| Abstract: |
1989-2006 is a period of the start and the end of deregulation of Chinese
health care sector and of disintegration of rural cooperative insurance
system. During this period, the government health policy has turned healthcare
providers all alike into profit seeking entities. Face to perverse effects, by
2003, Chinese government begun to restore rural cooperative insurance system.
From CHNS data source, we constitute two samples: 89-93 and 04-06 with
respectively 2117 and 2594 rural patients surveyed roughly in the same
villages in 9 Chinese provinces to compare their health choice behaviors with
the evolution of price, income, distance, insurance, age, and regional
inequality. Using Mixed Multinomial Logit (MMNL) estimations, we have obtained
three main results. First, even in both periods there is clear price effect,
in 04-06 it tends to be weaker, and heterogeneity in price preference has
increased. This corresponds well the fact that between the two periods price
level has significantly increased and price variation reduced. Second, there
is a stronger negative distance effect and heterogeneity in 2004-06, while in
89-93 this negative impact was lower and absent for providers farther than
10km. One interpretation is the existence of a substitution effect: when
patients have less possibility to discriminate providers by price, they
increase their preference in choice by distance. Third, while, wealth effect
exists in some choices in 89-93, it becomes absent in 04-06. Explanations may
be that one the one hand both supply side and demand side conditions on health
care have been improved even, to less extent though, for the poor, and on the
other hand, health care is necessary goods and is price inelastic. But
meanwhile, we observed catastrophic effect for the poor: the poorer patients
have their share of consumption in income more decreased after health care. |