Health Insurance and Health Care among the Mid-Aged and Older Chinese: Evidence from the National Baseline Survey of CHARLS

Abstract

We document the recent profile of health insurance and health care among mid-aged and older Chinese using data from the China Health and Retirement Longitudinal Study conducted in 2011. Overall health insurance coverage is about 93%. Multivariate regressions show that respondents with lower income as measured by per capita expenditure have a lower chance of being insured, as do the less-educated, older, and divorced/widowed women and rural-registered people. Premiums and reimbursement rates of health insurance vary significantly by schemes. Inpatient reimbursement rates for urban people increase with total cost to a plateau of 60%; rural people receive much less. Demographic characteristics such as age, education, marriage status, per capita expenditure, and self-reported health status are not significantly associated with share of out-of-pocket cost after controlling community effects. For health service use, we find large gaps that vary across health insurance plans, especially for inpatient service. People with access to urban health insurance plans are more likely to use health services. In general, Chinese people have easy access to median low-level medical facilities. It is also not difficult to access general hospitals or specialized hospitals, but there exists better access to healthcare facilities in urban areas. Copyright © 2016 John Wiley & Sons, Ltd.

Keywords: CHARLS; H51; I11; I13; health care; health insurance.

Figure 1

Reimbursement rates for inpatients with any insurance for the last visit in the last year, by total cost Notes: Bandwidth=0.8. Sample restricted to these having positive inpatient cost. 10% extreme observations (5% at each end) based on values of total cost are excluded in plotting the figure. We run the lowess using whole sample.

Figure 2

Cumulative percentage of share of out-of-pocket (OOP) expenditure of per capita expenditure (PCE): inpatient service Notes: Weighted using individual sampling weights with household and individual response adjusted. Observations with share of OOP expenditure of PCE larger then 1 are trimmed.