Childhood Nutrition in Rural China: What Impact Does Public Health Insurance Have?

from Value in Health at on November 10, 2020 at 12:09PM

Available online 10 November 2020

Childhood Nutrition in Rural China: What Impact Does Public Health Insurance Have?


Although previous studies have examined the impact of public health insurance on nutrient intake, no such study exists for children, especially those from poor households of rural China.

The New Cooperative Medical Scheme (NCMS) significantly reduced intake of calories, fat, and protein by children and the effects differed by age and sex.

The NCMS reduced nutrient intake via increased out-of-pocket medical expenditures.

Reforms to increase the generosity in the NCMS coverage to protect households from high out-of-pocket expenses are important to pursue.



To investigate the impact of public health insurance coverage, specifically the New Cooperative Medical Scheme (NCMS), on childhood nutrition in poor rural households in China, and to identify the mechanisms through which health insurance coverage affects nutritional intake.


Longitudinal data on 3291 children were taken from four time periods (2004, 2006, 2009, and 2011) from the China Health and Nutrition Survey (CHNS). Panel data analysis was performed with the fixed-effect model and the propensity score matching with difference-in-differences (PSM-DID) approach.


The introduction of the NCMS was associated with a decline in calories, fat, and protein intake, and an increase in the intake of carbohydrates. The NCMS had the greatest negative effect on children aged 0 to 5 years, particularly girls. Out-of-pocket medical expenses were identified as the main channel through which the NCMS affected the nutritional intake of children.


The study showed that the NCMS neither significantly improved the nutritional status of children nor enhanced intake of high-quality nutrients among rural poor households. These findings were attributed to the way in which health-seeking behavior was modified in the light of NCMS coverage. Specifically, NCMS coverage tended to increase healthcare utilization, which in turn increased out-of-pocket medical expenditures. This encouraged savings to aid financial risk protection and resulted in less disposable income for food consumption.





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© 2020 ISPOR-The Professional Society for Health Economics and Outcomes Research. Published by Elsevier Inc.