature review. Health Economics 17(2): 149–165.Google Scholar
Eggleston, K, Wang, J Rao, K (2008b) From plan to market in the health sector? China’s experience. Journal of Asian Economics 19(5–6): 400–412.Google Scholar
Feldstein, S (1973) The welfare loss of excess health insurance. Journal of Political Economy 81(2): 251–280.Google Scholar
Figueras, J, Robinson, R Jakubowski, E (2005) Purchasing to Improve Health Systems Performance, New York: Open University Press.Google Scholar
Gosden, T, Forland, F, Kristiansen, IS, Sutton, M, Leese, B, Giuffrida, A, Sergison, M Pedersen, L (2001) Impact of payment method on behavior of primary care physicians. Journal of Health Services Research and Policy 6(1): 44–55.Google Scholar
Grytten, J Sørensen, R (2001) Type contract and supplier-induced demand for primary physicians in Norway. Journal of Health Economics 20(3): 379–393.Google Scholar
Gu, X (2013) Ways to Public Interests for New Health System Reform (XinYigai de Gongyi Xing Lujing), Kunming: Yunnan Education Press (Yunnan Jiaoyu Chubanshe) (in Chinese).Google Scholar
Gustafsson, B, Li, S Sicular, T (eds) (2008) Inequality and Public Policy in China, London: Cambridge University Press.Google Scholar
He, Z, Yu, J Gu, X (2014) Public Hospital Privatization: Theory and Policy (Gongli Yiyuan Gaizhi: Lilun yu Zhengce), Hangzhou: Zhejiang University Press (Zhejiang Daxue Chubanshe) (in Chinese).Google Scholar
Hitoshi, S Fushimi, K (2014) Supplier-induced demand for newborn treatment: evidence from Japan. Journal of Health Economics 35: 162–178.Google Scholar
Hunter, D (2008) The Health Debate, Bristol: The Policy Press at the University of Bristol.Google Scholar
Jackson, T, Yip, W Han, W (2015) Realigning demand and supply side incentives to improve primary health care seeking in rural China. Health Economics 24(7): 755–772.Google Scholar
Kris, D Jegers, M (2000) A model of physician behaviour with demand inducement. Journal of Health Economics 19(2): 231–258.Google Scholar
Li, JS, He, PP He, RB (2014) Theoretical and empirical analysis of the supplier induced demand in health care market in China. Grey Systems 4(2): 440–444.Google Scholar
Li, L, Chen, Q Powers, D (2012) Chinese healthcare reform: a shift toward social development. Modern China 38(6): 630–645.Google Scholar
Liu, D Darimont, B (2013) The health care system of the People’s Republic of China: between privatization and public health care. International Social Security Review 66(1): 97–116.Google Scholar
Liu, G, Wu, X, Peng, C Fu, Z (2003) Urbanization and health care in rural China. Contemporary Economic Policy 21(1): 11–24.Google Scholar
Liu, G Zhao, Z (2006) Urban employee health insurance reform and the impact on out-of-pocket payment in China. International Journal of Health Planning and Management 21(3): 211–228.Google Scholar
Liu, X Mills, A (1999) Evaluating payment mechanisms: How can we measure unnecessary care? Health Policy and Planning 14(4): 409–413.Google Scholar
Ma, J, Lu, M Quan, H (2008) From a national, centrally planned health system to a system based on the market: Lessons from China. Health Affairs 27(4): 937–948.Google Scholar
Madden, D, Nolan, A Nolan, B (2005) GP reimbursement and visiting behaviour in Ireland. Health Economics 14(10): 1047–1060.Google Scholar
McGuire, G Pauly, M (1991) Physician response to fee changes with multiple payers. Journal of Health Economics 10(4): 385–410.Google Scholar
McGuire, T (2000) Physician agency in J Culyer and P Newhouse (eds), Handbook of Health Economics, Amsterdam: Elsevier, 461–536.Google Scholar
Rizzo, A Blumenthal, D (1996) Is the target income hypothesis an economic heresy? Medical Care Research and Review 53(3): 243–266.Google Scholar
Rösner, H (2004) China’s health insurance system in transformation: preliminary assessment, and policy suggestions. International Social Security Review 57(3): 65–90.Google Scholar
Rudoler, D, Beber, R, Barnsley, J, Glazier, RH, Dass, AR Laporte, A (2015) Paying for primary care: the factors associated with physician self-selection into payment models. Health Economics 24(9): 1229–1242.Google Scholar
Saich, T (2008) Providing Public Goods in Transitional China, New York: Palgrave MacMillan.Google Scholar
Santerre, E Neun, P (2002) Health Economics: Theories, Insights, and Industry Studies, Fort Worth, TX: Harcourt Brace and Company.Google Scholar
Schremmer, J, Coheur, A, Jacquier, C Diabate, V (2009) Extending health care coverage: potential linkages between statutory social security and community-based social protection. International Social Security Review 62(1): 25–43.Google Scholar
Shih, T Ming, S (2012) Physicians’ perception of demand-induced supply in the information age: a latent class model analysis. Health Economics 21(3): 252–269.Google Scholar
Stone, A (1997) The doctor as businessman: the changing politics of a cultural icon. Journal of Health Politics, Policy and Law 22(2): 533–556.Google Scholar
Wagstaff, A Lindelow, M (2008) Can insurance increase financial risk? The curious case of health insurance in China. Journal of Health Economics 27(4): 990–1005.Google Scholar
Wagstaff, A, Lindelow, M, Gao, J, Xu, L Qian, J (2009a) Extending health insurance to the rural population: an impact evaluation of China’s new cooperative medical scheme. Journal of Health Economics 28(1): 1–19.Google Scholar
Wagstaff, A, Yip, W, Lindelow, M Hsiao, W (2009b) China’s health system and its reform: a review of recent studies. Health Economics, 18(Supplement 2): 7–23.Google Scholar
Wang, H, Zhang, L, Yip, W Hsiao, W (2011) An experiment in payment reform for doctors in rural China reduced some unnecessary care but did not lower total costs. Health Affairs 30(12): 2427–2436.Google Scholar
Watts, B, Shiner, B, Klauss, G Weeks, W (2011) Supplier-induced demand for psychiatric admissions in northern New England. BMC Psychiatry 11(6): 146–152.Google Scholar
World Health Organization (WHO) (2000) The World Health Report 2000—Health Systems: Improving Performance, Geneva: WHO.Google Scholar
World Health Organization (WHO) (2010) The World Health Report 2010—Health Systems Financing: The Path to Universal Coverage, Geneva: WHO.Google Scholar
Yip, W Hsiao, W (2008) The Chinese health system at a crossroads. Health Affairs 27(2): 460–468.Google Scholar
Yip, W Hsiao, W (2009) China’s health care reform: a tentative assessment. China Economic Review 20(4): 613–619.Google Scholar
Yip, W, Hsiao, W, Chen, W, Hu, S, Ma, J Maynard, A (2012) Early appraisal of China’s huge and complex health-care reforms. Lancet 379: 833–842.Google Scholar
Yip, W, Hsiao, W, Meng, Q, Chen, W Sun, X (2010) Realignment of incentives for health-care providers in China. Lancet 375: 1120–1130.Google Scholar
Zhan, S, Tang, S, Guo, Y Bloom, G (1998) Drug prescribing in rural health facilities in China: implications for service quality and cost. Tropical Doctor 28(1): 42–48.Google Scholar
Zhang, J (2007) A DID analysis of the impact of health insurance reform in the city of Hangzhou. Health Economics 16(12): 1389–1402.Google Scholar
Zhong, N (2015) Zhong Nanshan on health reform: government should be in charge of public health workers’ wages (Zhong Nanshan Tan Yigai: Zhengfu yin Fuze Yiwu Renyuan Gongzi), http://news.qq.com/a/20150819/061535.htm (in Chinese) [17 October 2015].Google Scholar
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