An Empirical Study on the Benefits Equity of the Medical Security Policy: the China Health and Nutrition Survey (CHNS)
Abstract
:1. Background
2. Methods
2.1. Theoretical Framework and Research Hypothesis
2.2. Models
2.3. Data
2.3.1. Data Source
Explained Variable
Explanatory Variables
Control Variables
2.3.2. Descriptive Statistics
3. Results
3.1. Medical Insurance Compensation Level and Hospitalization Possibility
3.2. Possible Impact Path
3.3. Further Analysis
3.3.1. Adding Participation in Private Health Insurance in the Model
3.3.2. Adding Social Medical Assistance in the Model
4. Discussion
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Variable | Sample | Definition | Mean | S.D. | Min | Max |
---|---|---|---|---|---|---|
Lowest income: 20% | 1701 | The per capita income of the family is between 0 and 5000 yuan, and the average income in this period is 2142.26 yuan | 0.20 | 0.40 | 0 | 1 |
Low income: 20% | 1701 | The per capita income of the family is between 5000 and 12,000 yuan, and the average income in this period is 8758.66 yuan | 0.20 | 0.41 | 0 | 1 |
Middle income: 20% | 1701 | The per capita income of the family is between 12,000 and 20,000 yuan, and the average income in this period is 15,880.97 yuan | 0.20 | 0.39 | 0 | 1 |
High income: 20% | 1701 | The family’s per capita income is between 20,000 and 32,800 yuan, and the average income in this period is 25,857.47 yuan | 0.20 | 0.40 | 0 | 1 |
Highest income: 20% | 1701 | The per capita income of the family is between 32,800 and 56,476 yuan, and the average income of this segment is 45,891.88 yuan | 0.20 | 0.40 | 0 | 1 |
Medicare Reimbursement Ratio | 1701 | Proportion of actual medical compensation received | 32.51 | 37.07 | 0 | 100 |
lnincome | 1701 | 1% shrinking of income, and take the logarithm | 5.75 | 2.01 | 1.10 | 11.51 |
social medical insurance | 1701 | Participation in social medical insurance = 1, not participation = 0 | 0.74 | 0.44 | 0 | 1 |
private medical insurance | 1701 | Participating in private medical insurance = 1, not participating = 0 | 0.37 | 0.48 | 0 | 1 |
social medical assistance | 1701 | Received social medical assistance = 1, not received = 0 | 0.08 | 0.26 | 0 | 1 |
hhsize | 1701 | Actual population size in household survey year | 3.85 | 1.72 | 1 | 15 |
job | 1701 | Participating in work = 1, not participating = 0 | 0.47 | 0.50 | 0 | 1 |
highedu | 1701 | Elementary school = 1, junior high school = 2, high school = 3, secondary vocational learning = 4, college or university = 5, master’s degree and above = 6 | 2.62 | 1.35 | 1 | 6 |
age | 1701 | Actual individual age in survey year | 44.44 | 21.58 | 8 | 100 |
age2 | 1701 | Age squared | 2440.7 | 1824 | 64 | 10,000 |
huzhu | 1701 | Householder = 1, No = 0 | 0.14 | 0.35 | 0 | 1 |
married | 1701 | Married = 1, unmarried = 0 | 0.30 | 0.46 | 0 | 1 |
whether or not ill | 1701 | ill = 1, not ill = 0 | 0.11 | 0.32 | 0 | 1 |
degree of illness | 1701 | not serious = 1, general = 2, quite serious = 3 | 1.68 | 0.66 | 1 | 3 |
Medicare Reimbursement Ratio | Hospitalization Possibility (3) IV-Probit | ||||
---|---|---|---|---|---|
(1) Heckman | (2) IV-Heckman | ||||
First Part (Probit) | Second Part (GLM) | First Part (Probit) | Second Part (2SLS) | ||
Lowest income 20% | −28.30 *** | −0.14 ** | −6.74 | 6.62 *** | −0.45 |
(3.55) | (0.06) | (6.78) | (0.20) | (0.34) | |
Low income 20% | −24.57 *** | −0.15 ** | −5.26 | 5.78 *** | −0.61 * |
(3.50) | (0.06) | (5.83) | (0.18) | (0.34) | |
Middle income 20% | −20.08 *** | −0.14 ** | −3.54 | 5.43 *** | −0.51 |
(3.38) | (0.06) | (5.43) | (0.17) | (0.35) | |
High income 20% | −12.11 *** | −0.26 *** | −2.02 | 4.33 *** | −0.53 |
(3.27) | (0.06) | (4.37) | (0.13) | (0.35) | |
Lambda | - | - | −35.51 *** (11.47) | 11.54 *** (0.34) | - |
/mills ratio | −5.56 *** (1.72) | - | - | - | |
Sample | 917 | 300 | 917 | 300 | 1128 |
DWH/Wald test | 3.98 *** (p = 0.00) | 3.98 *** (p = 0.00) | 0.10 (p = 0.75) | ||
Sargan test | - | 8.46 (p = 0.36) | - | ||
First stage F | - | 511.37 (p = 0.00) | - |
Total Hospitalization Costs | Applicability of Medical Insurance (3) IV-Probit | ||||
---|---|---|---|---|---|
(1) Heckman | (2) IV-Heckman | ||||
First Part (OLS) | Second Part (GLM) | First Part (OLS) | Second Part (2SLS) | ||
Lowest income 20% | −0.17 | −0.16 ** | −0.26 | 0.30 *** | 0.22 |
(0.25) | (0.08) | (0.30) | (0.01) | (0.37) | |
Low income 20% | 0.39 | −0.16 ** | 0.42 | 0.29 *** | −0.56 |
(0.24) | (0.08) | (0.30) | (0.01) | (0.89) | |
Middle income 20% | 0.16 | −0.09 | 0.16 | 0.29 *** | 0.75 |
(0.24) | (0.08) | (0.28) | (0.01) | (0.21) | |
High income 20% | 0.23 | −0.26 *** | 0.09 | 0.32 *** | 0.67 |
(0.27) | (0.08) | (0.32) | (0.02) | (0.19) | |
lambda | - | - | −9202.1 ** (3965.9) | 3903.9 *** (1421.9) | - |
/mills ratio | −0.56 *** (0.11) | - | - | - | |
Sample | 591 | 300 | 591 | 300 | 897 |
DWH/Wald test | - | 0.60 *** (0.00) | 0.04 (p = 0.85) | ||
Sargan test | - | 62.55 (0.45) | - | ||
First stage F | - | 744.71 (0.00) | - |
Medicare Reimbursement Ratio | Total Hospitalization Costs | |||||||
---|---|---|---|---|---|---|---|---|
(1) Heckman | (2) IV-Heckman | (3) Heckman | (4) IV-Heckman | |||||
First Part (Probit) | Second Part (GLM) | First Part (probit) | Second Part (2SLS) | First Part (OLS) | Second Part (GLM) | First Part (OLS) | Second Part (2SLS) | |
Lowest income 20% | −29.36 *** | 0.75 *** | −7.57 | 5.81 *** | −0.54 * | 0.75 *** | −0.26 | 0.30 *** |
(4.55) | (0.20) | (6.35) | (0.24) | (0.28) | (0.21) | (0.28) | (0.01) | |
Low income 20% | −25.99 *** | 0.63 *** | −6.066 | 6.594 *** | 0.04 | 0.63 *** | 0.394 | 0.299 *** |
(4.41) | (0.18) | (5.63) | (0.28) | (0.27) | (0.19) | (0.29) | (0.01) | |
Middle income 20% | −24.39 *** | 0.38 ** | −5.41 | 5.82 *** | −0.08 | 0.42 ** | 0.15 | 0.30 *** |
(4.37) | (0.18) | (5.82) | (0.24) | (0.27) | (0.18) | (0.29) | (0.01) | |
High income 20% | −13.60 *** | −0.04 | −0.824 | 5.51 *** | 0.14 | −0.04 | 0.06 | 0.33 *** |
(4.58) | (0.17) | (5.74) | (0.23) | (0.29) | (0.17) | (0.32) | (0.02) | |
Lambda2/Lambda3 | - | - | −32.39 *** | 9.79 *** | - | - | −10,046.3 ** | 4223.2 *** |
- | - | (10.07) | (0.37) | - | - | (4917.6) | (1282.1) | |
/mills ratio | −10.88 (7.58) | - | - | −1.63 *** (0.44) | - | - | ||
DWH | - | 3.19 ** (p = 0.01) | - | 0.37 *** (p = 0.00) | ||||
Sargan test | - | 0.24 (p = 0.62) | - | 63.01 (p = 0.28) | ||||
First stage F | - | 487.61 | - | 749.60 | ||||
Sample | 580 | 300 | 580 | 300 | 572 | 300 | 572 | 300 |
Medicare Reimbursement Ratio | Total Hospitalization Costs | |||||||
---|---|---|---|---|---|---|---|---|
(1) Heckman | (2) IV-Heckman | (3) Heckman | (4) IV-Heckman | |||||
First Part (Probit) | Second Part (GLM) | First Part (Probit) | Second Part (2SLS) | First Part (OLS) | Second Part (GLM) | First Part (OLS) | Second Part (2SLS) | |
Lowest income 20% | −18.02 | 0.54 ** | 4.12 | 5.25 *** | −0.11 | 0.55 ** | −0.34 | 0.29 *** |
(22.50) | (0.27) | (5.09) | (0.27) | (1.29) | (0.27) | (0.29) | (0.01) | |
Low income 20% | −8.94 | 0.29 | 5.51 | 4.58 *** | 1.01 | 0.30 | 0.42 | 0.30 *** |
(21.36) | (0.28) | (5.0) | (0.22) | (1.20) | (0.28) | (0.30) | (0.01) | |
Middle income 20% | 23.85 | 0.05 | 2.31 | 4.17 | 0.86 | 0.06 | 0.14 | 0.30 *** |
(24.47) | (0.31) | (4.62) | (0.59) | (1.37) | (0.31) | (0.29) | (0.01) | |
High income 20% | −25.42 | 0.26 | 6.42 | 1.09 | 0.22 | 0.26 | 0.07 | 0.32 *** |
(21.34) | (0.28) | (14.27) | (0.65) | (1.19) | (0.28) | (0.324) | (0.02) | |
Lambda4/Lambda5 | - | - | −15.59 *** | 4.87 *** | - | - | 15.10 | 18.66 *** |
- | - | (4.94) | (0.23) | - | - | (27.32) | (5.38) | |
/mills ratio | 3.80 (13.53) | - | - | 0.03 (0.72) | - | - | ||
Sample | 788 | 338 | 587 | 300 | 591 | 300 | 591 | 300 |
DWH | - | 0.09 *** (p = 0.00) | - | 0.31 ** (p = 0.03) | ||||
Sargan test | - | 0.37 (p = 0.83) | - | 74.62 (p = 0.57) | ||||
First stage F | - | 65.72 | - | 760.72 |
IV-Heckman Two-Stage Model | ||||||
---|---|---|---|---|---|---|
Insured Sample | Private Health Insurance | Social Medical Assistance | ||||
(1) First Part (Probit) | (2) Second Part (2SLS) | (3) First Part (Probit) | (4) Second Part (2SLS) | (5) First Part (Probit) | (6) Second Part (2SLS) | |
Lowest income 20% | −7.222 | 17.74 *** | −10.45 | 26.86 *** | −30.11 | 21.74 |
(19.77) | (2.68) | (29.08) | (5.23) | (30.06) | (14.31) | |
Low income 20% | −3.608 | 11.22 *** | −5.60 | 16.25 *** | 5.39 | 11.26 *** |
(12.38) | (1.33) | (17.84) | (2.88) | (12.40) | (2.293) | |
Middle income 20% | −2.590 | 10.34 *** | −0.681 | 10.34 *** | 52.00 | 33.72 * |
(10.47) | (1.15) | (10.74) | (1.20) | (45.28) | (17.79) | |
High income 20% | 5.981 | 8.20 *** | 5.58 | 9.34 *** | 48.07 | 29.35 |
(9.65) | (0.69) | (8.73) | (0.98) | (44.15) | (22.10) | |
lambda6/lambda7/lambda8 | −1.090 | 25.90 *** | 5.50 | 45.16 *** | 111.2 | 76.03 |
(27.93) | (3.62) | (46.78) | (8.96) | (112.0) | (52.88) | |
Sample | 788 | 155 | 587 | 144 | 591 | 89 |
DWH | 4.82 *** (p = 0.00) | 2.33 * (p = 0.07) | 7.21 *** (p = 0.00) | |||
Sargan test | 0.89 (p = 1.67) | 3.56 (p = 0.54) | 2.18 (p = 2.74) | |||
First stage F | 22.70 | 49.13 | 154.39 |
IV-Heckman Two-Stage Model | ||||||
---|---|---|---|---|---|---|
Insured Sample | Private Health Insurance | Social Medical Assistance | ||||
(1) First Part (OLS) | (2) Second Part (2SLS) | (3) First Part (OLS) | (4) Second Part (2SLS) | (5) First Part (OLS) | (6) Second Part (2SLS) | |
Lowest income 20% | −82.47 | 91.14 *** | −74.97 | 122.6 *** | −100.2 | 132.1 |
(79.79) | (18.36) | (102.4) | (31.06) | (974.8) | (37069.1) | |
Low income 20% | −42.54 | 56.78 *** | −33.30 | 72.80 *** | −84.65 | 65.72 |
(51.12) | (10.57) | (60.62) | (16.03) | (203.7) | (7286.3) | |
Middle income 20% | 52.14 | 52.96 *** | 13.66 | 46.92 *** | 86.90 | 206.5 |
(58.93) | (9.37) | (40.19) | (9.45) | (2116.8) | (80,925.3) | |
High income 20% | 77.17 | 41.33 *** | 80.52 | 42.66 *** | −22.30 | 176.8 |
(56.71) | (6.35) | (61.63) | (7.85) | (1402.7) | (53,698.2) | |
lambda6/lambda7/lambda8 | 94.14 | 132.8 *** | 91.41 | 204.9 *** | 55.15 | 463.4 |
(122.7) | (25.66) | (174.5) | (51.78) | (3870.7) | (148,055.4) | |
Sample | 657 | 161 | 573 | 148 | 386 | 94 |
DWH | 9.31 * (p = 0.06) | 0.83 *** (p = 0.00) | 20.51 *** (p = 0.00) | |||
Sargan test | 2.69 (p = 1.32) | 0.64 (p = 0.17) | 8.56 (p = 0.58) | |||
First stage F | 14.37 | 32.79 | 253.61 |
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Liu, H.; Dai, W. An Empirical Study on the Benefits Equity of the Medical Security Policy: the China Health and Nutrition Survey (CHNS). Int. J. Environ. Res. Public Health 2020, 17, 1203. https://doi.org/10.3390/ijerph17041203
Liu H, Dai W. An Empirical Study on the Benefits Equity of the Medical Security Policy: the China Health and Nutrition Survey (CHNS). International Journal of Environmental Research and Public Health. 2020; 17(4):1203. https://doi.org/10.3390/ijerph17041203
Chicago/Turabian StyleLiu, Huan, and Weidong Dai. 2020. "An Empirical Study on the Benefits Equity of the Medical Security Policy: the China Health and Nutrition Survey (CHNS)" International Journal of Environmental Research and Public Health 17, no. 4: 1203. https://doi.org/10.3390/ijerph17041203