| In recent years, with household wealth rises and the development of financial practices, household finance becomes an important research field of Finance. Study of household financial risk and asset portfolio choice, etc, would help households establish the optimal wealth allocation rules, in the meantime, promote financial market reform and improve the quality of national economy development. From a new prospective of health insurance, we explore the Chinese households' financial problems, which could help us better understand Chinese households' financial risk status and financial decision-making behavior, and provide data support for the policy makers as well.The purpose of the dissertation is to explore how does health insurance affect Chinese households' financial risk and portfolio choice. We use four empirical chapters to identify the topic. Data sets are from Urban Residents Basic Medical Insurance (URBMI) survey and Chinese Household Income Project Survey (CHIPS) which are nationally representative. Our study could rich household finance research, and provide empirical data support for China's financial market reform and health system reform as well.Chapter2explores the effect of health insurance on residents' utilization of health service and financial burden. The question rises naturally how does the current health insurance policy play a role when residents face health shock under the background of health insurance system reform? Using data from Urban Residents Basic Medical Insurance (URBMI) survey, we explore the effects of health insurance on residents' utilization of health service and financial burden who suffered serious disease. We find that residents who are covered by health insurance are likely to use more health services than uninsured residents. In the meantime, the insured residents have lower financial burden than the uninsured residents. In sum, health insurance significantly improves residents' utilization of health service and reduces their medical financial burden, especially for the old and the chronic, but policy makers should pay more attention to low-income residents and migrants.In chapter3, using data from URBMI survey, we identify factors which affect the financial risk of Chinese urban households and the role of health insurance. Results show that family income level, chronic disease and family age are the main factors that increase households' medical financial risk. In addition, health insurance significantly reduces financial risk for urban households. The effects tend to be stronger for these households that have higher reimbursement rate. Lastly, health insurance system significantly reduces catastrophic expenditures of low-income households, but the senior citizens and those who have chronic conditions didn't benefit more from current health insurance system than others. Therefore, policy makers need to design different health insurance policies for different groups to protect them from catastrophic expenditure risk.Under health insurance converge, households may reduce their precautionary saving and adjust their portfolio allocation. Under the framework of precautionary saving theory, it has been found that health insurance promotes households' consumptions in China, but few papers have investigated the effect of health insurance on the structure of households' assets. Hence, in chapter4, using2002Chinese Household Income Project Survey (CHIPS). we explore the effect of health insurance on portfolio choice in rural and urban households respectively. We find that health insurance has significant effects on portfolio choice in urban and rural areas. The insured households prefer to assets with higher risk more than households without insurance. This study has theoretical and practical significance in understanding households'investment behavior.Equity of health insurance is one of the principles of Chinese medical system reform. Chapter5evaluates the reimbursement equalities of Urban Employees' Basic Medical Insurance (UEBMI) and Urban Residents'Basic Medical Insurance (URBMI) which cover500million urban residents. From the theory model, we find that, for equitable health insurance whose total amounts of premiums will be used for participants'medical expenses, the lower income groups will obtain less reimbursement than higher income groups. In the empirical part, using data from URBMI survey from year2007to2011, we explore the inequality of UEBMI and URBMI by conducting two part model and other econometric models, and get results which are consistent with the theory results. Hence, we get conclusion that, under the equal reimbursement system, urban basic health insurance policy will cause lower income groups get less insurance compensation than higher income groups, and compensation inequality would aggravate the bad health situation of lower income groups. Chinese government needs to pay more attention of inequality in health system for further healthcare reform.In the dissertation, the possible innovation points are showed below:Firstly, the dissertation topic selected has both academic value and practical significance. There is a lack of literature assess the effect of current health insurance policy on households'financial burden. In the meantime, what about Chinese households'financial risk status? Which level of medical security could effectively reduce such risk? Answering these questions could also help us understand more about households'financial risk, and to be reference for health care policy makers. Hence, chapter2and chapter3have practical significance. The question rises naturally when health insurance reduces households'financial risk, whether will households adjust assets structure? Chapter4is the first study about health insurance and households' portfolio choice in China. Chapter5has a certain forward-looking. Current research literature on Chinese health insurance system reform mainly focus on the effectiveness. However. equality of health insurance relates to the success of health care system reform. Through the study of chapter5, we hope to obtain more attention and discussion about equity issues of health insurance policy.Secondly, about research method, we employ several econometric approaches to identify problems objectively and scientifically. We use Heckman Selection Model in Chapter2to modify the sample selection bias. In Chapter3, we define medical security level to study health insurance policy instead of comparing groups covered by health insurance and with no-insurance. In Chapter4, we take serious about endogeneity problem, and use "quasi-social experiment" and instrument method to solve it. In the meanwhile, we conduct Probit model, Tobit model and Heckman Selection Model to identify the corresponding problem. The biggest breakthrough in Chapter5is combining the theoretical model with empirical research to get robust conclusions about health insurance inequality. Thirdly, our two datasets used in the dissertation are national representative. One is Urban Residents Basic Medical Insurance (URBMI) survey data, another one is Chinese Household Income Project Survey (CHIPS). URBMI survey data is the unique large-scale household tracking data for Chinese residents'health status, health behavior and health insurance, which coved Chinese9cities,127,000samples from year2007to2011. CHIPS2002data covered12provinces of China,6835urban household samples and9200rural household samples. Health insurance policy in CHIPS2002established is based on the labor relation under the planned economic system. Residents have less opportunity to choose health insurance according to their own factors. Such health insurance system maybe could be treated as ideal quasi-social experiment. That's the main reason why we choose this data.Fourthly, the dissertation findings could help us understand more about households'financial status and financial behavior, and provide reference for policy makers to reduce households' financial risk and inequality of health insurance. We find that, current health insurance policy not only improve residents' utilization of medical resources, but also reduce their financial burden significantly. The higher of medical security level is, the larger impact gets. Households covered by health insurance tend to increase risk in their asset portfolio. However, we find inequalities in health insurance policy. The lower income groups are less healthy but use less medical resources and get less reimbursement than the richer groups. Hence, raising equality of health insurance could expand the positive impact of health insurance.The four empirical chapters are independent from each other. Every chapter focuses on one issue, with its own background, literature, research strategy and completes empirical results. However, these four chapters are also inter-related. Firstly, chapter2and3both focus on households'financial risk from health care. Chapter2treat individual as a unit to study the difference of financial burden among residents with and without health insurance. Using same data as Chapter2, Chapter3treats household as a unit to identify the role of medical security level on reducing households'financial risk. From the study of chapter2and3, we find that Chinese households face high financial risk. Current health insurance policy reduces their financial risk significantly. The higher medical security level is, the effect is larger. Whether will households adjusting their asset portfolio after health insurance reduce their financial risk? In chapter4, we identify the relationship between health insurance and Chinese households'asset portfolio. We find that the insured households prefer to assets with higher risk more than households without insurance. Hence, it implies from Chapter2,3and4that health insurance has significant positive effects on households'financial risk and behavior. However, chapter5finds that different income groups get different reimbursement from health insurance fund pool, which showed inequality. Hence, positive effects of health insurance would be larger if inequality of health insurance would be reduced. |
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