Send to

Choose Destination
Int J Health Care Finance Econ. 2013 Dec;13(3-4):319-31. doi: 10.1007/s10754-013-9134-5. Epub 2013 Oct 2.

Sleeping money: investigating the huge surpluses of social health insurance in China.

Author information

Center for Chinese Public Administration Research, School of Government, Sun Yat-sen University, N0. 135, Xingangxi Road, Guangzhou , 510275, People's Republic of China,


The spreading of social health insurance (SHI) worldwide poses challenges for fledging public administrators. Inefficiency, misuse and even corruption threaten the stewardship of those newly established health funds. This article examines a tricky situation faced by China's largest SHI program: the basic health insurance (BHI) scheme for urban employees. BHI accumulated a 406 billion yuan surplus by 2009, although the reimbursement level was still low. Using a provincial level panel database, we find that the huge BHI surpluses are related to the (temporarily) decreasing dependency ratio, the steady growth of average wages, the extension of BHI coverage, and progress in social insurance agency building. The financial situations of local governments and risk pooling level also matter. Besides, medical savings accounts result in about one third of BHI surpluses. Although these findings are not causal, lessons drawn from this study can help to improve the governance and performance of SHI programs in developing countries.

[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Springer
Loading ...
Support Center