Empirical essays on the evaluation of health care reforms in rural China
type: CreativeWork
description: This thesis is comprised of three empirical studies on health care reforms in rural China. It specifically examines the determinant of enrolment in the social health insurance program, the effects of the insurance on health care utilization, and the extent of income-related inequity in the use of health care before and after the reforms. Chapter 2 analyses the determinant of enrolment in the New Rural Cooperative Medical Scheme (NRCMS) from 2004 to 2006. The results show that people who use low-level public health facilities (village clinics or town hospitals) are more likely to be insured while people who use high-level public health facilities (county or city hospitals) are less likely to be covered. The relationship remains strong and significant after controlling for various groups of independent variables, such as demographics, socio-economic characteristics and health variables. The results may be attributed to generous reimbursements for health services delivered by low-level health facilities, making insurance more attractive for people who use primary care. However, the fact that people who use high-level facilities are less likely to purchase the NRCMS may indicate problems related to weak health systems at the primary level and a breakdown in the referral system. Chapter 3 provides evidence on the effectiveness of the NRCMS on health care utilization to explore whether the insurance has helped patients to obtain more and better quality health services. As the program is a non-random policy initiative rolled out nationally, various matching methods with difference-in-difference (DID) models are employed based on data from the China Health and Nutrition Survey (CHNS). The results show that the introduction of the NRCMS was not clearly related to the overall use of medical care, but it may have directed patients from town hospitals towards village clinics and county hospitals. On the one hand, the NRCMS appears to partly rationalise the use of health service…
abstract: This thesis is comprised of three empirical studies on health care reforms in rural China. It specifically examines the determinant of enrolment in the social health insurance program, the effects of the insurance on health care utilization, and the extent of income-related inequity in the use of health care before and after the reforms. Chapter 2 analyses the determinant of enrolment in the New Rural Cooperative Medical Scheme (NRCMS) from 2004 to 2006. The results show that people who use low-level public health facilities (village clinics or town hospitals) are more likely to be insured while people who use high-level public health facilities (county or city hospitals) are less likely to be covered. The relationship remains strong and significant after controlling for various groups of independent variables, such as demographics, socio-economic characteristics and health variables. The results may be attributed to generous reimbursements for health services delivered by low-level health facilities, making insurance more attractive for people who use primary care. However, the fact that people who use high-level facilities are less likely to purchase the NRCMS may indicate problems related to weak health systems at the primary level and a breakdown in the referral system. Chapter 3 provides evidence on the effectiveness of the NRCMS on health care utilization to explore whether the insurance has helped patients to obtain more and better quality health services. As the program is a non-random policy initiative rolled out nationally, various matching methods with difference-in-difference (DID) models are employed based on data from the China Health and Nutrition Survey (CHNS). The results show that the introduction of the NRCMS was not clearly related to the overall use of medical care, but it may have directed patients from town hospitals towards village clinics and county hospitals. On the one hand, the NRCMS appears to partly rationalise the use of health service…
author: Yang, Miaoqing
author: Hollingsworth, Bruce
author: Green, Colin
date published: 2016-06
date modified: 2026-07-24T02:48:32Z
provider: Lancaster University
publisher: Networked Digital Library of Theses and Dissertations
type: WebPage
source organization: Lancaster University