Department of Economics and Management, Karlsruhe Institute of Technology, Karlsruhe, Kronenstraße 34, 76133 Karlsruhe, Germany.
Department of Global Health and Social Medicine, Faculty of Social Science and Public Policy, King's College London, 3.09 Bush House NE, Strand, London WC2R 2LS, UK.
Health Policy Plan. 2021 Aug 12;36(7):1013-1022. doi: 10.1093/heapol/czab017.
Although public voluntary health insurance (VHI) has been adopted in many low- and middle-income countries to improve access to care for the population, a common issue with VHI is its high dropout rate. Using the New Cooperative Medical Scheme (NCMS)-a public VHI in China-as a case study, this article employs a fixed-effects negative binomial regression model combining the difference-in-difference-in-differences approach and multivariate distance matching to examine the factors associated with dropping out and the impact of dropout on outpatient care utilization among middle-aged and older people in rural China. Drawing data from the China Health and Retirement Longitudinal Study, our results showed that healthy people, vulnerable people and people who use less healthcare tended to drop out. Dropout had a significant negative impact on outpatient care utilization, especially for those with worse health statuses and those living in poorer provinces. We also found that the impact of dropout on outpatient utilization was more pronounced at secondary and tertiary hospitals than at primary care clinics. We urge policymakers to rethink the design of the NCMS by waiving premiums for the most vulnerable people.
虽然公共自愿健康保险（VHI）已在许多低收入和中等收入国家采用，以改善人群的医疗服务可及性，但 VHI 的一个常见问题是其高退保率。本文以中国新型农村合作医疗制度（NCMS）为例，采用固定效应负二项回归模型结合差分法、双重差分法和多元距离匹配方法，考察了影响中国农村中老年人群退保的因素以及退保对门诊服务利用的影响。本研究的数据来自中国健康与养老追踪调查，结果表明，健康状况较好、脆弱人群和医疗服务利用率较低的人群更倾向于退保。退保对门诊服务利用有显著的负面影响，尤其是对健康状况较差和所在省份较贫困的人群。我们还发现，退保对门诊利用率的影响在二级和三级医院比在基层医疗机构更为明显。我们敦促政策制定者重新考虑为最脆弱人群免除保费的 NCMS 设计。
