Do Chinese Older Adults Rely on Social Insurance Schemes? Primary Coverage on out-of-Pocket Medical Expenses for Outpatient and Inpatient Treatments

Abstract

This study assesses the associations between primary sources of insurance coverage and out-of-pocket outpatient and inpatient medical expenses among Chinese older adults. The 2012 and 2014 waves of the Chinese Longitudinal Healthy Longevity Survey (n = 6,924) were analyzed. Sources of coverage for survey participants were recorded as the: New Cooperative Medical Scheme (NCMS), Urban Employment Basic Medical Insurance (UEBMI), and the Urban Residence Basic Medical Insurance (URBMI). Self-payment, “other” financial sources and unaffordability were also recorded. The Heckman two-step procedure was employed to control selection bias. The outcomes in the first step of the Heckman model determined whether or not the participants had any outpatient or inpatient expenses in the past year. The outcomes in the second step were out-of-pocket expenses for outpatient or inpatient treatments. Majority of older participants still claimed self-payment as the primary financial source to cover medical expenses. Having UEBMI coverage was associated with more outpatient and inpatient out-of-pocket expenses, compared to the NCMS scheme (all p < 0.01). Self-payment was positively associated with outpatient and inpatient medical expenses (all p < 0.01). However, URBMI coverage was not associated with either outcome, compared to NCMS. Further policy implications and research directions are discussed.