[雙語(yǔ)翻譯]--（節(jié)選）外文翻譯---中國(guó)醫(yī)療制度改革關(guān)于自付費(fèi)用和儲(chǔ)蓄的影響（原文）

1、The health care system reform in China: Effects on out-of-pocket expenses and savingVincenzo ATELLA a,1, Agar BRUGIAVINI b,2, Noemi PACE b,?a Centre for Economic and International Studies (CEIS), Department of Economics

2、and Finance, University of Rome Tor Vergata, Via Columbia 2, 00133 Rome, Italy b Department of Economics, University Ca' Foscari of Venice, Cannaregio 873, 30121 Venezia, Italya r t i c l e i n f o a b s t r a c tArt

3、icle history:Received 11 July 2014Received in revised form 13 February 2015Accepted 13 February 2015Available online xxxxThis paper aims to evaluate the impact of 1998 Chinese health care reform on out-of-pocketexpenditu

4、re and on saving. Existing evidence on the results achieved by this reform in terms ofreduction of out-of-pocket medical expenditures is still mixed and contradictory, and very littleis known about the impact of these me

5、asures on the consumption and saving behavior of theChinese population. To shed more light on this issue we use data collected in 1995 and 2002 bythe Chinese Household Income Project (CHIP). Contrary to previous evidence

6、, our findings suggestthat the effects of the reform have been more articulated and heterogeneous. In fact, we find thatonce properly accounting for income distribution and unobserved heterogeneity (potentiallyinduced by

7、 health status), out-of-pocket medical expenses and saving rate are affected by thereform in a differentiated way. In particular, we find that out-of-pocket expenses decrease onlyfor high income individuals with good hea

8、lth status and the saving rate increases only for lowincome individuals with good health status. This result is actually worrisome, as it suggests thatthe public health coverage after the reform provides financial protec

9、tion only to individuals thatare relatively better off (with good health status and/or high income).© 2015 Elsevier Inc. All rights reserved.JEL classification:D14I13P36Keywords:ChinaHealth insuranceHealth care syst

10、em reformHousehold savingOut-of-pocket expenditures1. IntroductionThe characterization of the determinants of households' saving decisions is important both for providing a framework to explainhousehold wealth accumu

11、lation per se, as well as for providing valuable information on a variety of welfare policies. Given the largesize of the Chinese economy and its importance at the international level, considerable effort has been devote

12、d in the economicliterature to understand Chinese households' saving decisions.In the '70s, China has launched several reforms affecting the economy and, in particular, the social security system. The mainobjecti

13、ve of these reforms was to transform China's stagnant, impoverished and centrally planned economic system into a moreflexible and decentralized system capable of generating sustained economic growth and increasing th

14、e well-being of Chinese citizens.The reforms began in 1978 and occurred in two stages. The first stage, between the late '70s and the early '80s, involved the de-collectivization of agriculture, the opening up of

15、 the country to foreign investments, and the permission for entrepreneurs to startup businesses. However, most industries remained state-owned. The second stage of the reform, between the late '80s and the'90s, i

16、nvolved the privatization and contracting out of much state-owned enterprises (SOEs) and the removal of price controls,protectionist policies, and redundant regulations, although state monopolies in sectors such as banki

17、ng and petroleum remainedChina Economic Review xxx (2015) xxx–xxx? Corresponding author. Tel.: +39 0412349187; fax: +39 0412349176.E-mail addresses: atella@uniroma2.it (V. Atella), brugiavi@unive.it (A. Brugiavini), n.pa

18、ce@unive.it (N. Pace). 1 Tel.: +39 0672595606; fax: +39 062020687. 2 Tel.: +39 0412349162; fax: +39 0412349176.CHIECO-00824; No of Pages 14http://dx.doi.org/10.1016/j.chieco.2015.02.0031043-951X/© 2015 Elsevier Inc.

19、 All rights reserved.Contents lists available at ScienceDirectChina Economic ReviewPlease cite this article as: Atella, V., et al., The health care system reform in China: Effects on out-of-pocket expenses and saving, Ch

20、ina Economic Review (2015), http://dx.doi.org/10.1016/j.chieco.2015.02.003Before an individual could access the social risk-pooling fund, however, he or she must first pay deductibles from a first tier ofindividual medic

21、al savings account and a second tier of direct deductible equal to 5% of annual income.At the end of 1998, the Chinese government established a social insurance program for urban workers that replaced the existingLIS and

22、 GIS in the cities, known as Basic Insurance Scheme (BIS). The program is financed by premium contributions from employers(6% of the annual employee's wage) and employees (2% of their annual wage).5 Retired workers a

23、re exempt from premium contribu-tions and the cost of their contributions is to be borne by their former employers.6 Compared with the old GIS and LIS, the new pro-gram expands coverage to private enterprises and smaller

24、 public enterprises. Moreover, self-employed workers are allowed to enterthe program. However, compared with the old system of GIS and LIS, the benefit structure under the new system has two major gapsin coverage. First,

25、 the dependents of the urban workers, who used to receive partial coverage, are no longer covered. Second, the newsystem has a ceiling on the insured amount of the individual medical expenditures (equivalent to four time

26、s the annual average wagein the region). Imposition of this ceiling is due to budget constraints as well as the political emphasis on the wide coverage, but itleaves most catastrophic illnesses uncovered.The Ministry of

27、Labor and Social Security (1999) estimated that the premium contribution based on the 8% of the current wage canonly cover about 70% of the total outlay under the old systems of GIS and LIS. Moreover, Gao, Raven, and Tan

28、g (2007) show that theproportion of elderly covered by health insurance in urban China has declined over the period 1998–2007. 73. Data and empirical analysisThe empirical analysis of this paper is based on cross-section

29、al data obtained from the Chinese Household Income Project surveys(CHIPs) conducted by the Chinese Academy of Social Science (CASS) in 1988, 1995 and 2002. The surveys use sub-samples from themain nationally representati

30、ve household survey program conducted by the Chinese National Bureau of Statistics in the urban andrural areas, and are designed to be representative of the whole Chinese population. For the scope of our analysis, we onl

31、y focus onthe 1995 and 2002 waves that represent respectively the pre-reform and post-reform periods. We exclude from the analysis the1988 wave because there are incomplete information on income and expenditure. Furtherm

32、ore, we do not consider the rural samplebecause the Basic Insurance Scheme (BIS) was introduced only in the urban areas.8 The urban sample included individuals and house-holds from 11 provinces and municipalities.9 The p

33、urpose of CHIPs urban data collection was to measure the distribution of personalincome. Moreover, the data provide a large set of information on each household member concerning his/her social and economicstatus, includ

34、ing employment characteristics, wage, tax, and sources of income, and demographic variables such as, age, gender,marital status, relationship to the household head. Information is also gathered on household's expendi

35、tures and on their livingconditions. 103.1. Data descriptionThe empirical analysis will be performed at household level, with some information collected at the head of the household level(socio-demographic and employment

36、 characteristics) and some other at the household level (income, expenditures and saving).Given the current structure of the Chinese health care assistance and our focus on saving behavior, we restrict the sample to incl

37、udeonly household heads aged 25–65, and we exclude household heads who are self-employed, employed without contract or employedwith short and temporary term contract (in total 434 observations). Moreover, to avoid potent

38、ial measurement errors, we droppedthe extreme values of the saving rate (values of the saving rate below the first percentile and above the 99th percentile). Afterperforming these selections we obtain a sample of 6445 ho

39、useholds in 1995 and 5869 households in 2002. However, for our empiricalanalysis the sample size reduces to 5305 households in 1995 and to 4194 in 2002, as the survey contains a non-negligible number ofmissing values for

40、 the income and some employment characteristic variables used as regressors.Table 1 reports the summary statistics (based on the final sample) of the variables used in the empirical analysis.5 The amount of the employer&

41、#39;s contribution was different across provinces and cities. The average contribution level was 6% of the employee's wage. 6 Liu (2002) provides an extensive description of the characteristics of BIS. 7 This may be

42、attributed to the reform of state-owned enterprises, which has resulted in many enterprises being closed and a substantial number of workers beinglaid off (Gao et al., 2001). As only the minimum living allowance was guar

43、anteed, the elderly who were laid off or whose employing enterprises were closed as a result ofthe ongoing economic reforms process may have lost their entitlements, such as the health insurance. 8 In our view using the

44、rural sample as control group may not represent a good identification strategy for at least two reasons. First, the health insurance system inurban and rural areas are completely different and were always managed as two

45、completely different sectors (Atella et al., 2014; Brown, De Brauw, Carrinet al., 1999; Gao et al., 2007; Liu, 2002). Second, since the beginning of the economic reform and also during the period 1995–2002 (the study pe

46、riod of the currentpaper) the rural and urban areas have been affected by different reforms of the economic and welfare system or by the same kind of reform but undertaken in differentyears and under different rules (e.g

47、. the “one child policy”, the pension reform, etc.). 9 In the 1995 wave, the 11 provinces and municipalities are Anhui, Beijing, Gansu, Guangdong, Henan, Hubei, Jiangsu, Liaoning, Shanxi, Sichuan, and Yunnan. In the2002

48、wave, Chongqing municipality is also included. Since it was one of the cities of Sichuan province and became the municipality in 1997, we combine Chongqing andSichuan together in the 2002 wave. These 11 provinces and mun

49、icipalities cover all the 6 geographical areas and can reflect the economic situation of China. In 2002,Guangdong ranked the first in GDP and Beijing municipality ranked the first in per capita GDP, whereas Gansu ranked

50、the 25th in GDP over all the Chinese 31 provincesand was one of the lowest per capita GDP all over the country; Liaoning was heavy industry center, where petrochemical industry, machinery manufacturing industryand metall

51、urgy industry occupied 70% of total Liaoning gross industrial output value; Henan was the most important agriculture province, where cultivated area rankedthe first all over the country (National Bureau of Statistics of

52、China, 2003). 10 In the 2002 wave, CHIPs provide two special data sets which investigate rural-to-urban migrant individual and household information. However, such data do notexist in the 1995 wave. Therefore we do not t

53、ake these rural-to-urban migrant households into account in our analysis.3 V. Atella et al. / China Economic Review xxx (2015) xxx–xxxPlease cite this article as: Atella, V., et al., The health care system reform in Chin