title: Examining the association between social health insurance participation and patients' out-of-pocket payments in China: the role of institutional arrangement.
abstract: Previous work on the relationship between social health insurance (SHI) participation and patients' out-of-pocket payments (OOP) in China has overlooked the mediating mechanisms of the institutional arrangement. This study establishes a conceptual framework involving the reimbursement, behavior management and purchasing mechanisms to elaborate on the institutional arrangement of SHI in China. Using structural equation modeling, data on 1645 hospitalized patients obtained from a nationally representative survey in China are analyzed. The results show that the behavior management and purchasing mechanisms of SHI perform poorly, undermining the function of the reimbursement mechanism and mitigating the association between SHI participation and OOP. As a result, SHI participation has a weak negative or even no significant association with the OOP of hospitalized patients. This seems to contradict the principles of SHI, which aims to reduce people's OOP and enhance their wellbeing. These findings are expected to provide valuable insights to the ongoing healthcare reform process in China.
authors.affiliation: Department of Social Work, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong. Electronic address: kevin-liukai@hotmail.com.
authors.forename: Kai
authors.initials: K
authors.lastname: Liu
authors.affiliation: Department of Social Work, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong.
authors.forename: Qiaobing
authors.initials: Q
authors.lastname: Wu
authors.affiliation: Center for Chinese Public Administration Research, School of Government, Sun Yat-sen University, No. 135 Xin Gang Xi Road, Guangzhou, China. Electronic address: liujq26@mail.sysu.edu.cn.
authors.forename: Junqiang
authors.initials: J
authors.lastname: Liu
mesh_terms: D000368:Aged; D002681:China; D005260:Female; D005382:Financing, Personal / Q000706:statistics & numerical data*; D018166:Health Care Reform; D019538:Health Care Surveys; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000458:organization & administration* / Q000706:statistics & numerical data*; D012051:Reimbursement Mechanisms
keywords: China; Institutional arrangement; Malfunction; Social health insurance; Structural equation modeling