Importance of medical information for health-care utilisation in China: a cross-sectional study

Abstract

BackgroundIncreasing concerns have arisen about provider misbehaviour in the Chinese health system, such as unnecessary care, with the potential consequence of an increase of health-care expenditure. This study aims to investigate the effect of medical information on health-care utilisation and expenditure in China based on the supplier-induced demand hypothesis. MethodsData were derived from the China Labour-force Dynamics Survey (CLDS) done in 2014 using a multistage stratified cluster-random sampling method in 29 provinces in China. Providing information about health-care provision to some patients but not others, we identified 806 informed patients and 22 788 uninformed patients as our analytical sample. Using the coarsened exact matching method to control for confounding factors, we identified the impact of health-care information provision in China on proportion of patients who were outpatients and expenditure in the past 2 weeks as well as proportion of patients who were inpatients and expenditure in the past year. All study procedures were approved by the Health Science Center Ethics Committee at Xi'an Jiaotong University, Shaanxi, China (approval number: 2015-644) and all patients gave written informed consent. FindingsAfter coarsened exact matching, although the outpatient rate of uninformed patients seemed to be 0·6% higher than that of informed patients (4·3% [95% CI 3·9–4·8] vs 3·7% [2·3–5·1]), and the inpatient rate of uninformed patients seemed to be 1·1% lower than that of informed patients (4·3% [3·7–4·6] vs 5·3% [3·6–6·9]), none of these effects were significant. Uninformed patients paid 680 CNY more per outpatient visit than did informed patients (1126 CNY [95% CI 885–1368] vs 446 CNY [248–643]), accounting for 56·7% of the average outpatient expenditure of uninformed patients. However, uninformed patients paid 2061 CNY less per inpatient visit than informed patients did (15 584 CNY [9% CI 12 052–19 115] vs 17 645 CNY [488430 406]). InterpretationThe medical information has limited effect on outpatient and inpatient health-care utilisation in the health-care market in China. However, our results highlight the need for policies to address the large outpatient care expenses attributable to medical information asymmetry in the health-care market in China. Creating incentives for providers to provide less health-care services that could be avoided in the process of outpatient services may work well to reduce health-care costs, improve the governance of public hospitals, and institute a stronger regulatory system. FundingChina Medical Board (15–277), Research Program of Shaanxi Soft Science (2015KRM117), the National high-level talents special support plan (thousands of people plan), Shaanxi provincial youth star of science and technology in 2016 and the Basic Scientific Research Funding of Xi'an Jiaotong University (SK2015007), China Scholarship Council (201706280307 and 201806280021), the US PEPPER Center Scholar Award (P30AG021342), National Institutes of Health/National Institute on Aging (R03AG048920 and K01AG053408).