Out-Patient Service and in-Patient Service: The Impact of Health Insurance on the Healthcare Utilization of Mid-Aged and Older Residents in Urban China

Abstract

Purpose

Medical insurance is a disease risk-sharing mechanism that can improve residents’ financial access to medical treatment and thus increase their utilization of health services. This paper aims to identify the impact of different kinds of medical insurances on the use of healthcare for Chinese mid-aged and older urban residents from four aspects: outpatient behaviour, outpatient costs, inpatient behaviour and inpatient costs.

Materials and Methods

The data used in this study were from 2015 China Health and Retirement Longitudinal Study (CHARLS) conducted by Peking University. Binary logit model and multiple linear regression model were used to analyse the impact of health insurance on the use of healthcare, and the PSM method was used to test the robustness of the results.

Results

Participating in either BMIUSE or BMISURR can significantly improve all kinds of healthcare utilization for mid-aged and older urban groups. However, there are huge differences on the healthcare utilization between BMISUE and BMISURR. Specifically, the probability of using inpatient care and inpatient costs of urban residents enrolled in the BMISUE are 4.2% and 45% higher, respectively, than those covered by the BMISURR, but there are no differences in outpatient care utilization and outpatient costs between these two health insurance programs.

Conclusion

This paper suggests that the large gaps between BMISUE and BMISURR only reflect on inpatient care and inpatient costs, there is no difference in outpatient services between these two health insurance programs. “Excessive demand”, “induced demand” and other moral hazard phenomena in BMISUE should be avoided when receiving hospitalization services.

Keywords:

• health insurance
• out-patient service
• in-patient service
• mid-aged and older urban residents
• CHARLS

Abbreviations

BMISUE, the Basic Medical Insurance System for Urban Employees; BMISURR, the Basic Medical Insurance System for Urban and Rural Residents; PSM, the propensity score matching; CHARLS, China Health and Retirement Longitudinal Study; NRCMS, the Chinese government set up the New Rural Cooperative Medical System; BMISUR, the Basic Medical Insurance System for Urban Residents.

Ethics Approval

Ethical approval for this study and written informed consent from the participants of the study were not required as per national legislation and institutional requirements.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

This research was funded by the National Social Science Foundation (project 16CGL046), the Youth Foundation of Humanities and Social Sciences by the Ministry of Education of the People’s Republic of China (project 15YJCZH118), the Scientific Research Projects by the State Ethnic Affairs Commission (MSQ16002), and the Fundamental Research Funds for the Central Universities (projects CSY16018 and 410500076).