Examining the association between social health insurance participation and patients' out-of-pocket payments in China: The role of institutional arrangement

Kai Liu, Qiaobing Wu, Junqiang Liu

Research output: Journal article publicationJournal articleAcademic researchpeer-review

26 Citations (Scopus)

Abstract

Previous work on the relationship between social health insurance (SHI) participation and patients' out-of-pocket payments (OOP) in China has overlooked the mediating mechanisms of the institutional arrangement. This study establishes a conceptual framework involving the reimbursement, behavior management and purchasing mechanisms to elaborate on the institutional arrangement of SHI in China. Using structural equation modeling, data on 1645 hospitalized patients obtained from a nationally representative survey in China are analyzed. The results show that the behavior management and purchasing mechanisms of SHI perform poorly, undermining the function of the reimbursement mechanism and mitigating the association between SHI participation and OOP. As a result, SHI participation has a weak negative or even no significant association with the OOP of hospitalized patients. This seems to contradict the principles of SHI, which aims to reduce people's OOP and enhance their wellbeing. These findings are expected to provide valuable insights to the ongoing healthcare reform process in China.
Original languageEnglish
Pages (from-to)95-103
Number of pages9
JournalSocial Science and Medicine
Volume113
DOIs
Publication statusPublished - 1 Jan 2014
Externally publishedYes

Keywords

  • China
  • Institutional arrangement
  • Malfunction
  • Social health insurance
  • Structural equation modeling

ASJC Scopus subject areas

  • Health(social science)
  • History and Philosophy of Science

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