title: Under regional characteristics of rural China: a clearer view on the performance of the New Rural Cooperative Medical Scheme.
abstract: The New Cooperative Medical Scheme (NCMS) was implemented in 2003 in response to the poor state of health care in rural China. Considering the substantial differences in regional socioeconomics, preferences for health care needs, and concurrent implementation of other health-related policies, the extent to which the impact of the NCMS differs in rural communities across China is unclear. The objective of this paper, therefore, was to explore the variation in the determinants of household enrolment and the impact of enrolment on health care utilization and medical expenditures in three large geographic regions in China. A quasi-experiment study was designed based on the panel data of the China Health and Nutrition Survey. The bounding approach was used to conduct a robust check of impact estimation under the assumption of unobserved bias. A major finding is that household income plays no significant role for enrolment, which indicates the equity of program coverage in income terms. However, regional circumstances matter. In the generally poorer western regions, households with a high ratio of migrant workers are less attracted to the NCMS program, and adoption of the program is related to the regional infrastructure environment variables in the eastern and western regions. The NCMS has improved medical care utilization for poor income groups and regions (western regions). The NCMS's impact on reducing the incidence of catastrophic expenditures is not shown for all regions.
authors.affiliation: Institute of Regional Economics and Finance, Sichuan Agricultural University, No. 211 Huiming Rd. Wenjiang District, Chengdu, 611130, China. liudanren@googlemail.com.|Center for Development Research (ZEF), University of Bonn, Walter-Flex-Str.3, 53113, Bonn, Germany. liudanren@googlemail.com.|Mannheim Institute of Public Health, Social and Preventive Medicine, University of Heidelberg, Ludolf-Krehl-Strasse 7-11, 68167, Mannheim, Germany. liudanren@googlemail.com.
authors.forename: Dan
authors.initials: D
authors.lastname: Liu
authors.affiliation: Center for Development Research (ZEF), University of Bonn, Walter-Flex-Str.3, 53113, Bonn, Germany.|UN-Water Decade Programme on Capacity Development (UNW-DPC), United Nation University, UN Campus, Platz der Vereinten Nationen 1, 53113, Bonn, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Tsegai
authors.affiliation: Department of Medicine, Epidemiology and Biostatistics, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, USA.|Mannheim Institute of Public Health, Social and Preventive Medicine, University of Heidelberg, Ludolf-Krehl-Strasse 7-11, 68167, Mannheim, Germany.
authors.forename: David
authors.initials: D
authors.lastname: Litaker
authors.affiliation: Center for Development Research (ZEF), University of Bonn, Walter-Flex-Str.3, 53113, Bonn, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: von Braun
keywords: Bounding approach; Health care access; Health care expenditure; Propensity score matching; Regional characteristics of rural China