The Impact of Supplementary Health Insurance on Residents' Consumption: Evidence from Critical Illness Insurance
HUANG Jialin, FU Hongqiao, SONG Ze
National School of Development, Peking University; School of Public Health, Peking University Health Science Center; School of Economics, Nankai University
Summary:
With increasing uncertainty in the international environment and the long-lasting impact of COVID-19, promoting consumption is crucial to maintaining economic growth and building a new development pattern for China. Reducing expenditure risks and stabilizing residents' expectations are the key to achieving consumption growth. A common explanation for the low consumption rate is that China's medical security system is insufficient: families must save for potential large medical expenses in the future, which will negatively impact current consumption. Supplementary health insurance, especially China's Critical Illness Insurance, which reimburses after the reimbursement of basic health insurance, can help families resist the risk of large medical expenses. Therefore, expanding the coverage of supplementary health insurance and improving the multilevel medical security system are important measures to stabilize families' expectations and promote consumption. In the context of China's deepening reform of the public health insurance system, the policy effect of China's Critical Illness Insurance on consumption has not been systematically and rigorously investigated. Critical Illness Insurance is supplementary to Urban Resident Basic Medical Insurance and New Rural Cooperative Medical Insurance. After the reimbursement of basic public health insurance, at least 50% of large medical expenses borne by individuals are reimbursed. What role does Critical Illness Insurance play in promoting resident consumption? What is the heterogeneity and impact mechanism? This study aims to answer these questions. By using the prefecture-by-prefecture rollout of China's Critical Illness Insurance and data from the China Family Panel Studies, we estimate the impact of supplementary health insurance on resident consumption through the difference-in-differences method. Our results show that Critical Illness Insurance significantly increases per capita consumption by approximately 6%. This effect is more pronounced in families with a higher initial hospitalization rate and higher savings rate, and in wealthier households. Furthermore, we test three potential mechanisms and find that Critical Illness Insurance mainly promotes household non-medical consumption and total consumption by reducing expectations for future health expenditure risks. These findings have policy implications for establishing a multilevel health insurance system and promoting consumption in China. Our work has important academic and policy implications. Academically, this paper makes the following two contributions. First, our results deepen the understanding of Chinese household consumption behavior. Most studies analyzing the influencing factors of resident consumption in the past 5 years focus on the effects of wealth changes. Few studies investigate the role of social security policies. Moreover, these studies focus more on basic pension insurance and basic health insurance, whereas our work studies the impact of supplementary health insurance on consumption and its impact mechanism, which extends the literature on consumption behavior. Second, this study enriches relevant research on supplementary health insurance, especially on China's Critical Illness Insurance. The literature on supplementary health insurance mainly focuses on its impact on health and medical expenses. In contrast, there are few studies on resident consumption, and most of them may suffer from sample selection bias and still have room for improvement in the method of causal identification. As China has achieved full coverage of basic public health insurance, this paper studies the impact of supplementary health insurance on consumption, which has strong policy implications for further promoting consumption and improving China's medical insurance policy. This paper finds that Critical Illness Insurance increases consumption, confirming that Chinese residents' concern about high medical expenses affects their consumption. Although China achieved full coverage of basic medical insurance from 2011 to 2012 and the government's funding for public health insurance keeps growing, the incidence of catastrophic health expenditure remains at a high level. Our results show that developing universal supplementary health insurance and improving the multilevel medical security system are effective measures to stimulate consumption. Especially when China's economic development is facing the triple pressure of shrinking demand, shocking supply, and weakening expectations, improving the medical security system is conducive to reducing residents' concerns related to consumption and stabilizing their expectations, and to further expanding domestic demand and promoting consumption. It is suggested that policymakers consider policies that improve the medical security system and even the social security system as one of the policy options to promote consumption and stabilize the economy.
黄家林, 傅虹桥, 宋泽. 补充医疗保险对居民消费的影响——来自城乡居民大病保险的证据[J]. 金融研究, 2022, 508(10): 58-76.
HUANG Jialin, FU Hongqiao, SONG Ze. The Impact of Supplementary Health Insurance on Residents' Consumption: Evidence from Critical Illness Insurance. Journal of Financial Research, 2022, 508(10): 58-76.
Angrist, J. D., and J. Pischke, 2009, Mostly Harmless Econometrics, Published by Princeton University Press.
[20]
Bai, C-E., and B. Wu, 2014, “Health insurance and consumption: Evidence from China's New Cooperative Medical Scheme,” Journal of Comparative Economics, 42(2), pp. 450~469.
[21]
Bommier, A., and F. L. Grand, 2019, “Risk aversion and precautionary savings in dynamic settings,” Management Science, 65(3), pp. 1386~1397.
[22]
Chou S-Y., J-T. Liu, and J K. Hammitt, 2003, “National Health Insurance and precautionary saving: evidence from Taiwan,” Journal of Public Economics, 87(9), pp. 1873~1894.
[23]
De Chaisemartin, C., and X. d'Haultfoeuille, 2020, “Two-way fixed effects estimators with heterogeneous treatment effects,” American Economic Review, 110(9), pp. 2964~2996.
[24]
Finkelstein, A., N. Hendren, and E. F. Luttmer, 2019, “The value of medicaid: Interpreting results from the oregon health insurance experiment,” Journal of Political Economy, 127(6), pp. 2836-2874.
[25]
Goodman-Bacon, A., 2021, “Difference-in-differences with variation in treatment timing,”Journal of Econometrics, 225(2), pp. 254~277.
[26]
Huang, W., and C. Zhang, 2021, “The Power of Social Pensions: Evidence from China's New Rural Pension Scheme,” American Economic Journal: Applied Economics, 13 (2), pp. 179~205.
[27]
Kantor S. E., and P. V. Fishback, 1996, “Precautionary Saving, Insurance, and the Origins of Workers' Compensation,” Journal of Political Economy, 104(2), pp. 419~442.
[28]
Santaeulalia-Llopis, R., and Y. Zheng, 2018, “The price of growth: consumption insurance in China 1989-2009,” American Economic Journal: Macroeconomics, 10(4), pp. 1-35.
[29]
Ta, Y., Y. Zhu, and H. Fu, 2020, “Trends in Access to Health Services, Financial Protection and Satisfaction between 2010 and 2016: Has China Achieved the Goals of Its Health System Reform?” Social Science & Medicine, 245, pp. 112715.
[30]
Wagstaff, A., and M. Pradhan, 2005, Health Insurance Impacts on Health and Nonmedical Consumption in a Developing Country, Published by World Bank.
[31]
Yip, W., H. Fu, A.T. Chen, T. Zhai, W. Jian, R. Xu, J. Pan, M. Hu, Z. Zhou, Q. Chen, W. Mao, Q. Sun, and W. Chen, 2019, “10 years of health-care reform in China: progress and gaps in Universal Health Coverage,” The Lancet, 394 (10204), pp. 1192~1204.
[32]
Zhang, Y., J. Vanneste, and J. Xu, 2019, “Critical Illness Insurance to Alleviate Catastrophic Health Expenditures: New Evidence from China,” International Journal of Health Economics and Management, 19, pp. 193~212.
[33]
Zhao, S., X. Zhang, and W. Dai, 2019, “Effect of the Catastrophic Medical Insurance on Household Catastrophic Health Expenditure: Evidence from China.” Gaceta Sanitaria, 34(4), pp. 370~376.
[34]
Zhao, W., 2019, “Does Health Insurance Promote People's Consumption? New Evidence from China,” China Economic Review, 53, pp. 65~86.