Demand for social health insurance: Evidence from the Chinese New Rural Cooperative Medical Scheme

This paper assesses the determinants of the enrolment in the New Rural Cooperative Medical Scheme (NRCMS), a heavily subsidized voluntary health insurance scheme in rural China. The analyses focus on the relationship between insurance purchase and health facility choice based on data drawn from the China Health and Nutrition Survey (CHNS). The results show that households from villages that reported use of village clinics are more likely to be insured compared with households from villages that reported use of county hospitals. The results indicate that the perception of quality of care is an important factor affecting people's enrolment decisions. The NRCMS is expected to help patients obtain better quality health services from higher-tier of the healthcare system that are unaffordable otherwise. However, given the prevailing fee-for-service payment mechanism for health care, the insurance may also drive up the healthcare cost and direct patients to use more expensive and unnecessary hospital care