School of Public Administration, Zhongnan University of Economics and Law, Wuhan, China.
School of Economics, Zhongnan University of Economics and Law, Wuhan, China.
Front Public Health. 2022 Sep 16;10:874619. doi: 10.3389/fpubh.2022.874619. eCollection 2022.
Health insurance lowers the price of medical services, which reduces the insured's demand for self-protection (such as, live a healthy lifestyle or invest in disease prevention) that could help reduce the probability of getting sick, then ex ante moral hazard happens. The purpose of this study is to examine the impact and its heterogeneity of health insurance on the self-protection of Chinese rural residents.
This study firstly builds a theoretical model of health insurance and self-protection. Then, based on the data from the 2004 to 2015 China Health and Nutrition Survey (CHNS), we adopt ordinary least squares model (OLS), probit model, and instrumental variable (IV) method to empirically investigate the impact of health insurance on Chinese rural residents' self-protection.
After addressing the endogeneity problem, the study finds that participating in health insurance exerts a significant negative impact on the demand for self-protection. Specifically, health insurance participation not only increases residents' tendency toward drinking liquor by 3.4%, and that of having general obesity by 3.7%, but also reduces residents' preventive medical expenditure (PME) by 1.057%, increasing Body Mass Index (BMI) by 0.784 kg/m. Further analysis shows that there is heterogeneity between groups, as health insurance participation reduces PME of people who are female, younger, and high-educated, and increases the tendency toward drinking liquor of people who are younger and low-educated.
To reduce the impact of ex ante moral hazard induced by health insurance, our findings suggest that it is necessary to improve the disease prevention function of health insurance and introduce a risk adjustment mechanism into the premium or co-payment design of health insurance.
医疗保险降低了医疗服务的价格，从而降低了参保人对自我保护（例如，健康生活或投资于疾病预防）的需求，这可能有助于降低患病的概率，从而产生事前道德风险。本研究旨在检验医疗保险对中国农村居民自我保护的影响及其异质性。
本研究首先构建了医疗保险和自我保护的理论模型。然后，基于 2004 年至 2015 年中国健康与营养调查（CHNS）的数据，我们采用普通最小二乘法（OLS）、概率模型和工具变量（IV）方法，实证研究了医疗保险对中国农村居民自我保护的影响。
在解决了内生性问题后，研究发现，参加医疗保险对自我保护的需求产生了显著的负向影响。具体而言，医疗保险参与不仅增加了居民饮酒的倾向 3.4%，普通肥胖的倾向 3.7%，还降低了居民的预防性医疗支出（PME）1.057%，增加了体重指数（BMI）0.784kg/m。进一步的分析表明，存在群体间的异质性，因为医疗保险参与降低了女性、年轻和高学历人群的 PME，增加了年轻和低学历人群饮酒的倾向。
为了降低医疗保险引发的事前道德风险的影响，我们的研究结果表明，有必要提高医疗保险的疾病预防功能，并在医疗保险的保费或共付额设计中引入风险调整机制。
