Health Economic Analysis of China’s Health Insurance System

This thesis consists of 3 chapters plus an introductory chapter and a concluding chapter. They are on three different topics, but they are all related to China’s health insurance system from 2000 to 2011.
Chapter 1 is the introduction to the thesis, providing background to the Chinese insurance system, the theoretical underpinning of the three chapters, a description of the datasets used in the thesis, and an overview of the thesis.
Chapter 2 investigates whether there is adverse or advantageous selection in China’s private health insurance market before 2003. We found evidence in favour of adverse selection in a pure private insurance market. For the public insurance group where people already got covered by a public insurance but face the choice of buying a supplementary private insurance, we found advantageous selection.
Chapter 3 examines whether implementing nearly universal coverage in 2009 led to a decrease in individual preventive behaviour prior to illness, termed ex-ante moral hazard. We exploit the longitudinal dimension of data from 2006 and 2009 and use Coarsened Exact Matching methods. The results do not provide strong evidence for ex-ante moral hazard.
Chapter 4 aims at evaluating whether there is ex-post moral hazard after the introduction of universal coverage. We measured ex-post moral hazard as the impact of co-payment rate on treatment cost, to assess the variation of total medical expenditure to patients due to the decrease of price. We conclude that there is ex-post moral hazard in outpatient services after the reform of universal coverage in China.
Chapter 5 is the concluding chapter, including a summary of the findings, policy implications, strength and limitations of the thesis, and challenges for future research.