The Effects Of Social Health Insurance Reform On People’s Out-of-pocket Health Expenditure In China: The Mediating Role Of The Institutional Arrangement
by Kai Liu /
2016 / English / PDF
3.2 MB Download
This study examines and explains the relationship between social
health insurance (SHI) participation and out-of-pocket
expenditures (OOP) as well as the mediating role the
institutional arrangement of SHI plays in this relationship in
China. Embracing a new institutionalist approach, it develops two
analytical perspectives: determination, which identifies the
mechanisms of social health insurance, and strategic interaction,
which explores the interaction among social health insurance
agencies, healthcare providers, patients, and institutions. It
reveals the poor performance of social health insurance in
decreasing out-of-pocket health expenditures caused by a
trade-off between the reimbursement, behavior management, and
purchasing mechanisms of social health insurance programs.
Further, it finds that the inequitable allocation of healthcare
resources and patients’ concerns regarding the benefits offset
the strategies used by social health insurance agencies to manage
care-seeking behavior. It also discovers that the complex
interactions between insurance agencies, doctors, patients and a
larger disenabling institutional surrounding restricts the
purchasing efficiency of social health insurance. This book is
characterized by its unique synthesis of the role of the
institutional arrangement of social health insurance in China,
the interaction between the stakeholders in health sectors, and
of the relationship between healthcare institutions, actors, and
policy outcomes. Providing a comprehensive overview, it enables
scholars and graduate students to understand the ongoing process
of social health insurance reform as well as the dynamics of
health cost inflation in China. It also benefits policymakers by
recommending a single-payer model based on an evidence-based
investigation.
This study examines and explains the relationship between social
health insurance (SHI) participation and out-of-pocket
expenditures (OOP) as well as the mediating role the
institutional arrangement of SHI plays in this relationship in
China. Embracing a new institutionalist approach, it develops two
analytical perspectives: determination, which identifies the
mechanisms of social health insurance, and strategic interaction,
which explores the interaction among social health insurance
agencies, healthcare providers, patients, and institutions. It
reveals the poor performance of social health insurance in
decreasing out-of-pocket health expenditures caused by a
trade-off between the reimbursement, behavior management, and
purchasing mechanisms of social health insurance programs.
Further, it finds that the inequitable allocation of healthcare
resources and patients’ concerns regarding the benefits offset
the strategies used by social health insurance agencies to manage
care-seeking behavior. It also discovers that the complex
interactions between insurance agencies, doctors, patients and a
larger disenabling institutional surrounding restricts the
purchasing efficiency of social health insurance. This book is
characterized by its unique synthesis of the role of the
institutional arrangement of social health insurance in China,
the interaction between the stakeholders in health sectors, and
of the relationship between healthcare institutions, actors, and
policy outcomes. Providing a comprehensive overview, it enables
scholars and graduate students to understand the ongoing process
of social health insurance reform as well as the dynamics of
health cost inflation in China. It also benefits policymakers by
recommending a single-payer model based on an evidence-based
investigation.