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The purpose of this paper is to examine the adverse selection in participation in the New Rural Cooperative Medical Scheme (NRCMS), as well as in outpatient and inpatient service utilization, in Chaoyang, Beijing, China.

Probit model is established to test whether the rural Hukou family member in Combined Household (CH) is statistically different from the Pure Rural Household (PRH) in enrollment in NRCMS. Seemingly Unrelated Regression (SUR) model is adopted to examine the difference in the utilization of outpatient and inpatient between the rural Hukou family members in the two kinds of households.

This paper finds that the rural Hukou family member in CH has more probability to enroll in NRCMS than the counterpart in PRH. In the period of six months, the rural Hukou family member in CH exceeds PRH by 0.73 times in outpatient visit number per capita. The former average spends yuan 157 more in outpatient service and is reimbursed yuan 53 more from NRCMS than the latter. Moreover, on average, rural Hukou family member has no difference in the inpatient service utilization between the two kinds of households in the period of 12 months.

This is the first study to empirically test the adverse selection in China's medical insurance market from the perspective of two different types of households, which are CH and PRH.

The New Rural Cooperative Medical Scheme (NRCMS), implemented in China since 2003, has greatly increased the access of the poor to health services and alleviated the hardship caused by catastrophic medical payments. Both the precautionary saving theory and the Buffer‐Stock saving theory would predict a positive effect of this event on consumption. The purpose of this paper is to empirically study the effects of medical insurance on durables consumption in rural China.

Using China Health and Nutrition Survey (CHNS) data, the authors study the effects of medical insurance on durable goods consumption in rural China through a panel binary choice model.

It is found that households with medical insurance have a significantly higher level of durables consumption, and their probabilities of purchasing durables increase by 2.0 per cent‐4.4 per cent, which support the precautionary saving theory and the Buffer‐Stock saving theory.

Unlike previous studies, the authors focus on the effects of medical insurance on the consumption of durables, which have a big weight in household wealth and are more sensitive to income uncertainty.

The Chinese society has embraced rapid social reforms since the late twentieth century, including educational and healthcare systems. The Chinese Central Government launched an ambitious health reform program in 2009 to improve service quality and provide affordable health services, regardless of individual socio-economic status. Currently, the Chinese social health insurance includes Urban Employee Basic Medical Insurance, Urban Resident Basic Medical Insurance, and New Cooperative Medical Insurance for rural residents. The purpose of this paper is to measure the association between individual education level and China’s social health insurance scheme following the reform.

Using the latest (2011) China Health and Nutrition Survey (CHNS) data and multivariable logistic regression models with cross-sectional design (n=11,960), the odds ratios (OR) and 95% confidence intervals (95% CI) are reported.

The authors found that education is associated with all social health insurance schemes in China after the reform (p<0.001). Residents with higher educational attainments, such as technical school (OR: 6.64, 95% CI: 5.44–8.13) or university and above (OR: 9.86, 95% CI: 8.14–11.96), are associated with UEBMI, compared with lower-educated individuals.

The Chinese Central Government announced a plan to combine all social health insurance schemes by 2020, except UEBMI, a plan with the most comprehensive financial package. Further research is needed to investigate potential disparities after unification. Policy makers should continue to evaluate China’s universal health coverage and social disparity.

This study is the first to investigate the association between residents’ educational attainment and three social health insurance schemes following the 2009 health reform. The authors suggest that educational attainment is still associated with each social health insurance coverage after the ambitious health reform.

The purpose of this paper is to study the effects of introducing a health insurance program in rural China between 2004 and 2006, the New Cooperative Medical Scheme (NCMS).

The authors apply difference in difference and propensity score matching methods (PSM-DID) to a widely used panel dataset, the China Health and Nutrition Survey (CHNS). Findings are robust across several treatment and comparison groups used in previous NCMS studies.

Households who participated in NCMS increased the use of preventive services and western medicine, while lowering the use of traditional Chinese medicine. NCMS also reduced hospital use, out of pocket payments, travel time to healthcare facilities and waiting time to see doctors. The authors estimate that reductions in travel and waiting time saved roughly 52m U.S. dollars in 2006.

Previously divergent findings on health insurance effects may be due to researchers studying health insurance across different healthcare delivery systems. In addition, in estimating how health insurance access affects healthcare costs, the authors should consider economic costs related to the time needed to access health services.

The authors study how health insurance access affects patients' choice of providers and economic costs to accessing health care services, outcomes that have not received much attention previously. The authors depart from previous NCMS studies by comparing several different approaches to identifying treatment and control groups when applying PSM-DID.

The purpose of this paper is to provide an overview of the organisational and procedural arrangements for healthcare reform in China, and describe the role of social values in the relevant decision‐making process.

An analysis of recent developments aimed at achieving universal coverage in China was undertaken in the context of describing the influence of underlying social values.

The key underlying social value was found to be social solidarity. Other values were implicit rather than explicitly stated, and were subservient to the overall aim of comprehensive coverage.

The paper shows that China is embarking on the largest‐scale health reforms in the world. There is an eagerness to share experiences with other countries in an attempt to ensure the success of the reforms. There is an increasing understanding of the need to make the values underpinning the reforms more explicit and, in particular, those concerned with efficiency and appropriateness.

Since the implementation of the New Cooperative Medical Scheme (NCMS) in 2003, this program has experienced rapid growth. Even so, little is known about the association between NCMS expansion and labor force supply among rural residents in China. The purpose of this paper is to examine the effects of the NCMS on labor force supply for rural Chinese populations.

Using data from the China Health and Nutrition Survey (CHNS), a difference-in-differences (DD) approach is employed to estimate the impact of NCMS expansion on labor supply outcomes, including hours of worked in agriculture, off-farm labor force participation, not working, and weeks off due to illness. A number of falsification tests are conducted to identify whether the assumption of common trends of DD analyses is satisfied. The robustness of results is checked through additional estimation, including panel fixed effects and instrumental variable approach.

Results show that the NCMS expansion has a positive effect on the hours of worked in agriculture and off-farm labor force participation, and reduces the likelihood of not working and weeks off due to illness. The effect on hours of agricultural production is larger for male adults, those aged 50 or more, and individuals in low-income families. This study demonstrates the importance of potential health improvements from public health insurance in promoting rural residents’ labor productivity.

Studies concerning the effects of public health insurance on labor supply in developing countries remain limited. The findings of this study provide important insights into how public health insurance programs, like the NCMS, may affect patterns of labor supply among rural residents, and can help policymakers improve health policies aimed to reduce the number of uninsured farmers while maintaining high levels of labor supply, productivity, and health status among the most vulnerable of populations.

Objectives – Purchasing has been promoted as a key policy instrument to improve health system performance. Despite its widespread adoption, there is little empirical evidence on how it works, the challenges surrounding its implementation, its impact, and the preconditions for it to function effectively, particularly in low- and middle-income settings. The objective of this chapter is to analyze critically the extent to which purchasing could be, and has been used strategically in China and to identify modifications that are needed for purchasing to be effective in assuring that the government's new funding for health care will result in efficient and effective health services.

Methods – We present a conceptual framework for purchasing, which identifies three critical principal–agent relationships in purchasing. We draw on evidence from secondary data, results of other research studies, interviews, and the impact evaluation of a social experiment in rural China that explicitly used purchasing to improve quality and efficiency. This information is used to examine purchasing relationships in urban social health insurance (SHI), the rural medical insurance scheme, and purchasing of public health services.

Findings – To date, use of strategic purchasing is limited in China. Both the urban and the rural health insurance schemes act as passive third-party payers, failing to take advantage of the opportunities to strengthen incentives to improve quality and efficiency. This may be because as government agencies, the extent to which the Ministries of Health and Labor and Social Security can act independently from provider interests, or act in the best interest of the population, is unclear. Other important challenges include ensuring adequate representation of the population's views and preferences and making better use of the leverage provided by purchasing to create appropriate provider incentives, through better integration of financing and improved coordination among purchasers.

Implications for policy – In designing purchasing arrangements, attention needs to be paid to all three principal–agent relationships. Successful purchasing appears to require mechanisms to mobilize and represent community preferences and more strategic contracting with providers. More research is needed to strengthen the evidence on which purchasing arrangements work, which do not work, and under what conditions different purchasing configurations can work most effectively.

The purpose of this paper is to explore the causality between social security policies and farmland reallocation in rural China.

It quantitatively analyzes the impact of each ongoing social security policy on farmland reallocation based on a data set from the 2011 China Health and Retirement Longitudinal Study (CHARLS, 2011).

The study finds that the inclination of a village farmers’ collective to reallocate farmland due to changes in the village population increased if social security policies do not effectively cover the village because farmers rely primarily on income from farmland to cover their basic living expenses. However, if social security policies provide adequate coverage, then farmers do not rely entirely on on-farm income and the likelihood of farmland reallocation decreases. Furthermore, the effectiveness of social security policies includes not only coverage but also the sufficiency of the security policies provided.

First, the authors use only cross-sectional data in this study, which may result in biased estimation and also limit temporal examination of the impact of social security systems, farmland reallocation and related policy variables. This limitation may be especially important in China because the country is undergoing a rapid socioeconomic transition. However, the research is constrained by the available data. Furthermore, there could be endogeneity problems that are difficult to address, given the current data set. These problems could involve the impacts of village-level economic, natural and social variables, the implementation of related public policies (land development and consolidation, land expropriation, etc.) and other economic variables.

These findings may provide implications for related policy reform in the near future.

These findings may facilitate a recognition and understanding of the causality between social security policies and farmland reallocation in rural China.

The purpose of this paper is to explore recent healthcare reform in China. Reflecting on the current literature, the viewpoint argues that greater attention should be paid to healthcare reform in China as a public policy process, particularly one that is built on policy experimentation.

The viewpoint argues that while recent efforts to understand the impact of reform have brought significant understanding of key issues and processes, such interest tends to focus on pragmatic concerns rather than pose wider theoretical and methodological questions about the nature and pace of reform.

The authors suggest that the lens of public policy is particular relevant and insightful given what has been documented elsewhere regarding China’s unique policy process characterised by “policy experimentation”. The authors discuss how a policy experiment perspective can provide a useful heuristic for understanding healthcare reform in China.

The viewpoint concludes by outlining possible applications of this approach and looks forward at the emerging research agenda in this area.

The Chinese population is rapidly ageing before they are rich. The purpose of this paper is to describe healthcare seeking behaviour and the critical factors associated with healthcare seeking behaviour.

Using a purposive sampling method, the authors recruited 44 adults aged 60 years or older from three provinces, representing the developed (Shanghai), undeveloped (Ningxia) regions and the regions in between (Hubei). From July to September 2008, using a semi-structured guide, the authors interviewed participants in focus group discussions.

The healthcare needs for chronic and catastrophic diseases were high; however, the healthcare demands were low and healthcare utilizations were even lower owing to the limited accessibility to healthcare services, particularly, in underdeveloped rural areas. “Too expensive to see a doctor” was a prime complaint, explaining substantial discrepancies between healthcare needs, demands and use. Care seeking behaviour varied depending on insurance availability, perceived performance, particularly hospital services, and prescription medications. Participants consistently rated increasing healthcare accessibility as a high priority, including offering financial aid, and improving service convenience. Improving social security fairness was the first on the elderly’s wish list.

Healthcare demand and use were lower than needs, and were influenced by multiple factors, primarily, service affordability and efficiency, perceived performance and hospital service quality.