Modelling medical insurance reform in China : distributional effects for urban employees and residents

  • Linping Xiong

    Student thesis: Doctoral Thesis


    In the last decade or so, China has begun to reform its health care system nationwide, due to pressures like an ageing population and increasing demand on health services. In the late 1990s,the Chinese government established the medical insurance scheme for urban employees and retirees. Then, in 2003,a new rural co-operative medical insurance scheme was established for rural areas in China. Most recently, in late 2007,a medical insurance program was introduced in 79 pilot cities, aiming to cover all urban residents who are not in the labour market and with all urban residents becoming beneficiaries by 2010. Given China's considerable size and diversity, both geographically and demographically, the reform of the medical care system faces many challenges. It is important to analyse and evaluate the impact of the reform on individuals' health care benefits and on their financial burden due to medical expenses. This research investigates the sustainability of the urban medical insurance system, involving both urban employed individuals and non-working residents. The key aims focus on three aspects. First, it assesses the distributional impacts of medical insurance policies and predicts medical expenses for urban employees and retirees. Second, it estimates the potential urban resident population entering the medical insurance scheme and predicts the medical costs. Third, it estimates and evaluates the contribution of the differing levels of the Chinese government to the medical insurance scheme. With co-operation from the Bureau of Labour and Social Security of Kunming (capital city of Yunnan Province, China),this thesis creates two static microsimulation models for predicting and evaluating the medical insurance policies in China's urban areas. The model for urban employees and retirees investigates the balances of the social pool fund and personal savings accounts, and the medical expenses shared by different kinds of payment modes. The model for non-working urban residents predicts the distributional impacts on families, estimates the medical expenses and evaluates the insurance capacity of the social pool fund. Three kinds of data are used in the research. The first is the individual level data of medical care records of the urban employees and retirees in Kunming. This administrative data helps to create the microsimulation model for urban employees and retirees for the period of 2006-2010. The second type of data involves the 0.1 per cent sample of the National Population Census in 2000 and the results of the 2005 Population Survey. These data provide the demographic information on urban residents and updated population structures. The third data type provides information on health service use of urban residents, which mainly comes from the second and the third National Health Services Surveys of 1998 and 2003.
    Date of Award2009
    Original languageEnglish
    SupervisorAnn Harding (Supervisor) & Laurie Brown (Supervisor)

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