Effects of Social Health Insurance Participation on Patients’ Out-of-Pocket Spending

Abstract

The slogan of SHI advocates a decrease in patients’ OOPS and a reduction in their health-related impoverishment. However, the problem of the affordability of healthcare seems not to be mitigated by the development of SHI, even though SHI schemes have covered almost the whole population of China. Why does the impact of SHI participation on mitigating the problem of affordability and medical expenses seem controversial? We explored this issue by investigating the mediating role that the institutional arrangement of SHI plays in the relationship between SHI participation and patients’ OOPS. We first conducted a quantitative study in order to answer the first two research questions proposed in Chap. 1; that is, “What is the effect of the expanding SHI participation on people’s medical expenditures?” and “Through what kind of institutional arrangement does SHI participation affect people’s OOPS?”