A comparison of rural and urban healthcare consumption and health insurance

Purpose – Since 1999, China has undergone reform of its healthcare system. City-based social health insurance (SHI) is the primary form of current health insurance, supplemented by various commercial health insurance programs. The rural new cooperative medical system (NCMS) was introduced in 1993 and extended to cover the whole of rural China in 2003. Design/methodology/approach – The paper developed a theoretical model for consumer demand of medical services and health insurance based on an expected utility framework with a two-stage decision under uncertainty. The model is then applied to current health insurance systems in China for urban citizens and rural residents separately. Least square and logistic regressions are employed. Findings – The major results are that although the factors driving the decisions on health insurance participation are basically the same for rural and urban citizens, the participation levels are quite different. The major difference is that urban SHI has higher coverage and urban citizens have higher income, resulting in a much larger urban medical expenditure. Practical implications – The empirical analysis reveals that health insurance programs have played an important role in the healthcare expenditure for urban residents, while the NCMS has not made a significant impact towards increasing the ability of rural residents to seek more medical services, based on data at 2004. Originality/value – This is the first paper employing a health production theory on China's new urban and rural healthcare programs.