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Abstract
BackgroundDoing “more” in healthcare can be a major threat to the delivery of high-quality health care. It is important to identify the supplier-induced demand (SID) of health care. This study aims to test SID hypothesis by comparing health care utilization among patients affiliated with healthcare professionals and their counterpart patients not affiliated with healthcare professionals.MethodsWe used coarsened exact matching to compare the health care utilization and expenditure between patients affiliated and not affiliated with healthcare professionals. Using cross-sectional data of the China Labour-force Dynamics Survey (CLDS) in 2014, we identified 806 patients affiliated with healthcare professionals and 22,788 patients not affiliated with healthcare professionals. The main outcomes were outpatient proportion and expenditure as well as inpatient proportion and expenditure.ResultsThe matched outpatient proportion of patients not affiliated with healthcare professionals was 0.6% higher (P = 0.754) than that of their counterparts, and the matched inpatient proportion was 1.1% lower (P = 0.167). Patients not affiliated with healthcare professionals paid significantly more (680 CNY or 111 USD, P < 0.001) than their counterparts did per outpatient visit (1126 CNY [95% CI 885–1368] vs. 446 CNY [95% CI 248–643]), while patients not affiliated with healthcare professionals paid insignificantly less (2061 CNY or 336 USD, P = 0.751) than their counterparts did per inpatient visit (15583 CNY [95% CI 12052–19115] vs. 17645 CNY [95% CI 4884–30406]).ConclusionOur results lend support to the SID hypothesis and highlight the need for policies to address the large outpatient care expenses among patients not affiliated with healthcare professionals. Our study also suggests that as the public becomes more informed, the demand of health care may persist while heath care expenditure per outpatient visit may decline sharply due to the weakened SID. To address misbehaviors and contain health care costs, it is important to realign provider incentives.
Highlights
Doing “more” in healthcare can be a major threat to the delivery of high-quality health care
We find that patients not affiliated with healthcare professionals are more likely to be healthy (38.2%), to have medical insurance (92.8%), to live in a rural area (62.0%), and to be less educated than patients affiliated with healthcare professionals
We identified the same trend in inpatient health care utilization, without much difference in inpatient reason
Summary
Doing “more” in healthcare can be a major threat to the delivery of high-quality health care. It is important to identify the supplier-induced demand (SID) of health care. Variation in physician income was used to test for induced behavior by examining the association between physician competition and health care utilization, and it was hypothesized that more intense competition would lead to fewer patients and an increase in SID [5,6,7,8,9,10,11]. Variation in patient information is important to test SID by identifying the effect of medical information on health care utilization [16, 17]. These studies suggest that medical information and physician incentives are important determinants of health care demand and health care expenditure. More work is needed before we can conclude about the economic importance of SID
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