Impact of subsidized distribution on follow-up uptake of vision health services for rural students: A field experiment in China

Abstract

Despite rising economic growth, low-income countries continue to exhibit a relatively low uptake of healthcare services and products. Short-term healthcare subsidies are commonly administered in low-income countries to promote long-term uptake of healthcare. To evaluate the impact of follow-up healthcare subsidies, we examined the effects of a one-time subsidy of providing free eyeglasses to school children in rural China. We contribute to the field by using a unique and rare 27-month, two-phase experiment that surveyed 4658 primary and secondary school students from Gansu and Shaanxi provinces in rural northwestern China. The sample was divided into an intervention group that received free eyeglasses for uncorrected refractive errors and a control group that received only prescription information. The impact of one-time subsidized eyeglasses on rural students’ long-term uptake of vision health care vision health was assessed using an instrumental variables (IV) approach. 90.0% of students from the intervention group that received one-time subsidized eyeglasses sought appropriate long-term healthcare, which was significantly higher (P < 0.001) than the control group at 61.3%. Multivariate logistic regression models (OR = 28.315, 95% CI = 10.972–73.074, P < 0.001) revealed that this one-time subsidy of free eyeglasses significantly predicted long-term uptake in related healthcare products and services. IV analysis suggested that wearing eyeglasses may increase the likelihood of students’ long-term uptake by 78.7% in the intervention samples compared to control schools; the magnitude of this coefficient provides evidence that wearing eyeglasses leads to a marginal improvement in long-term uptake within the sample. This result passed a series of robustness tests. Learning by doing and social learning are crucial pathways through which short-term, targeted subsidies might affect long-term adoption, at least for some classes of preventative health items. The provision of short-term, one-off healthcare subsidies can be an efficient and cost-effective strategy for boosting both short-term and long-term healthcare-seeking behavior. Providing a useful reference for promoting long-term health-seeking behavior in rural or other less developed regions in China and elsewhere in the world.