Center for Chinese Public Administration Research, School of Government, Sun Yat-sen University, No. 135 Xin Gang Xi Road, Guangzhou, 510275, China.
Lingnan College, Sun Yat-sen University, No. 135 Xin Gang Xi Road, Guangzhou, 510275, China.
Soc Sci Med. 2020 Jun;255:112981. doi: 10.1016/j.socscimed.2020.112981. Epub 2020 Apr 13.
Large hospitals in China are overcrowded, while primary care tends to be underutilized, resulting in inefficient allocation of resources. This paper examines the impacts of a policy change in a mandatory public employee health insurance program in China designed to encourage the utilization of primary care by reducing patient cost-sharing. We use a unique administrative insurance claim dataset from the Urban Employee Basic Medical Insurance (UEBMI) scheme between 2013 and 2015. The sample includes 40,024 individuals. We conduct an event-study analysis controlling for individual fixed effects and find that the change in cost-sharing increased primary care utilization, decreased non-primary care utilization, and increased total outpatient utilization without impacting total spending. In addition, the policy change did not affect the likelihood of having avoidable inpatient admissions. Further, patients with hypertension or diabetes increased their primary care utilization even when using additional coverage for patients with chronic diseases, the cost-sharing rates for which did not change during the period of our study, rather than their standard UEBMI benefits. This study provides evidence that changes in cost-sharing can affect healthcare utilization, suggesting that supply-side incentives can play an important role in building a primary care-based integrated healthcare delivery system in China.
中国的大医院人满为患，而基层医疗服务的利用率往往较低，导致资源配置效率低下。本文考察了中国一项强制性公共雇员健康保险计划政策变化的影响，该计划旨在通过降低患者自付费用来鼓励利用基层医疗服务。我们使用了 2013 年至 2015 年期间城市职工基本医疗保险（UEBMI）计划的独特行政保险理赔数据集，样本包括 40024 人。我们进行了事件研究分析，控制了个体固定效应，结果表明，自付费用的变化增加了基层医疗服务的利用，减少了非基层医疗服务的利用，并增加了总门诊利用量，而没有影响总支出。此外，该政策变化并没有影响可避免住院的可能性。此外，患有高血压或糖尿病的患者增加了他们的基层医疗服务利用，即使他们在使用慢性病患者的额外覆盖范围，而在我们研究期间，慢性病患者的自付费用率并没有变化，而是他们的 UEBMI 标准福利。本研究提供了证据表明，自付费用的变化会影响医疗保健的利用，这表明供应方激励措施可以在中国建立以基层医疗为基础的综合医疗服务提供系统方面发挥重要作用。
