Skip to main content
Erschienen in: International Journal of Health Economics and Management 4/2015

01.12.2015 | Research Article

Medical expenditure in urban China: a quantile regression analysis

verfasst von: Jianmei Zhao, Hai Zhong

Erschienen in: International Journal of Health Economics and Management | Ausgabe 4/2015

Einloggen, um Zugang zu erhalten

Abstract

Many countries have been trying to expand their public health insurance coverage in recent years. To achieve two fundamental policy goals—equity in health care utilization and control of health care costs—policymakers need a better understanding of the underlying determinants of individual health care expenditure beyond the results of mean regressions. In this paper, we apply a quantile regression method to investigate the heterogeneous effects of various determinants of medical expenditure in China. Comparing with the average effects, we find that health care expenditures at the upper end of the distribution are under stronger influences of need factors such as poor health status, and weaker influences of socioeconomic factors and insurance status. On the other hand, health care expenditures at the lower end of the distribution are under stronger influences of socioeconomic factors and insurance status, and weaker influences of need factors. Our study may provide useful information to policymakers for the optimal design of their health care systems, and it may be of particular interests to the health policymakers in China, where is currently still in a period of reshaping its health-care system.
Fußnoten
1
One exception is Kowalski (2010), in which the author adopts a quantile regression approach.
 
2
For both surveys, the questionnaire was designed by Chinese and foreign researchers and implemented by China’s National Bureau of Statistics (NBS). Although most survey contents in 2009 survey are similar to the CHIP 2002 data, some questions or answer options in 2009 RUMiCI (also called CHIP 2008) data are different from those from the CHIP 2002 data.
 
3
For detailed sampling information, please refer http://​rumici.​anu.​edu.​au.
 
4
Among them, inability to work group includes formally retired people or individuals who are unable to work. Unemployed group is composed of lay-off workers and purely unemployed individuals. Finally, the group named not ready for job contains full-time homemakers, students, and other idle persons.
 
5
To control the potential city-specific effect and heteroscedasticity problem (errors clustered at city level), we have tried to add a group of city dummies instead of the provincial dummies, and reached similar results. To save more degrees of freedom, we run the regressions with provincial dummies.
 
6
From Tables 7 and 8, an interesting finding is that the marginal effects of age for GIS holders are relatively stable across health care expenditure distribution, and much stronger than that for UEBMI holders. Rising health expenditures on the elderly is a major concern for policymakers in the developed world. Our results indicate that it might be closely related to features of health insurance plans.
 
Literatur
Zurück zum Zitat Blomqvist, A. (1997). Optimal non-linear health insurance. Journal of Health Economics, 16(3), 303–321.CrossRefPubMed Blomqvist, A. (1997). Optimal non-linear health insurance. Journal of Health Economics, 16(3), 303–321.CrossRefPubMed
Zurück zum Zitat Chiappori, P. A., Durand, F., & Geoffard, P. Y. (1998). Moral hazard and the demand for physician services: First lessons from a French natural experiment. European Economic Review, 42, 499–511.CrossRef Chiappori, P. A., Durand, F., & Geoffard, P. Y. (1998). Moral hazard and the demand for physician services: First lessons from a French natural experiment. European Economic Review, 42, 499–511.CrossRef
Zurück zum Zitat Cutler, D., & Zeckhauser, R. (2000). The anatomy of health insurance. In A. Culyer & J. Newhouse (Eds.), Handbook of health economics. Amsterdam: North Holland. Cutler, D., & Zeckhauser, R. (2000). The anatomy of health insurance. In A. Culyer & J. Newhouse (Eds.), Handbook of health economics. Amsterdam: North Holland.
Zurück zum Zitat DiMatteo, L. (2003). The income elasticity of health care spending: A comparison of parametric and nonparametric approaches. The European Journal of Health Economics, 4(1), 1–20.CrossRef DiMatteo, L. (2003). The income elasticity of health care spending: A comparison of parametric and nonparametric approaches. The European Journal of Health Economics, 4(1), 1–20.CrossRef
Zurück zum Zitat DiMatteo, L., & DiMatteo, R. (1998). Evidence on the determinants of Canadian provincial government health expenditures: 1965–1991. Journal of Health Economics, 17(2), 211–228.CrossRef DiMatteo, L., & DiMatteo, R. (1998). Evidence on the determinants of Canadian provincial government health expenditures: 1965–1991. Journal of Health Economics, 17(2), 211–228.CrossRef
Zurück zum Zitat Dow, W. H., & Norton, E. C. (2003). Choosing between and interpreting the heckit and two-part models for corner solutions. Health Services & Outcomes Research Methodology, 4, 5–18.CrossRef Dow, W. H., & Norton, E. C. (2003). Choosing between and interpreting the heckit and two-part models for corner solutions. Health Services & Outcomes Research Methodology, 4, 5–18.CrossRef
Zurück zum Zitat Duarte, F. (2012). Price elasticity of expenditure across health care services. Journal of health economics, 31, 824–841.CrossRefPubMed Duarte, F. (2012). Price elasticity of expenditure across health care services. Journal of health economics, 31, 824–841.CrossRefPubMed
Zurück zum Zitat Duan, N., Manning, W. G., Morris, C. N., & Newhouse, J. P. (1983). A comparison of alternative models for the demand for medical care. Journal of Business and Economic Statistics, 1, 115–126. Duan, N., Manning, W. G., Morris, C. N., & Newhouse, J. P. (1983). A comparison of alternative models for the demand for medical care. Journal of Business and Economic Statistics, 1, 115–126.
Zurück zum Zitat Duan, N., Manning, W., Morris, C., & Newhouse, J. (1984). Choosing between the sample-selection model and the multi-part model. Journal of Business and Economic Statistics, 2, 283–289. Duan, N., Manning, W., Morris, C., & Newhouse, J. (1984). Choosing between the sample-selection model and the multi-part model. Journal of Business and Economic Statistics, 2, 283–289.
Zurück zum Zitat Duan, N., Manning, W., Morris, C., & Newhouse, J. (1985). Comments on selectivity bias. Advances in Health Economics and Health Services Research, 6, 19–24. Duan, N., Manning, W., Morris, C., & Newhouse, J. (1985). Comments on selectivity bias. Advances in Health Economics and Health Services Research, 6, 19–24.
Zurück zum Zitat Eichner, M. (1998). The demand for medical care: What people pay does matter. The American Economic Review, 88, 117–121. Eichner, M. (1998). The demand for medical care: What people pay does matter. The American Economic Review, 88, 117–121.
Zurück zum Zitat Ellis, R., & Manning, W. (2007). Optimal health insurance for prevention and treatment. Journal of Health Economics, 26(6), 1128–1150.CrossRefPubMed Ellis, R., & Manning, W. (2007). Optimal health insurance for prevention and treatment. Journal of Health Economics, 26(6), 1128–1150.CrossRefPubMed
Zurück zum Zitat Felder, S. (2008). To wait or to pay for medical treatment? Restraining ex-post moral hazard in health insurance. Journal of Health Economics, 27(6), 1418–1422.CrossRefPubMed Felder, S. (2008). To wait or to pay for medical treatment? Restraining ex-post moral hazard in health insurance. Journal of Health Economics, 27(6), 1418–1422.CrossRefPubMed
Zurück zum Zitat Gao, J., Tang, S., Tolhurst, R., & Rao, K. (2001). Changing access to health services in urban China: Implications for equity. Health Policy and Planning, 16, 302–312.CrossRefPubMed Gao, J., Tang, S., Tolhurst, R., & Rao, K. (2001). Changing access to health services in urban China: Implications for equity. Health Policy and Planning, 16, 302–312.CrossRefPubMed
Zurück zum Zitat Goldberger, A. S. (1983). Abormal selection bias. In S. Karlin & T. Amemiya (Eds.), Studies in econometrics? Time series and multivariate statistics. New York: Academic Press. Goldberger, A. S. (1983). Abormal selection bias. In S. Karlin & T. Amemiya (Eds.), Studies in econometrics? Time series and multivariate statistics. New York: Academic Press.
Zurück zum Zitat Hay, J. W., & Olsen, R. J. (1984). Let them eat cake: A note on comparing alternative models of the demand for medical care. Journal of Business and Economic Statistics, 2, 279–282. Hay, J. W., & Olsen, R. J. (1984). Let them eat cake: A note on comparing alternative models of the demand for medical care. Journal of Business and Economic Statistics, 2, 279–282.
Zurück zum Zitat Hitiris, T., & Posnett, J. (1992). The determinants and effects of health expenditure in developed countries. Journal of Health Economics, 11, 173–187.CrossRefPubMed Hitiris, T., & Posnett, J. (1992). The determinants and effects of health expenditure in developed countries. Journal of Health Economics, 11, 173–187.CrossRefPubMed
Zurück zum Zitat Kaestner, R., & Dave, D. (2006). Health insurance and ex ante moral hazard: Evidence from medicare. NBER working paper no. 12764. Kaestner, R., & Dave, D. (2006). Health insurance and ex ante moral hazard: Evidence from medicare. NBER working paper no. 12764.
Zurück zum Zitat Kenkel, D. (1990). Consumer health information and the demand for medical care. Review of Economics and Statistics, 72, 587–595.CrossRef Kenkel, D. (1990). Consumer health information and the demand for medical care. Review of Economics and Statistics, 72, 587–595.CrossRef
Zurück zum Zitat Kowalski, A. (2010). Censored quantile instrumental variables estimates of the price elasticity of expenditure on medical care. NBER working paper no. 15085. Kowalski, A. (2010). Censored quantile instrumental variables estimates of the price elasticity of expenditure on medical care. NBER working paper no. 15085.
Zurück zum Zitat Leung, S. F., & Yu, S. (1996). On the choice between sample selection and two-part models. Journal of Econometrics, 72, 197–229.CrossRef Leung, S. F., & Yu, S. (1996). On the choice between sample selection and two-part models. Journal of Econometrics, 72, 197–229.CrossRef
Zurück zum Zitat Lin, W., Liu, G. G., & Chen, G. (2009). The urban resident basic medical insurance: A landmark reform towards universal coverage in China. Health Economic, 18(S2), S83–S96.CrossRef Lin, W., Liu, G. G., & Chen, G. (2009). The urban resident basic medical insurance: A landmark reform towards universal coverage in China. Health Economic, 18(S2), S83–S96.CrossRef
Zurück zum Zitat Liu, G. G., Zhao, Z., Cai, R., Yamada, T., & Yamada, T. (2002). Equity in health care access to: Assessing the urban health. Social Science & Medicine, 55, 1779–1794.CrossRef Liu, G. G., Zhao, Z., Cai, R., Yamada, T., & Yamada, T. (2002). Equity in health care access to: Assessing the urban health. Social Science & Medicine, 55, 1779–1794.CrossRef
Zurück zum Zitat Maddala, G. S. (1985). A survey of the literature on selectivity bias as it pertains to health care market. In R. Scheffler & L. Rossiter (Eds.), Advances in health economics and health services research. Greenwich, CT: JAI Press. Maddala, G. S. (1985). A survey of the literature on selectivity bias as it pertains to health care market. In R. Scheffler & L. Rossiter (Eds.), Advances in health economics and health services research. Greenwich, CT: JAI Press.
Zurück zum Zitat Manning, W. G., Blumberg, L., & Moulton, L. H. (1995). The demand for alcohol: The differential response to price. Journal of Health Economics, 14, 123–148.CrossRefPubMed Manning, W. G., Blumberg, L., & Moulton, L. H. (1995). The demand for alcohol: The differential response to price. Journal of Health Economics, 14, 123–148.CrossRefPubMed
Zurück zum Zitat Manning, W. G., Newhouse, J., Duan, N., Keeler, E., & Leibowitz, A. (1987). Health insurance and the demand for medical care: Evidence from a randomized experiment. The American Economic Review, 77(3), 251–277.PubMed Manning, W. G., Newhouse, J., Duan, N., Keeler, E., & Leibowitz, A. (1987). Health insurance and the demand for medical care: Evidence from a randomized experiment. The American Economic Review, 77(3), 251–277.PubMed
Zurück zum Zitat Mocan, N. H., Tekin, E., & Zax, J. S. (2004). The demand for medical care in urban China. World Development, 32, 289–304.CrossRef Mocan, N. H., Tekin, E., & Zax, J. S. (2004). The demand for medical care in urban China. World Development, 32, 289–304.CrossRef
Zurück zum Zitat Musgrove, P. (1983). Family health care spending in Latin America. Journal of Health Economics, 2, 245–257.CrossRefPubMed Musgrove, P. (1983). Family health care spending in Latin America. Journal of Health Economics, 2, 245–257.CrossRefPubMed
Zurück zum Zitat Van Doorslaer, E., Wagstaff, A., et al. (2000). Equity in the delivery of health care in Europe and the U.S. Journal of Health Economics, 19, 553–583.CrossRefPubMed Van Doorslaer, E., Wagstaff, A., et al. (2000). Equity in the delivery of health care in Europe and the U.S. Journal of Health Economics, 19, 553–583.CrossRefPubMed
Zurück zum Zitat Vera-Hernandez, M. (2003). Structural estimation of a principal-agent model: Moral hazard in medical insurance. The RAND Journal of Economics, 34(4), 670–693.CrossRefPubMed Vera-Hernandez, M. (2003). Structural estimation of a principal-agent model: Moral hazard in medical insurance. The RAND Journal of Economics, 34(4), 670–693.CrossRefPubMed
Zurück zum Zitat Wagstaff, A., & Lindelow, M. (2008). Can insurance increase financial risk? The curious case of health insurance in China. Journal of Health Economics, 27, 990–1005.CrossRefPubMed Wagstaff, A., & Lindelow, M. (2008). Can insurance increase financial risk? The curious case of health insurance in China. Journal of Health Economics, 27, 990–1005.CrossRefPubMed
Zurück zum Zitat Wagstaff, A., Lindelow, M., Gao, J. X., & Qian, J. (2009). Extending health insurance to the rural population: An impact evaluation of China’s new cooperative medical scheme. Journal of Health Economics, 28, 1–19.CrossRefPubMed Wagstaff, A., Lindelow, M., Gao, J. X., & Qian, J. (2009). Extending health insurance to the rural population: An impact evaluation of China’s new cooperative medical scheme. Journal of Health Economics, 28, 1–19.CrossRefPubMed
Zurück zum Zitat Wedig, G. J. (1988). Health status and the demand for health: Results on price elasticities. Journal of Health Economics, 7, 151–163.CrossRefPubMed Wedig, G. J. (1988). Health status and the demand for health: Results on price elasticities. Journal of Health Economics, 7, 151–163.CrossRefPubMed
Zurück zum Zitat Yip, W. S., & Hsiao, W. C. (2008). The Chinese health system at a crossroads. Health Affairs, 27, 460–468.CrossRefPubMed Yip, W. S., & Hsiao, W. C. (2008). The Chinese health system at a crossroads. Health Affairs, 27, 460–468.CrossRefPubMed
Zurück zum Zitat Yip, W. S., & Hsiao, W. C. (2009). Non-evidence-based policy: How effective is China’s new cooperative medical scheme in reducing medical impoverishment? Social Science & Medicine, 68, 201–209.CrossRef Yip, W. S., & Hsiao, W. C. (2009). Non-evidence-based policy: How effective is China’s new cooperative medical scheme in reducing medical impoverishment? Social Science & Medicine, 68, 201–209.CrossRef
Zurück zum Zitat Zhao, Z. (2006). Income inequality, unequal health care access, and mortality in China. Population and Development Review, 32, 461–483.CrossRef Zhao, Z. (2006). Income inequality, unequal health care access, and mortality in China. Population and Development Review, 32, 461–483.CrossRef
Zurück zum Zitat Zhong, H. (2011). Effect of patient reimbursement methods on health-care utilization: Evidence from China. Health Economics, 20, 1312–1329.CrossRefPubMed Zhong, H. (2011). Effect of patient reimbursement methods on health-care utilization: Evidence from China. Health Economics, 20, 1312–1329.CrossRefPubMed
Metadaten
Titel
Medical expenditure in urban China: a quantile regression analysis
verfasst von
Jianmei Zhao
Hai Zhong
Publikationsdatum
01.12.2015
Verlag
Springer US
Erschienen in
International Journal of Health Economics and Management / Ausgabe 4/2015
Print ISSN: 2199-9023
Elektronische ISSN: 2199-9031
DOI
https://doi.org/10.1007/s10754-015-9174-0