Department of Public Administration, College of Management and Economics, Tianjin University, 92 Weijin Road, Nankai District, Tianjin 300072, China.
Department of Public Administration, School of Public Policy & Management, Tsinghua University, 30 Shuangqing Road, Haidian District, Beijing 100084, China.
Health Promot Int. 2024 Oct 1;39(5). doi: 10.1093/heapro/daae115.
China's healthcare system faces significant challenges, notably the underutilization of primary healthcare resources and the inefficient distribution of healthcare services. In response, this article explores the effectiveness of the New Rural Cooperative Medical System (NRCMS) in improving healthcare accessibility and primary care utilization. Employing a multi-period difference-in-differences model and using data from the China Family Panel Studies spanning 2012-20, it aims to empirically examine how health insurance policy incentivizing primary care influences rural residents' health-seeking behaviour and enhances the efficiency of resource utilization. Results indicate that NRCMS significantly improves the probability of rural residents seeking healthcare services at primary healthcare centres (PHCs), especially for outpatient services. This effect can be attributed to the substantially higher outpatient reimbursement rates at PHCs compared to higher-level medical institutions. Conversely, the Urban Resident Basic Medical Insurance fails to increase urban residents' engagement with primary care, reinforcing the role of price sensitivity in healthcare choices among insured lower-income rural population. Furthermore, the study reveals a stronger preference for PHCs among younger, less-educated insured residents and highlights a synergistic effect between the availability of primary healthcare resources and insurance coverage on primary care utilization. These findings offer crucial implications for refining health insurance policies to improve healthcare service accessibility and efficiency.
中国的医疗体系面临重大挑战，主要表现为基层医疗资源利用不足和医疗服务分配效率低下。为此，本文探讨了新型农村合作医疗制度（NRCMS）在提高医疗可及性和基层医疗利用方面的有效性。本文运用多期双重差分模型，利用中国家庭追踪调查（CFPS）2012-20 年的数据，实证检验了医疗保险政策对基层医疗的激励如何影响农村居民的就医行为，以及如何提高资源利用效率。研究结果表明，NRCMS 显著提高了农村居民到基层医疗机构（PHC）寻求医疗服务的概率，特别是在门诊服务方面。这种效果可以归因于与更高层次的医疗机构相比，PHC 的门诊报销率要高得多。相反，城镇居民基本医疗保险并没有增加城镇居民对基层医疗的参与度，这强化了价格敏感性在保险覆盖下的低收入农村人群的医疗选择中的作用。此外，研究还揭示了在年轻、受教育程度较低的参保居民中，对基层医疗机构的偏好更强，并强调了基层医疗资源的可及性和保险覆盖范围对基层医疗利用的协同效应。这些发现为完善医疗保险政策以提高医疗服务的可及性和效率提供了重要启示。
