Abstract
Introduction
Private health insurance (PHI) is an important supplement to the basic health insurance schemes in the Chinese healthcare system. However, there is an absence of evidence on whether the strategy of engaging PHI to reduce burden is effective in China. As such, we aimed to investigate the association between supplemental PHI and the out-of-pocket (OOP) burden of household healthcare expenditure in China.
Methods
We conducted a panel data analysis using data from three waves of China Health and Retirement Longitudinal Study (CHARLS). Specifically, a two-part model (TPM) with a first-stage probit and second-stage generalized linear model (GLM) framework was used to analyze the data. To account for individual-level random effects in both stages and their correlation in the TPM analysis, we proposed a generalized structural equation modeling (GSEM) approach to implement the estimation. The proposed approach allowed us to simultaneously analyze the association of PHI with the probability of having any healthcare and the OOP burden conditional on having any healthcare expenditure.
Results
Using the GSEM estimates, we found that supplemental PHI was significantly associated with a higher probability (4.29 percentage points) of having any OOP healthcare expenditure but a lower OOP burden conditional on having any expenditure (−2.37 percentage points). Overall, supplemental PHI was insignificantly associated with a lower OOP burden (−1.05 percentage points).
Discussion
Our findings suggested that supplemental PHI in China may be able to effectively improve access to healthcare while keeping the OOP healthcare expenditure burden flat. Also, GSEM is a feasible method to estimate random-effect TPMs.
Data Sharing Statement
The datasets analyzed during the current study are publicly available at http://charls.pku.edu.cn/en.
Ethics and Consent Statement
The procedures followed in this study were in accordance with the ethical standards. Only de-identified secondary data which was publicly available was analyzed.
Disclosure
YJ reports no conflict of interest related to the submitted work. WN was a health economics and outcomes research fellow at University of Southern California when the submitted work was conducted and was an employee of Medtronic Inc. at the time of submission.