The impact of health insurance on health outcomes and spending of the elderly: evidence from China's New Cooperative Medical Scheme

Health Econ. 2015 Jun;24(6):672-91. doi: 10.1002/hec.3053. Epub 2014 Apr 29.


This paper investigates the effects of China's New Cooperative Medical Scheme (NCMS) on health outcomes and healthcare expenditure of the elderly in rural China, using panel data from the 2005 and 2008 waves of the Chinese Longitudinal Healthy Longevity Survey. We employ a strategy that combines propensity score matching with a difference-in-differences approach to address selection bias. Results show that the NCMS has significantly improved the elderly enrollees' activities of daily living and cognitive function but has not led to better self-assessed general health status. We find no significant effect of NCMS on mortality for the previously uninsured elderly in NCMS counties, although there is moderate evidence that it is associated with reduced mortality for the elderly enrollees. We also find that the elderly participants are more likely to get adequate medical services when sick, which provides a good explanation for the beneficial health effects of NCMS. However, there is no evidence that the NCMS has reduced their out-of-pocket spending. Furthermore, we also find that low-income seniors benefit more from NCMS participation in terms of health outcomes and perceived access to health care, suggesting that the NCMS helps reduce health inequalities among the rural elderly.

Keywords: China; health insurance; health outcome; health spending; the elderly.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Activities of Daily Living
  • Age Factors
  • Aged
  • Aged, 80 and over
  • China
  • Cognition*
  • Female
  • Health Expenditures / statistics & numerical data*
  • Health Services Accessibility / statistics & numerical data
  • Health Status*
  • Humans
  • Longitudinal Studies
  • Male
  • Mortality / trends
  • National Health Programs / economics*
  • National Health Programs / statistics & numerical data*
  • Patient Acceptance of Health Care / statistics & numerical data
  • Rural Population / statistics & numerical data
  • Self Report
  • Sex Factors
  • Socioeconomic Factors