The Effects of Social Health Insurance Reform on People’s Out-of-Pocket Health Expenditure in China

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Author :
Publisher : Springer
ISBN 13 : 9811017778
Total Pages : 184 pages
Book Rating : 4.8/5 (11 download)

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Book Synopsis The Effects of Social Health Insurance Reform on People’s Out-of-Pocket Health Expenditure in China by : Kai Liu

Download or read book The Effects of Social Health Insurance Reform on People’s Out-of-Pocket Health Expenditure in China written by Kai Liu and published by Springer. This book was released on 2016-09-21 with total page 184 pages. Available in PDF, EPUB and Kindle. Book excerpt: This study examines and explains the relationship between social health insurance (SHI) participation and out-of-pocket expenditures (OOP) as well as the mediating role the institutional arrangement of SHI plays in this relationship in China. Embracing a new institutionalist approach, it develops two analytical perspectives: determination, which identifies the mechanisms of social health insurance, and strategic interaction, which explores the interaction among social health insurance agencies, healthcare providers, patients, and institutions. It reveals the poor performance of social health insurance in decreasing out-of-pocket health expenditures caused by a trade-off between the reimbursement, behavior management, and purchasing mechanisms of social health insurance programs. Further, it finds that the inequitable allocation of healthcare resources and patients’ concerns regarding the benefits offset the strategies used by social health insurance agencies to manage care-seeking behavior. It also discovers that the complex interactions between insurance agencies, doctors, patients and a larger disenabling institutional surrounding restricts the purchasing efficiency of social health insurance. This book is characterized by its unique synthesis of the role of the institutional arrangement of social health insurance in China, the interaction between the stakeholders in health sectors, and of the relationship between healthcare institutions, actors, and policy outcomes. Providing a comprehensive overview, it enables scholars and graduate students to understand the ongoing process of social health insurance reform as well as the dynamics of health cost inflation in China. It also benefits policymakers by recommending a single-payer model based on an evidence-based investigation.

Health Policy Reform in China

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Author :
Publisher : World Scientific
ISBN 13 : 9814425893
Total Pages : 363 pages
Book Rating : 4.8/5 (144 download)

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Book Synopsis Health Policy Reform in China by : Jiwei Qian

Download or read book Health Policy Reform in China written by Jiwei Qian and published by World Scientific. This book was released on 2014 with total page 363 pages. Available in PDF, EPUB and Kindle. Book excerpt: Most of the existing literature on health system reform in China deals with only one part of the reform process (for example, financing reform in rural areas, or the new system of purchasing pharmaceuticals), or consists of empirical case studies from particular cities or regions. This book gives a broad overview of the process of health system reform in China. It draws extensively both on the Western literature in health economics and on the experience of health care reform in a number of other countries, including the US, UK, Holland, and Japan, and compares China''s approach to health care reform with other countries. It also places the process of health system reform in the context of re-orienting China''s economic policy to place greater emphasis on equity and income distribution, and analyzes the interaction of the central and local governments in designing and implementing the reforms. This book will be of interest to policymakers, academics, students of health economics, health policy and health administration, and people who are interested in Chinese social policy. Sample Chapter(s). Chapter 1: Health Policy in China: Introduction and Background (189 KB). Contents: Introduction: Health Policy in China: Introduction and Background; Health Systems and Health Reform: International Models; Main Components of Health Reform: Strengthening China''s Social Insurance System; Providing Primary Care; The Hospital Sector and Hospital Reform; China''s National Drug Policy: A Work in Progress; Health Care and Harmonious Development in China: Health Policy and Inequality; Decentralized Government, Central-Local Fiscal Relations, and Health Reform; China''s Health System in the Future: Health Services in the Future: Social Insurance and Purchasing; China''s Future Health Care System: A Mixed Public-Private Model?. Readership: Policy makers, academics, students of health economics, health policy, and health administration, and people who are interested in Chinese social policy.

China's Urban Health Care Reform

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Author :
Publisher : Lexington Books
ISBN 13 : 9780739113509
Total Pages : 192 pages
Book Rating : 4.1/5 (135 download)

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Book Synopsis China's Urban Health Care Reform by : Chack-kie Wong

Download or read book China's Urban Health Care Reform written by Chack-kie Wong and published by Lexington Books. This book was released on 2006 with total page 192 pages. Available in PDF, EPUB and Kindle. Book excerpt: The authors find that economic growth does not automatically improve health care, and that prioritizing health care as China has done does not necessarily lead to cost efficiency and equity in health care for the whole nation.

Extending Health Insurance to the Rural Population

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Author :
Publisher : World Bank Publications
ISBN 13 :
Total Pages : 40 pages
Book Rating : 4./5 ( download)

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Book Synopsis Extending Health Insurance to the Rural Population by :

Download or read book Extending Health Insurance to the Rural Population written by and published by World Bank Publications. This book was released on 2007 with total page 40 pages. Available in PDF, EPUB and Kindle. Book excerpt: Abstract: In 2003, after over 20 years of minimal health insurance coverage in rural areas, China launched a heavily subsidized voluntary health insurance program for rural residents. The authors use program and household survey data, as well as health facility census data, to analyze factors affecting enrollment into the program and to estimate its impact on households and health facilities. They obtain estimates by combining differences-in-differences with matching methods. The authors find some evidence of lower enrollment rates among poor households, holding other factors constant, and higher enrollment rates among households with chronically sick members. The household and facility data point to the scheme significantly increasing both outpatient and inpatient utilization (by 20-30 percent), but they find no impact on utilization in the poorest decile. For the sample as a whole, the authors find no statistically significant effects on average out-of-pocket spending, but they do find some-albeit weak-evidence of increased catastrophic health spending. For the poorest decile, by contrast, they find that the scheme increased average out-of-pocket spending but reduced the incidence of catastrophic health spending. They find evidence that the program has increased ownership of expensive equipment among central township health centers but had no impact on cost per case.

Public Medical Insurance Reforms in China

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Author :
Publisher : Springer Nature
ISBN 13 : 9811677905
Total Pages : 259 pages
Book Rating : 4.8/5 (116 download)

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Book Synopsis Public Medical Insurance Reforms in China by : Xinxin Ma

Download or read book Public Medical Insurance Reforms in China written by Xinxin Ma and published by Springer Nature. This book was released on 2021-12-11 with total page 259 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book investigates public medical insurance reform in China and studies its effects from both institutional and empirical study perspectives. It provides the reader with academic evidence for understanding the transformation of public medical insurance and its effect on the utilization of healthcare services, expenditure for medical care, individuals’ financial portfolio allocation, and well-being. The main content of the book comprises two parts. First, institutional transformations of public medical insurance are considered: medical insurance reform in rural and urban China, and problems of medical insurance reform in the country. Second, it looks at the impact of public medical insurance reforms in China: evidence-based on empirical studies, including determinants of participation in medical insurance, the New Rural Cooperative Medical Scheme and its effects on the utilization of healthcare services, medical insurance and its effects on out-of-pocket expenditure, risky financial market participation, and well-being in China. This study provides academic evidence about these issues based on economic theories and econometric methods using many kinds of nationwide Chinese representative survey data. The book is highly recommended to readers who are interested in up-to-date and in-depth empirical studies on the mechanisms of participation in medical insurance and the impact of public medical insurance reforms on individuals and household behaviors in China. This volume will be of interest to those who are interested in the Chinese economy, social security policymakers, and scholars with an econometric analysis background.

Aging in Asia

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Author :
Publisher : National Academies Press
ISBN 13 : 0309254094
Total Pages : 486 pages
Book Rating : 4.3/5 (92 download)

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Book Synopsis Aging in Asia by : National Research Council

Download or read book Aging in Asia written by National Research Council and published by National Academies Press. This book was released on 2012-07-31 with total page 486 pages. Available in PDF, EPUB and Kindle. Book excerpt: The population of Asia is growing both larger and older. Demographically the most important continent on the world, Asia's population, currently estimated to be 4.2 billion, is expected to increase to about 5.9 billion by 2050. Rapid declines in fertility, together with rising life expectancy, are altering the age structure of the population so that in 2050, for the first time in history, there will be roughly as many people in Asia over the age of 65 as under the age of 15. It is against this backdrop that the Division of Behavioral and Social Research at the U.S. National Institute on Aging (NIA) asked the National Research Council (NRC), through the Committee on Population, to undertake a project on advancing behavioral and social research on aging in Asia. Aging in Asia: Findings from New and Emerging Data Initiatives is a peer-reviewed collection of papers from China, India, Indonesia, Japan, and Thailand that were presented at two conferences organized in conjunction with the Chinese Academy of Sciences, Indian National Science Academy, Indonesian Academy of Sciences, and Science Council of Japan; the first conference was hosted by the Chinese Academy of Social Sciences in Beijing, and the second conference was hosted by the Indian National Science Academy in New Delhi. The papers in the volume highlight the contributions from new and emerging data initiatives in the region and cover subject areas such as economic growth, labor markets, and consumption; family roles and responsibilities; and labor markets and consumption.

Universal Health Coverage in China

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Author :
Publisher : BoD – Books on Demand
ISBN 13 : 3732239586
Total Pages : 206 pages
Book Rating : 4.7/5 (322 download)

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Book Synopsis Universal Health Coverage in China by : David S. Weis

Download or read book Universal Health Coverage in China written by David S. Weis and published by BoD – Books on Demand. This book was released on 2019-05-03 with total page 206 pages. Available in PDF, EPUB and Kindle. Book excerpt: This study investigates the situation of Universal Health Care (UHC) in China from a health economic perspective. The first chapter introduces the historical background, analyzes the relevance of UHC and sheds light on the current health insurance status. In this chapter a new holistic health insurance theory is proposed that allows the inclusion of preventive medicine. The second chapter introduces the "Definition and concept" consisting of three dimensions: Firstly, the height dimension with the leading question "What proportion of the costs is covered?". Secondly, the depth dimension that is concerned with the question "Which benefits are covered?". This chapter puts a special focus on the important economic role of non-communicable diseases. Thirdly, the breadth dimension which investigates the question "Who is insured?". The third chapter, looking at the first dimension, found a high but shrinking amount of out-of-pocket payments and catastrophic health payments. Comparing the payment and benefit distributions, it found the ability to pay principle and insufficient separation of health service payments from its consumption. The second dimension discovered problems concerning the roles of ministries, financing and the benefit package. Reforming these areas will be necessary to provide people with appropriate health care. The third dimension showed that migrant workers are exposed to more health risks, have less access to health care and a lower health status. The de facto coverage rate for the Chinese population (including migrant workers) was calculated to be 81.19% in 2011 and 82.16% in 2020. The goals of the Chinese Communist Party (90% in 2011 and nearly 100% in 2020) are hence not reached. The study closes with a "Summary and conclusion, a "Boundaries and discussion" and an "Outlook" section.

Health Care Policy In East Asia: A World Scientific Reference (In 4 Volumes)

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Author :
Publisher : World Scientific
ISBN 13 : 9813236124
Total Pages : 1278 pages
Book Rating : 4.8/5 (132 download)

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Book Synopsis Health Care Policy In East Asia: A World Scientific Reference (In 4 Volumes) by :

Download or read book Health Care Policy In East Asia: A World Scientific Reference (In 4 Volumes) written by and published by World Scientific. This book was released on 2019-11-25 with total page 1278 pages. Available in PDF, EPUB and Kindle. Book excerpt: During the past three decades, health care systems in the East Asian regions of China, Japan, South Korea, and Taiwan have undergone major changes. Each system has its unique achievements and challenges. Global health care policymakers are increasingly interested in understanding the changes that have taken place in these four systems. This four-volume reference set is designed to help health care professionals, academics, policymakers, and general readers gain a good grasp of the background and latest developments in the health care systems of China, Japan, South Korea, and Taiwan. This reference set provides an in-depth comparative health policy analysis and discussion of health care reform strategies in each of these systems. One unique feature of this set is that each volume has been edited by a leading scholar who has been deeply involved in the development of the health care system in that particular region. Each of these editors also has invited both scholars and practitioners to provide a first-hand description and analysis of key health care reform issues in that system. The many examples provided in each volume demonstrate how findings of evidence-based policy research can be implemented into policy practice.Volume 1 describes and discusses China's ambitious and complex journey of health care reform since 2009. The Chinese government has achieved universal health insurance coverage and has embarked on reforms of the service delivery system and provider payment methods that are aimed at controlling health expenditure growth and improving efficiency. This volume includes pilot and social experiments initiated by the government and researchers and their evaluations that have guided the formulation of health reform policies. It provides information on how to make reforms work at the local and provincial levels. The findings detailed in this volume will contribute to a global knowledge base in health care reforms.Volume 2 provides a comprehensive review and evaluation of the Japanese health care system. Japan has a long history of health care system development and provision of universal health coverage, with a mature and well-developed health care system among East Asian countries. However, due to increases in health care costs, economic stagnation and the country's rapidly aging population, Japan has undergone significant health care reform during the last two decades, both in the delivery as well as financing of health services in its hospital sector, medical technology sector and long-term care insurance. Despite these challenges and reforms, health outcomes among the Japanese population have been progressively among the best in the world. This volume shows how policy research can lead to policy analysis, implementation and assessment. It also provides valuable lessons learnt for mutual learning among other health care systems.Volume 3 offers a comprehensive review of the developments in South Korea's national health insurance system since 1989 in terms of financing, delivery systems, and outcomes. The volume analyzes the efficiency of cost and service delivery by public sectors versus private sectors. It points out areas of challenge to future Korean health care reform. Chapter authors in this volume are leading experts involved in Korean health care policy implementation.Volume 4 reviews the development and achievements of Taiwan Health Insurance since 1995. Because of its continuous reform in payment, services delivery, and pharmaceutical technology, Taiwan has been considered a model example of universal health insurance among global health systems. This volume shows the processes used to translate policy research findings into policy changes. While the health care reform in Taiwan is ongoing, the Taiwan example provides a real-world and practical understanding of health care system changes.In summary, this four-volume set makes an outstanding contribution to health care system reform and policy research, based on solid scholarly work. It also introduces policy researchers and academic communities to current debates about health systems, health financing, and universal health coverage. This reference volume is a must for anyone keen on East Asia's health care system reform dynamics and changing scene.

Research for Universal Health Coverage

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Author :
Publisher : World Health Organization
ISBN 13 : 9241564598
Total Pages : 164 pages
Book Rating : 4.2/5 (415 download)

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Book Synopsis Research for Universal Health Coverage by : Christopher Dye

Download or read book Research for Universal Health Coverage written by Christopher Dye and published by World Health Organization. This book was released on 2013 with total page 164 pages. Available in PDF, EPUB and Kindle. Book excerpt: "The World Health Report: research for universal health coverage" focuses on the importance of research in advancing progress towards universal health coverage. In addition, it identifies the benefits of increased investment in health research by low- and middle-income countries using case studies from around the world, and proposes ways to further strengthen this type of research.

A Theoretical Analysis, Performance Evaluation, And Reform Solution Of The Health Care System In China

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Publisher : World Scientific
ISBN 13 : 9811227195
Total Pages : 394 pages
Book Rating : 4.8/5 (112 download)

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Book Synopsis A Theoretical Analysis, Performance Evaluation, And Reform Solution Of The Health Care System In China by : Hong Sheng

Download or read book A Theoretical Analysis, Performance Evaluation, And Reform Solution Of The Health Care System In China written by Hong Sheng and published by World Scientific. This book was released on 2021-06-22 with total page 394 pages. Available in PDF, EPUB and Kindle. Book excerpt: Medical expenditure has become a heavy burden on the public sector and the family system in many countries. Expanding the coverage and reimbursement of medical insurance has become a common way to reduce the burden. This book will elaborate on how medical insurance may increase the burden instead.It explains why the existing medical insurance system results in increased medical costs, where higher costs may offset the benefits of certainty brought by medical insurance, forming the 'paradox of medical care insurance'. This assumption is verified by empirical evidence in China, through a new method developed to find out the actual medical costs, using two parameters: ratio of self-payment of medical insurance and the level of monopoly in the supply of medical services. The book also describes the history, the current situation, and the reform of the health care system in China.

Reforming China's Rural Health System

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Author :
Publisher : World Bank Publications
ISBN 13 : 0821379836
Total Pages : 276 pages
Book Rating : 4.8/5 (213 download)

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Book Synopsis Reforming China's Rural Health System by :

Download or read book Reforming China's Rural Health System written by and published by World Bank Publications. This book was released on 2009-01-01 with total page 276 pages. Available in PDF, EPUB and Kindle. Book excerpt: Since 1978 when it embarked on sweeping agricultural and industrial reforms, China's economic growth has been remarkable. Its success in transforming itself within just three decades from a very poor low-income country to a successful middle-income country is unparalleled. During this period, however, and in contrast to the first 30 years of the People's Republic, progress in the health sector has been disappointing. For example, during the period 1980-2007, China increased its income per head as a percentage of the OECD average from 3 percent to 15 per cent, but infant mortality fell no faste.

The Impact of Health Insurance in Low- and Middle-Income Countries

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Author :
Publisher : Rowman & Littlefield
ISBN 13 : 0815705611
Total Pages : 239 pages
Book Rating : 4.8/5 (157 download)

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Book Synopsis The Impact of Health Insurance in Low- and Middle-Income Countries by : Maria-Luisa Escobar

Download or read book The Impact of Health Insurance in Low- and Middle-Income Countries written by Maria-Luisa Escobar and published by Rowman & Littlefield. This book was released on 2011-01-01 with total page 239 pages. Available in PDF, EPUB and Kindle. Book excerpt: Over the past twenty years, many low- and middle-income countries have experimented with health insurance options. While their plans have varied widely in scale and ambition, their goals are the same: to make health services more affordable through the use of public subsidies while also moving care providers partially or fully into competitive markets. Colombia embarked in 1993 on a fifteen-year effort to cover its entire population with insurance, in combination with greater freedom to choose among providers. A decade later Mexico followed suit with a program tailored to its federal system. Several African nations have introduced new programs in the past decade, and many are testing options for reform. For the past twenty years, Eastern Europe has been shifting from government-run care to insurance-based competitive systems, and both China and India have experimental programs to expand coverage. These nations are betting that insurance-based health care financing can increase the accessibility of services, increase providers' productivity, and change the population's health care use patterns, mirroring the development of health systems in most OECD countries. Until now, however, we have known little about the actual effects of these dramatic policy changes. Understanding the impact of health insurance–based care is key to the public policy debate of whether to extend insurance to low-income populations—and if so, how to do it—or to serve them through other means. Using recent household data, this book presents evidence of the impact of insurance programs in China, Colombia, Costa Rica, Ghana, Indonesia, Namibia, and Peru. The contributors also discuss potential design improvements that could increase impact. They provide innovative insights on improving the evaluation of health insurance reforms and on building a robust knowledge base to guide policy as other countries tackle the health insurance challenge.

China's Healthcare System and Reform

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Author :
Publisher : Cambridge University Press
ISBN 13 : 1316738396
Total Pages : 929 pages
Book Rating : 4.3/5 (167 download)

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Book Synopsis China's Healthcare System and Reform by : Lawton Robert Burns

Download or read book China's Healthcare System and Reform written by Lawton Robert Burns and published by Cambridge University Press. This book was released on 2017-01-26 with total page 929 pages. Available in PDF, EPUB and Kindle. Book excerpt: This volume provides a comprehensive review of China's healthcare system and policy reforms in the context of the global economy. Following a value-chain framework, the 16 chapters cover the payers, the providers, and the producers (manufacturers) in China's system. It also provides a detailed analysis of the historical development of China's healthcare system, the current state of its broad reforms, and the uneasy balance between China's market-driven approach and governmental regulation. Most importantly, it devotes considerable attention to the major problems confronting China, including chronic illness, public health, and long-term care and economic security for the elderly. Burns and Liu have assembled the latest research from leading health economists and political scientists, as well as senior public health officials and corporate executives, making this book an essential read for industry professionals, policymakers, researchers, and students studying comparative health systems across the world.

Healthy China: Deepening Health Reform in China

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Author :
Publisher : World Bank Publications
ISBN 13 : 146481323X
Total Pages : 410 pages
Book Rating : 4.4/5 (648 download)

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Book Synopsis Healthy China: Deepening Health Reform in China by : The World Bank;World Health Organization

Download or read book Healthy China: Deepening Health Reform in China written by The World Bank;World Health Organization and published by World Bank Publications. This book was released on 2019-04-04 with total page 410 pages. Available in PDF, EPUB and Kindle. Book excerpt: The report recommends that China maintain the goal and direction of its healthcare reform, and continue the shift from its current hospital-centric model that rewards volume and sales, to one that is centered on primary care, focused on improving the quality of basic health services, and delivers high-quality, cost-effective health services. With 20 commissioned background studies, more than 30 case studies, visits to 21 provinces in China, the report proposes practical, concrete steps toward a value-based integrated service model of healthcare financing and delivery, including: 1) Creating a new model of people-centered quality integrated health care that strengthens primary care as the core of the health system. This new care model is organized around the health needs of individuals and families and is integrated with higher level care and social services. 2) Continuously improve health care quality, establish an effective coordination mechanism, and actively engage all stakeholders and professional bodies to oversee improvements in quality and performance. 3) Empowering patients with knowledge and understanding of health services, so that there is more trust in the system and patients are actively engaged in their healthcare decisions. 4) Reforming public hospitals, so that they focus on complicated cases and delegate routine care to primary-care providers. 5) Changing incentives for providers, so they are rewarded for good patient health outcomes instead of the number of medical procedures used or drugs sold. 6) Boosting the status of the health workforce, especially primary-care providers, so they are better paid and supported to ensure a competent health workforce aligned with the new delivery system. 7) Allowing qualified private health providers to deliver cost-effective services and compete on a level playing field with the public sector, with the right regulatory oversight, and 8) Prioritizing public investments according to the burden of disease, where people live, and the kind of care people need on a daily basis.

Financing Healthcare in China

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Author :
Publisher : Routledge
ISBN 13 : 1315516284
Total Pages : 138 pages
Book Rating : 4.3/5 (155 download)

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Book Synopsis Financing Healthcare in China by : Sabrina Ching Yuen Luk

Download or read book Financing Healthcare in China written by Sabrina Ching Yuen Luk and published by Routledge. This book was released on 2016-07-22 with total page 138 pages. Available in PDF, EPUB and Kindle. Book excerpt: China’s current social medical insurance system has nominally covered more than 95 per cent of 1.4 billion population in China and is moving towards the ambitious goal of universal health insurance coverage. Challenges posed by a rapidly ageing population, an inherently discriminatory design of the health insurance system, the disorder of drug distribution system and an immature legal system constrain the Chinese government from realizing its goal of universal health insurance coverage in the long run. This book uses a refined version of historical institutionalism to critically examine China's pathway to universal health insurance coverage since the mid-1980s. It pays crucial attention to the processes of transforming China's healthcare financing system into the basic social medical insurance system alongside rapid socio-economic changes. Financing Healthcare in China will interest researchers and government and think-tank officials interested in the state of healthcare reforms in China. Healthcare specialists outside of East Asia may also be interested in its general study of healthcare in developing countries. Scholars and students interested in the healthcare field will also find this useful.

Healthcare Reform in China

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Author :
Publisher : Springer
ISBN 13 : 3319697366
Total Pages : 250 pages
Book Rating : 4.3/5 (196 download)

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Book Synopsis Healthcare Reform in China by : Carine Milcent

Download or read book Healthcare Reform in China written by Carine Milcent and published by Springer. This book was released on 2018-02-14 with total page 250 pages. Available in PDF, EPUB and Kindle. Book excerpt: How efficient is the Chinese healthcare system? Milcent examines the medication market in China against the global picture of healthcare organization, and how public healthcare insurance plans have been implemented in recent years, as well as reforms to tackle hospital inefficiency. Healthcare reforms, demographic changes and an increase in wealth inequity have altered healthcare preferences, which need to be addressed. Significantly, the patient–medical staff relationship is analysed, with new proposals for different lines of communication. Milcent puts forward digital healthcare in China as a tool to solve inefficiency and rising tensions, and generate profit. Where China is leading in the digitalization of healthcare, other countries can learn important lessons. Chinese social models are also put into context with respect to current reforms and experimentation.

Can Insurance Increase Financial Risk?

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Author :
Publisher :
ISBN 13 :
Total Pages : 28 pages
Book Rating : 4.:/5 (318 download)

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Book Synopsis Can Insurance Increase Financial Risk? by : Adam Wagstaff

Download or read book Can Insurance Increase Financial Risk? written by Adam Wagstaff and published by . This book was released on 2005 with total page 28 pages. Available in PDF, EPUB and Kindle. Book excerpt: The most basic argument for insurance is that it reduces financial risk. But since insurance opens up new opportunities for consuming expensive high-technology care which permits health improvements that are valued by the insured, and because in many settings the provider is able and has an incentive to exploit the informational advantage he has over the patient, it is not immediately obvious that insurance will in practice reduce financial risk. The authors analyze the effect of insurance on the probability of an individual incurring "high" annual health expenses using data from three household surveys-one a cross-section survey, the other two panel surveys. All come from China, a country where providers have until recently largely been paid fee-for-service (often according to a schedule that encourages the overprovision of high-technology care and the underprovision of basic care) and who are only lightly regulated. The authors define annual spending as "high" if it exceeds 5 percent of average income in the sample and as "catastrophic" if it exceeds 10 percent of the household's own per capita income. The estimates of the effect of insurance on financial risk allow for the possible endogeneity of health insurance in the panel datasets by allowing for a time-invariant fixed effect capturing unobserved risk that may be correlated with insurance status, and in the cross-section dataset by using instrumental variables, where availability of and eligibility for health insurance are used as instruments. The results suggest that during the 1990s China's government and labor insurance schemes increased financial risk associated with household health care spending, but that the rural cooperative medical scheme significantly reduced financial risk in some areas but increased it in others (though not significantly). From the results, it appears that China's new health insurance schemes (private schemes, including coverage of schoolchildren) have also increased the risk of high levels of out-of-pocket spending on health. Where the authors find evidence of health insurance increasing the risk of "high" out-of-pocket expenses, the marginal effect is of the order of 15-20 percent; in the case of "catastrophic" expenses, it is even larger.