Online Program

WITHDRAWN: Evaluating the Heterogeneous Health Effects of Health Insurance Coverage With Geographical Variation: An Example from China’s Rural Insurance Scheme

Katherine Donato, Harvard University 
Slawa Rokicki, Harvard University 

Keywords: Causal inference, GIS, Spatial analysis, Health insurance, Biomarkers, Utilization, Rural Health

Analyses of health insurance programs are often unable to account for geographical differences that likely play a large role in uneven health benefits of health insurance coverage. These geographical differences include distance to a health center and topological barriers. In this presentation, we discuss how to account for spatial heterogeneity in access to health care in order to obtain better estimates of the effect of health insurance on health outcomes. Understanding the influence of patient access and geographical distance on the effectiveness of health insurance reform can be used to more effectively target future health policy interventions. We apply our model to China’s New Cooperative Medical Scheme (NCMS), a rural health insurance program that aims to improve health for the country’s 800 million previously uninsured rural residents. The program has seen a dramatic increase in enrollment since its rollout in 2003, with over 90% coverage by 2009. However, until now evaluation of this program has focused on self-reported measures of health and has failed to account for geographical differences, leading to inconclusive results. In our analysis, we use objective health measures (biomarkers) and exploit variation in regional rollout times. We also account for geographic variation by incorporating gravity-, container-, and travel cost-based GIS measures of accessibility to health centers. We found significant decreases in abnormal triglycerides levels and diastolic blood pressure among NCMS participants. However, beneficial results were concentrated among those with better access to health care, as measured by at least one GIS measure of accessibility to health centers practicing Western medicine, indicating that increasing health insurance coverage among residents with poor access to care has limited effectiveness.