https://orcid.org/0000-0002-0944-0470
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Abstract
Background
This paper re-evaluates the impacts of China’s New Cooperative Medicine Scheme (NCMS), a social health insurance program targeting China’s rural population, on the incidences of chronic diseases among its enrollees. Although coverage under the NCMS expanded rapidly following its implementation in 2003, previous studies have failed to reach a consensus on its health impacts. Existing conflicting results may be due to methodological problems such as implausible identification assumptions and the failure to focus on the most relevant beneficiaries.
Methods
Drawing on data from a longitudinal sample from the China Health and Nutrition Survey (CHNS), we focus on a subgroup of patients over the age of 55 years to re-estimate the NCMS’s impact on incidences of chronic disease among enrollees. We adopt a triple-difference (difference-in-difference-in-differences) method, relaxing the parallel-trend assumption commonly invoked in the previous double-difference (difference-in-differences) studies.
Results
Our triple-difference estimates suggest that the NCMS has significantly reduced the incidences of apoplexy and diabetes among rural residents aged 55 years or older. The impacts of the NCMS on chronic disease are underestimated by the commonly adopted double-difference method. The triple-difference method allows evaluations to focus on the most relevant subgroups for detecting program impacts.
Conclusion
Our findings that the NCMS has significantly positive impacts on elderly enrollees’ incidences of chronic diseases also suggest the need for examining its impacts on other vulnerable groups, such as low-income individuals, young children, and individuals with poor health conditions.
Acknowledgments
The authors thank Hans Binswanger, Xiangming Fang, Paul Glewwe, Wuyang Hu, Songqing Jin, Albert Park, participants of the 2013 AAEA annual meetings in Washington DC, USA, and two anonymous reviewers for their helpful comments on earlier versions of this paper. We also thank Chunchen Pei for her excellent research assistance. Dr. Suzhen Wang’s research was partially supported by the National Natural Science Foundation of China (No. 81872719), the National Bureau of Statistics Foundation Project (No. 2018LY79), the Natural Science Foundation of Shandong Province (No. ZR201807090257), and the Poverty Alleviation Fund project of Weifang Medical University (No. FP1801001). This research was conducted based upon the data from the China Health and Nutrition Survey (CHNS). We thank the National Institute of Nutrition and Food Safety, China Center for Disease Control and Prevention; the Carolina Population Center, University of North Carolina at Chapel Hill; the National Institutes of Health (NIH; R01-HD30880, DK056350, and R01-HD38700); and the Fogarty International Center, NIH, for financial support for the CHNS data collection and analysis files since 1989.
Disclosure
The authors report no conflicts of interest in this work.