A Chinese conundrum: Does higher insurance coverage for hospitalisation reduce financial protection for the patients who most need it?

IF 2.9 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES
Xiaoying Zhu, Ajay Mahal, Shenglan Tang, Barbara Mcpake
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Abstract

This paper evaluates the relationship between the degree of cost-sharing and the utilization of outpatient and inpatient health services in China. Using data from the 2015 China Health and Retirement Longitudinal Study (CHARLS), we estimated the association between outpatient and inpatient service utilization and cost-sharing levels associated with outpatient and inpatient services, as well as a comparative metric that quantifies the relative cost-sharing burden between the two. We found that patients in areas with higher levels of cost-sharing for outpatient services exhibit a lower propensity to use outpatient care and a higher inclination to utilize costly hospitalisation services. Conversely, as the ratio of cost-sharing for outpatient services to that for inpatient services increases, the likelihood of patients forgoing doctor-initiated hospitalisation correspondingly increases. This suggests that when cost-sharing for outpatient care rises relative to inpatient care, observed increases in inpatient care utilization reflect an escalation in moral hazard rather than a correction for the underutilization of inpatient services. We conclude that both substitution and complementary roles exist between outpatient and inpatient services. Our findings suggest that a more effective design of cost-sharing is needed to enhance the equity and efficiency of China's health system.

中国式难题:提高住院保险覆盖率是否会减少对最需要经济保障的患者的经济保障?
本文评估了费用分担程度与中国门诊和住院医疗服务利用率之间的关系。利用 2015 年中国健康与退休纵向研究(CHARLS)的数据,我们估算了门诊和住院服务利用率与门诊和住院服务相关费用分担水平之间的关系,以及量化两者之间相对费用分担负担的比较指标。我们发现,在门诊服务费用分担水平较高的地区,患者使用门诊护理的倾向较低,而使用昂贵的住院服务的倾向较高。相反,随着门诊服务费用分担与住院服务费用分担比例的增加,患者放弃医生倡议的住院治疗的可能性也相应增加。这表明,当门诊病人的费用分担相对于住院病人的费用分担增加时,观察到的住院病人使用率的增加反映的是道德风险的上升,而不是对住院病人服务使用不足的纠正。我们的结论是,门诊和住院服务之间既存在替代作用,也存在互补作用。我们的研究结果表明,需要对费用分担进行更有效的设计,以提高中国医疗体系的公平性和效率。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Health policy and planning
Health policy and planning 医学-卫生保健
CiteScore
6.00
自引率
3.10%
发文量
98
审稿时长
6 months
期刊介绍: Health Policy and Planning publishes health policy and systems research focusing on low- and middle-income countries. Our journal provides an international forum for publishing original and high-quality research that addresses questions pertinent to policy-makers, public health researchers and practitioners. Health Policy and Planning is published 10 times a year.
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