School of Insurance, Shandong University of Finance and Economics, Jinan, Shandong, China.
School of Economics and Management, Beijing Jiaotong University, Beijing, China.
Value Health. 2021 Mar;24(3):317-324. doi: 10.1016/j.jval.2020.06.017. Epub 2020 Nov 10.
To investigate the impact of public health insurance coverage, specifically the New Cooperative Medical Scheme (NCMS), on childhood nutrition in poor rural households in China, and to identify the mechanisms through which health insurance coverage affects nutritional intake.
Longitudinal data on 3291 children were taken from four time periods (2004, 2006, 2009, and 2011) from the China Health and Nutrition Survey (CHNS). Panel data analysis was performed with the fixed-effect model and the propensity score matching with difference-in-differences (PSM-DID) approach.
The introduction of the NCMS was associated with a decline in calories, fat, and protein intake, and an increase in the intake of carbohydrates. The NCMS had the greatest negative effect on children aged 0 to 5 years, particularly girls. Out-of-pocket medical expenses were identified as the main channel through which the NCMS affected the nutritional intake of children.
The study showed that the NCMS neither significantly improved the nutritional status of children nor enhanced intake of high-quality nutrients among rural poor households. These findings were attributed to the way in which health-seeking behavior was modified in the light of NCMS coverage. Specifically, NCMS coverage tended to increase healthcare utilization, which in turn increased out-of-pocket medical expenditures. This encouraged savings to aid financial risk protection and resulted in less disposable income for food consumption.
调查公共医疗保险覆盖范围（特别是新型农村合作医疗制度，简称新农合）对中国贫困农村家庭儿童营养的影响，并确定医疗保险覆盖范围影响营养摄入的机制。
从中国健康与营养调查（CHNS）的四个时间点（2004 年、2006 年、2009 年和 2011 年）获取了 3291 名儿童的纵向数据。采用固定效应模型和倾向评分匹配双重差分法（PSM-DID）进行面板数据分析。
新农合的引入与热量、脂肪和蛋白质摄入的减少以及碳水化合物摄入的增加有关。新农合对 0 至 5 岁儿童的负面影响最大，特别是女孩。自付医疗费用被确定为新农合影响儿童营养摄入的主要途径。
本研究表明，新农合既没有显著改善儿童的营养状况，也没有提高农村贫困家庭儿童对优质营养素的摄入。这些发现归因于新农合覆盖范围改变了寻求医疗保健的行为方式。具体而言，新农合覆盖范围倾向于增加医疗保健利用，从而增加自付医疗费用。这鼓励了储蓄以帮助金融风险保护，导致用于食品消费的可支配收入减少。
