Abstract
In 2009, China launched a new health care reform as it endeavoured to develop a tiered system of disease diagnosis and treatment to promote the integration of medical resources. This was important for improving service capacity and building medical alliances that would eventually lead to improved health service utilisation efficiency. However, while the 2009 reform aimed to provide universal health insurance coverage to all citizens, its overall effect on health service utilisation efficiency remains unclear. We aimed to examine the new health care reform’s mixed effect by applying a longitudinal study using China Health and Nutrition Survey (CHNS) data and the difference-in-difference (DID) method to estimate the health reform’s impact on health insurance coverage rate. Then, we studied whether the increase in health insurance coverage rate affected health service utilisation efficiency in China. Our results showed that the increase in insurance coverage rate has indeed made expensive medical services available to low-income individuals. However, it also increased the likelihood of use of hospitals rather than primary care facilities, since there is more insurance cover for outpatient visits, which has led to an increased demand for quality services. This effect has generated a negative impact on health care utilisation which directly pertains to systemic inefficiency. This study thus indicates that China’s latest health reform requires further policies to improve its overall efficiency.
Highlights
Over the past 70 years, China has made significant progress in providing efficient and affordable health care services to a large portion of its population
This paper aims to study the mixed effects of the two policies: whether the introduction of the universal health insurance coverage policy has a negative effect on the policy that encourages a tiered health service system to improve health service utilisation efficiency
This paper extends the existing literature to investigate the causal relationships between health care reforms, health insurance coverage rates, and individuals’ decisions to visit upper-level hospitals through an econometric analysis
Summary
Over the past 70 years, China has made significant progress in providing efficient and affordable health care services to a large portion of its population. The country has implemented more than five large health care reform waves since the 1950s to meet the rapid increase in demand for an efficient medical service system. Yip and colleagues found that from 2008 to 2017, the health expenditures spent by the Chinese government on health care quadrupled from 359 billion yuan to. Under the 2009 health care reform’s framework, the Chinese government intended to deliver additional reforms to overhaul its hospital-centric, treatment-based delivery system [2]. Strengthening primary health care systems (PHC) and diverting patients with common diseases from hospital-based care to community-based care is one of the top priorities of health care reform [3,4]
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