National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention, Beijing 100050, China.
Int J Environ Res Public Health. 2018 Feb 23;15(2):383. doi: 10.3390/ijerph15020383.
The obesity rate in China has risen significantly in the past few decades. While a number of causes for the rise in obesity have been explored, little attention has been paid to the role of health insurance per se. This study aims to investigate the impact of health insurance on the risk of obesity in rural China using longitudinal data from the China Health and Nutrition Survey (CHNS). We employed pooled ordinary least squares (OLS), probit estimation, and pooled two-stage least squares (2SLS) for an instrumental variable (IV). The IV model revealed that New rural cooperative medical insurance (NRCMS) participation had a significant positive impact on people's tendency towards unhealthy lifestyles, for instances, high-fat food (8.01% for female and 7.35% for male), cigarette smoking (25% for male), heavy drinking (25% for female), sedentary activity (6.48 h/w for female and 6.48 h/w for male), waist circumference (1.97 cm for female and 1.80 cm for male), body mass index (0.58 kg/m² for female), which in turn leads to an elevated probability of general obesity (51% for female) and abdominal obesity (24% for female and 20% for male). An "ex ante moral hazard" is prevalent in rural China, which should not be ignored by policymakers so as to minimize the related low efficiency in the process of promoting the universal coverage of insurance.
中国的肥胖率在过去几十年中显著上升。尽管已经探讨了肥胖率上升的一些原因，但很少有人关注医疗保险本身的作用。本研究旨在利用中国健康与营养调查（CHNS）的纵向数据，调查医疗保险对中国农村肥胖风险的影响。我们采用了普通最小二乘法（OLS）、概率单位估计法和工具变量（IV）的两阶段最小二乘法（2SLS）。IV 模型表明，新型农村合作医疗保险（NRCMS）的参与对人们不健康生活方式的倾向有显著的正向影响，例如高脂肪食物（女性为 8.01%，男性为 7.35%）、吸烟（男性为 25%）、酗酒（女性为 25%）、久坐不动（女性为 6.48 小时/周，男性为 6.48 小时/周）、腰围（女性为 1.97 厘米，男性为 1.80 厘米）、体重指数（女性为 0.58kg/m²），这反过来又增加了一般性肥胖（女性为 51%）和腹部肥胖（女性为 24%，男性为 20%）的可能性。中国农村普遍存在“事前道德风险”，政策制定者不应忽视这一点，以尽量减少在推广保险全覆盖过程中相关的低效率。
