The expansion of public health insurance and the demand for private health insurance in rural China

This paper examines the impact of the New Cooperative Medical Scheme (NCMS) on private health insurance purchasing decisions in rural China, using longitudinal data from the China Health and Nutrition Survey (CHNS, 2000-2006). A Difference-in-difference (DID) approach is employed to estimate NCMS effects. The overall effects of NCMS were modest, but differed for adults and children. We find that adults were 2.1% more likely to purchase private health insurance when NCMS became available. NCMS had a larger positive effect on adult private coverage in higher income groups and in communities with a preexisting health care financing system, known as the Cooperative Medical Scheme (CMS). We also find evidence suggesting that NCMS crowded out child private health insurance, especially in lower income groups. However, this finding is not robust to controlling for other covariates including household characteristics and availability of private insurance in the community. For both adults and children, risk preferences and socio-economic status, including income and education, are important predictors of private insurance take-up. We find no evidence for adverse selection in the demand for private health insurance.

Research Highlights►The overall effects of NCMS on private coverage were modest. ► NCMS had a positive effect on adult private coverage. ►NCMS crowded out child private coverage in lower income groups. ►Risk preferences and SES are important predictors of private insurance take-up. ►No evidence for adverse selection in the demand for private health insurance.