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The fertility effects of public pension: Evidence from the new rural pension scheme in China.

ABSTRACT: Public pension insurance has become a major form of social protection around the world. However, little is known about the association between public pension expansion and individuals' fertility in developing economies. In this paper, we examine the effects of the New Rural Pension Scheme (NRPS) on the fertility of married women in rural China. Using data from the China Family Panel Studies (CFPS), the difference-in-differences approach is employed to estimate the impact of NRPS expansion on fertility outcomes. The robustness of results is checked through additional estimations, including difference-in-differences with propensity score matching, fixed-effects model, and instrumental variable approach. Results show that the NRPS expansion has a significantly negative effect on the number of children, and it reduces the likelihood of having a second child. The fertility-reducing effect of the NRPS is larger for the younger, well-educated women and those in high-income families. Considerations of the fertility effects and their population differences are needed in the impact evaluations of relevant public pension reform.

SUBMITTER: Shen Z

PROVIDER: S-EPMC7292397 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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The fertility effects of public pension: Evidence from the new rural pension scheme in China.

Shen Zheng Z Zheng Xiaodong X Yang Hualei H

PloS one 20200612 6

Public pension insurance has become a major form of social protection around the world. However, little is known about the association between public pension expansion and individuals' fertility in developing economies. In this paper, we examine the effects of the New Rural Pension Scheme (NRPS) on the fertility of married women in rural China. Using data from the China Family Panel Studies (CFPS), the difference-in-differences approach is employed to estimate the impact of NRPS expansion on fer ...[more]

PMID: 32530927

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Project description:BackgroundMany researchers have examined the impact of social insurance on health in elderly. However, in most cases, they have only demonstrated correlational results and have not been able to determine causal effects, possibly because confounding biases have not been fully addressed. In this study, we investigated the health effects of the New Rural Pension Scheme (NRPS) on the elderly (age≥60 years old) with chronic diseases in rural areas, and to explore the causal relationship and effects of NRPS and health status.MethodsThis paper used data from the 2018 China Health and Retirement Longitudinal Study (CHARLS) and applied Bayesian networks and fuzzy regression discontinuity design to conduct causal analysis. Bayesian networks were used to explore the causal directed acyclic graphs of factors related to NRPS and health status. Based on the results of Bayesian network, a fuzzy regression discontinuity design was employed to estimate the causal effect of NRPS on health status.ResultsAmong rural elderly with chronic diseases, Bayesian network mapping of causal relationships among NRPS, health status and covariates showed that age was a common cause of NRPS receipt and satisfaction with health. The results of the fuzzy regression discontinuity analysis showed that the effect of receiving NRPS on the health status was positive, but there was no statistically significant difference concerning the interval estimates. The results of the subgroup analysis with chronic obstructive pulmonary disease (COPD) and asthma indicated that the effect of NRPS receipt on the health status of elderly people with COPD was positive. There was a statistically significant effect of receiving NRPS on self-rated health description ([Formula: see text]) and health satisfaction ([Formula: see text]) in COPD population and a statistically significant effect of receiving NRPS on health satisfaction in asthma population ([Formula: see text]).ConclusionThis paper has confirmed the contribution and positive causal effect of NRPS on health status in a subgroup of older adults with COPD and asthma, using the CHARLS database as evidence. Thus, Chinese government should increase the take-up rate of the NRPS to enhance their positive impact on health status of elderly people with chronic diseases in rural areas.

Project description:ObjectivesTo determine whether China's New Rural Cooperative Medical Scheme (NCMS), which aims to provide health insurance to 800 million rural citizens and to correct distortions in rural primary care, and the individual policy attributes have affected the operation and use of village health clinics.DesignWe performed a difference-in-difference analysis using multivariate linear regressions, controlling for clinic and individual attributes as well as village and year effects.Setting100 villages within 25 rural counties across five Chinese provinces in 2004 and 2007. Participants 160 village primary care clinics and 8339 individuals.Main outcome measuresClinic outcomes were log average weekly patient flow, log average monthly gross income, log total annual net income, and the proportion of monthly gross income from medicine sales. Individual outcomes were probability of seeking medical care, log annual "out of pocket" health expenditure, and two measures of exposure to financial risk (probability of incurring out of pocket health expenditure above the 90th percentile of spending among the uninsured and probability of financing medical care by borrowing or selling assets).ResultsFor village clinics, we found that NCMS was associated with a 26% increase in weekly patient flow and a 29% increase in monthly gross income, but no change in annual net revenue or the proportion of monthly income from drug revenue. For individuals, participation in NCMS was associated with a 5% increase in village clinic use, but no change in overall medical care use. Also, out of pocket medical spending fell by 19% and the two measures of exposure to financial risk declined by 24-63%. These changes occurred across heterogeneous county programmes, even in those with minimal benefit packages.ConclusionsNCMS provides some financial risk protection for individuals in rural China and has partly corrected distortions in Chinese rural healthcare (reducing the oversupply of specialty services and prescription drugs). However, the scheme may have also shifted uncompensated new responsibilities to village clinics. Given renewed interest among Chinese policy makers in strengthening primary care, the effect of NCMS deserves greater attention.

Project description:BackgroundThe New Rural Cooperative Medical Scheme (NCMS) includes a maternal care benefits package that is associated with increasing maternal health services. The local compensation policies have been frequently adjusted in recent years. This study examined the association between the NCMS maternal-services policy adjustment and expense reimbursement in Yuyao, China.MethodsTwo household surveys were conducted in Yuyao in 2008 and 2011 (before and after the NCMS policy adjustment, respectively). Local women (N = 154) who had delivery history in the past three years were recruited. A questionnaire was used to collect information about delivery history, maternal health services utilization (prenatal care, postnatal care, and the grade of delivery institutions), NCMS participation, and reimbursement status. Logistic regression analyses were used to predict the association between policy adjustment and maternal health utilization and the association between policy adjustment and out-of-pocket proportion. Next, t-tests and covariance analyses adjusting for household income were used to compare the out-of-pocket proportion between 2008 and 2011.ResultsResults revealed that compensation policy adjustment was associated with an increase in postnatal visits (adjusted OR = 3.32, p = 0.009) and the use of second level or above institutions for delivery (adjusted OR = 2.32, p = 0.03) among participants. In 2008, only 9.1% of pregnant women received reimbursement from the NCMS; however, this rate increased to 36.8% in 2011. After policy adjustment, there were no significant changes in the proportion of out-of-pocket expenses shared in delivery fee (F = 0.24, p = 0.63) and in household income (F = 0.46, p = 0.50).ConclusionsFinancial compensation increase improved maternal health services utilization; however, this effect was limited. Although the reimbursement rate was raised, the out-of-pocket proportion was not significant changed; therefore, the compensation design scheme must be adjusted in practice.

Dataset Information

The fertility effects of public pension: Evidence from the new rural pension scheme in China.

Publications

The fertility effects of public pension: Evidence from the new rural pension scheme in China.

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