Dong Fureng Institute of Economic and Social Development, Wuhan University, Wuhan, Hubei Province, China.
Australian National Institute of Management and Commerce, Australian Technology Park, Sydney, NSW, Australia.
Int J Equity Health. 2023 Aug 26;22(1):166. doi: 10.1186/s12939-023-01985-5.
In China, rural residents experience poorer health conditions and a higher disease burden compared to urban residents but have lower healthcare services utilization. Rather than an insurance focus on enhanced healthcare services utilization, we aim to examine that whether an income shock, in the form of China's New Rural Pension Scheme (NRPS), will affect outpatient, inpatient and discretionary over-the-counter drug utilization by over 60-year-old rural NRPS residents.
Providing a monthly pension of around RMB88 (USD12.97), NRPS covered all rural residents over 60 years old. Fuzzy regression discontinuity design (FRDD) was employed to explore the NRPS causal effect on healthcare services utilization, measured by outpatient and inpatient visits and discretionary over-the-counter drug purchases. The nationwide China Health and Retirement Longitudinal Study (CHARLS) 2018 provided the data.
Without significant changes in health status and medication needs, 60-plus-year-old NRPS recipients significantly increased the probability of discretionary OTC drug purchases by 33 percentage points. NRPS had no significant effect on the utilization of outpatient and inpatient utilization. The increase in the probability of discretionary OTC drug purchases from the NRPS income shock was concentrated in healthier and low-income rural residents. Robustness tests confirmed that FRDD was a robust estimation method and our results are robust.
NRPS was an exogenous income shock that significantly increased the probability of discretionary over-the-counter drug purchases among over 60-year-old rural residents, but not the utilization of inpatient or outpatient healthcare services. Income remains an important constraint for rural residents to improve their health. We recommend policymakers consider including commonly used over-the-counter drugs in basic health insurance reimbursements for rural residents; provide health advice for rural residents to make discretionary over-the-counter drug purchases; and to mount an information campaign on over-the-counter drug purchasing in order to increase the health awareness of rural residents.
与城镇居民相比，中国农村居民的健康状况较差，疾病负担较重，但医疗服务利用率较低。我们的目标不是关注医疗保险对医疗服务利用率的提高，而是研究中国新型农村社会养老保险（NRPS）形式的收入冲击是否会影响 60 岁以上农村 NRPS 居民的门诊、住院和非处方药品的使用。
NRPS 为 60 岁以上的农村居民提供每月约 88 元（12.97 美元）的养老金。模糊回归不连续设计（FRDD）被用来探索 NRPS 对医疗服务利用的因果效应，通过门诊和住院就诊次数和非处方药品购买来衡量。全国性的中国健康与养老追踪调查（CHARLS）2018 提供了数据。
在健康状况和用药需求没有显著变化的情况下，60 岁以上的 NRPS 领取者购买非处方药品的可能性显著增加了 33 个百分点。NRPS 对门诊和住院的利用没有显著影响。来自 NRPS 收入冲击的购买非处方药品的可能性的增加集中在健康状况较好和低收入的农村居民中。稳健性检验证实，FRDD 是一种稳健的估计方法，我们的结果是稳健的。
NRPS 是一种外生的收入冲击，它显著增加了 60 岁以上农村居民购买非处方药品的可能性，但并没有增加门诊或住院的医疗服务利用率。收入仍然是农村居民改善健康状况的一个重要制约因素。我们建议政策制定者考虑将农村居民常用的非处方药品纳入基本医疗保险报销范围；为农村居民提供健康咨询，以购买非处方药品；并开展非处方药品购买的宣传活动，以提高农村居民的健康意识。
