Choice Of Health Facility Research Articles

Health-seeking behavior and barriers to treatment of patients with upper gastrointestinal cancer detected by screening in rural China: real-world evidence from the ESECC trial

BackgroundTo fully realize efficacy in cancer screening, timely and appropriate treatment for participants with malignant lesions is critical. However, the health-seeking behavior of patients with upper gastrointestinal (G.I.) cancer identified in population-level screening programs in China is unknown. MethodsA community-based real-world investigation was conducted with 136 upper G.I. cancer patients detected in a large screening cohort in an area of high-risk for upper G.I. cancer in China. Using local medical claims data and semi-structured face-to-face interview, we collected information regarding the clinical treatment regimen and factors which result in the lack of timely and appropriate treatment. FindingsThe treatment records for 133 upper G.I. cancer patients were acquired. Among these, 48 (36•09%) patients did not receive treatment within three months of initial diagnosis, and treatment of early-stage cancer was more likely to be delayed. Sixteen patients did not seek further diagnostic testing due to their low health-awareness and socio-economic status. Another 20 participants proactively sought further diagnostic evaluation in health care facilities but were prevented from receiving further treatment due to low sensitivity of given diagnostic test(s), failure to recognize the significance of screening results, and/or lack of basic knowledge of diagnosis and treatment for early cancer on the part of clinicians. The treatment regimen offered to patients depended largely on the level of health care facilities they visited, and non-medical factors were the main reasons for choice of health care facilities. InterpretationA coordinated, system-based management strategy is urgently needed to support the design of upper G.I. cancer screening programs in rural populations in China. FundingThe Charity Project of the National Ministry of Health (201202014), the National Key R & D Program of China (2016YFC0901404), the National Science & Technology Fundamental Resources Investigation Program of China (2019FY101102), and the National Natural Science Foundation of China (82073626).

A Novel Uni-directional Flow Circular Facility Layout for Effective Social Distancing

Hospitals have a complex infrastructure with a wide range of functional units of medical services. A well-designed facility layout planning is essential for the smooth functioning as well as to provide safe and convenient services to patients at the right time. A functional layout is suggested to optimize time and resources in the process of service delivery, reducing the challenges of patients and healthcare professionals involved in patient care. This article focuses on developing a new facility functional layout that promotes convenience, comfort and economy with enhanced quality of medical care. A pathway of patient movement is effectively designed for better health outcomes, especially when there is a huge inflow of patients seeking information about the choice of healthcare facilities and subsequent medical attention. A circular hospital facility layout with unidirectional flow is proposed, which will effectively prevent face-to-face movement of incoming and outgoing patients and their bystanders, thereby preventing spread of diseases or infection and speed up the service delivery process. The authors believe that the proposed layout will substantially improve quality, service and speed of medical procedures, though the initial investment might be higher for implementing this layout. This study is of paramount importance in maintaining social distancing at hospitals as it prevents chaotic movement of patients and more specifically total avoidance of face-to-face situations between incoming and outgoing patients.

Utilization of Health Care Services among the Farmers of Rural Field Practice Area of Department of Community Medicine KIMS, Hubballi: A Cross Sectional Study

Background: Farmers suffer from a multitude of problems; from the socio-economic problems to thatrelated to their health. Availability of quality services at the nearest possible areas at the reasonable or nocost results in better utilization of health services.Objectives: To assess the illness behavior among the farmers and to assess the utilization of health care services and to assess the barriers for utilization of health servicesMethodology: A community based cross sectional study was conducted in the rural field practice area of KIMS, Hubballi among 324 farmers. House to house survey was conducted using pre designed semistructured piloted questionnaire.Results: Out of 324 farmers, majority were males, Majority of the study participants were small scale farmers. Government hospital was the first priority for 39.5% of the farmers. Majority of the farmers did not complete the course of treatment.. The choice of health care facility was associated with the gender and the distance from the health care facility. Distance (32.4%) to the health care facility was reported as the main barrier for utilization of public health services.Conclusion: The health care preference for public and private is equal among the study participant. There isa significant gender difference in the preference of health care facility. The barriers for the utilization shouldbe addressed to enhance the proper utilization of public health care services.

Factors Influencing the Vietnamese Older Persons in Choosing Healthcare Facilities.

Background:The rapidly growing aging population poses major challenges for health systems in Vietnam. This study was therefore aimed to examine factors influencing the choices of healthcare facilities among older patients in Vietnam, using a national survey on older people.Methods:We applied multinomial logistic regression models based on Andersen’s Behavioral Model with various predisposing factors, enabling factors and healthcare-needs factors associated with different types of healthcare facilities where older patients utilized services.Data:We used data from the Vietnam Aging Survey (VNAS) in 2011. This was the first-ever nationally representative survey on older persons in Vietnam.Results:Among those who used healthcare services, 15.1% visited central hospitals; 23.6% visited provincial hospitals; 28.0% visited district hospitals; 8.8% visited commune heath centres; 18.3% visited private hospitals/clinics; and 6.2% visited other facilities. The results showed that “having to pay cost” and “having sufficient income” were strong predictors for using commune health centres, district hospitals, and private facilities, while “having health insurance” was not a significant predictor for using these facilities. Also, we showed that apart from enabling factors (such as age, gender, educational levels, employment status, living regionand place of residence), predisposing factor (such as health insurance, perceived sufficient income, household wealth and having to pay medical cost) as well as need factors (such as self-rated health and chronic disease) were also associated with the choice of healthcare facilities.Conclusions:Based on the findings, we discussed the implications of the results for organizing healthcare finance and delivery to achieve efficiency and equity for older people in Vietnam.

Eliciting women's preferences for place of child birth at a peri-urban setting in Nairobi, Kenya: A discrete choice experiment.

Maternal and newborn mortality rates are high in peri-urban areas in cities in Kenya, yet little is known about what drives women's decisions on where to deliver. This study aimed at understanding women's preferences on place of childbirth and how sociodemographic factors shape these preferences. This study used a Discrete Choice Experiment (DCE) to quantify the relative importance of attributes on women's choice of place of childbirth within a peri-urban setting in Nairobi, Kenya. Participants were women aged 18-49 years, who had delivered at six health facilities. The DCE consisted of six attributes: cleanliness, availability of medical equipment and drug supplies, attitude of healthcare worker, cost of delivery services, the quality of clinical services, distance and an opt-out alternative. Each woman received eight questions. A conditional logit model established the relative strength of preferences. A mixed logit model was used to assess how women's preferences for selected attributes changed based on their sociodemographic characteristics. 411 women participated in the Discrete Choice Experiment, a response rate of 97.6% and completed 20,080 choice tasks. Health facility cleanliness was found to have the strongest association with choice of health facility (β = 1.488 p<0.001) followed respectively by medical equipment and supplies availability (β = 1.435 p<0.001). The opt-out alternative (β = 1.424 p<0.001) came third. The attitude of the health care workers (β = 1.347, p<0.001), quality of clinical services (β = 0.385, p<0.001), distance (β = 0.339, p<0.001) and cost (β = 0.0002 p<0.001) were ranked 4th to 7th respectively. Women who were younger and were the main income earners having a stronger preference for clean health facilities. Older married women had stronger preference for availability of medical equipment and kind healthcare workers. Women preferred both technical and process indicators of quality of care. DCE's can lead to the development of person-centered strategies that take into account the preferences of women to improve maternal and newborn health outcomes.

Healthcare services utilisation among patients with hypertension and diabetes in rural Ghana.

BackgroundNon-communicable diseases (NCDs) remain a global burden and is projected to increase due to aging, rapid urbanization and unhealthy lifestyles. The study was conducted to determine the prevalence of hypertension and diabetes in rural districts in the Ashanti region of Ghana and to determine factors that influence utilization of health care services.SettingOffinso North, Amansie West, Ahafo Ano South, and Asante Akim South.MethodsA population based prospective cross-sectional study comprising of adults aged 18 years and above was carried out from January 2016 to March 2016. A multistage sampling method was employed to select four rural districts in the Ashanti region of Ghana. A structured questionnaire was used to collect primary data from respondents.ResultsA total of 684 participants were recruited in the study. The prevalence of hypertension and diabetes was found to be 16.23% and 5.41% respectively. The prevalence of diabetes and hypertension comorbidity was 1.61%. The public hospital was the most preferred choice of facility (52.56%) for patients with NCDs.Educational level significantly decreased the likelihood of seeking healthcare in OTCMS and Health Centre to Hospitals (RRR = 0.1, 95% CI = 0.011–0.917, p = 0.042) and (RRR = 0.4, 95% CI = 0.198-0.679, p = 0.001) respectively.ConclusionThe prevalence of self -reported hypertension and diabetes observed in this study was relatively lower for hypertension and higher for diabetes as compared to other studies in Ghana. The public hospital is the most preferred choice of health facilities for patients with hypertension and diabetes in the rural districts.

The Effect of Health Service Quality on Health Facility Choice and Health Outcomes in Malawi

We study the impact of health care service quality on health facility choice and health outcomes in Malawi. We use Malawi Demographic and Health Survey (MDHS) 2015 and Malawi Service Provision Assessment (MSPA) 2013-2014 to examine the effect. MSPA provides many useful health care service quality information that has not been examined much in the previous studies. We create health care service quality measures to represent infrastructure quality, medical supplies quality and health facility management quality. We examine the impact of these quality measures on the demand for health services and health outcomes. We find that people who live closer to quality health facilities are more likely to utilize health services such as facility delivery. However, we do not find strong and significant evidences that healthcare quality is associated with positive health outcomes due to the insufficient data and the weak identification strategies.

SOCIAL SUPPORT AND HEALTHCARE-SEEKING BEHAVIOR OF OLDER PERSONS IN NIGERIA

The choice of healthcare facility by older persons is an important factor in their healthcare seeking behavior, and this can be associated with a number of factors. This study investigated the relationship between social support and healthcare facility choice of older persons in Nigeria. Other factors associated with the choice of healthcare facilities by older persons were also identified. Quantitative data were collected from a sample of 3,696 elderly aged 60 years above (55.6% male; 44.4% females; mean age = 69.2, SD = 8.60) who were selected through multi-stage systematic random sampling. Binary logistic regression analysis revealed that older persons who received social support were more likely to seek treatment in formal healthcare facilities, while older persons who did not receive any form of social support were more likely to seek treatment in informal healthcare facilities. Membership of social or religious groups was found to be a predictor of health seeking behavior among the older adults. Sex, age, level of education, and ability to handle activities of daily living (ADL), and ease of access to the nearest health facility, were found to be significantly associated with choice of healthcare facilities. The article concludes that there is need for conscious planning to provide formal supports to ease access of older persons to available health facilities. Such facilitation should include financial support and removal of existing physical and cultural barriers to health care utilization by older persons.

Migration status and healthcare seeking behaviours among the Chinese labor-force: a nationally representative study

ObjectivesWe aimed to analyse the healthcare seeking behaviours (HSB) of populations with different migration status and examine the relationship between migration status and HSB.DesignA secondary analysis of cross-sectional data of...

Measurement Error in Discrete Health Facility Choice Models: an Example from Urban Senegal.

We use individual-level health facility choice data from urban Senegal to estimate consumer preferences for facility characteristics related to maternal health services. We find that consumers consider a large number of quality related facility characteristics, as well as travel costs, when making their health facility choice. In contrast to the typical assumption in the literature, our findings indicate that individuals frequently bypass the facility nearest their home. In light of this, we show that the mismeasured data used commonly in the literature produces biased preference estimates; most notably, the literature likely overestimates consumer distaste for travel.

Abortion care seeking in India: patterns and predictors.

Unsafe abortions remain a considerable public health problem and continue to be a leading cause of maternal morbidity and mortality throughout the world. This study assessed whether women's choice of type of health care facility for abortion in India varied by their socio-demographic and economic characteristics, and aimed to determine the significant predictors of choice of health care facility. Data were taken from the 2015-16 Indian National Family and Health Survey (NFHS-4). The study sample included women aged 15-49 years, irrespective of their marital status, who had terminated their last pregnancy by induced abortion in the five years before the survey (N = 6876). A bivariate analysis was carried out to assess the pattern in the choice of health care facility type for an abortion, and a multinomial logistic regression model was fitted to assess the predictors affecting the choice of health care facility type for an abortion. The results showed that, at the time of the 2015-16 survey, women in India went to private facilities more than public facilities for abortion care, irrespective of their age, distance to facility and financial constraints. The probability of visiting a private facility increased with women's age, gestational age and the wealth quintile. A wide variation in choice of health facility for abortion care by socioeconomic characteristics was observed.

SAĞLIK HİZMETLERİ TALEBİNİN NESTED MULTİNOMİNAL LOGİT MODEL İLE ANALİZİ: KAYSERİ İLİNDE BİR UYGULAMA

Determining the factors affecting the demand for healthcare services are important in terms of providing health services more effectively and a more efficient health system. In addition, effective provision of healthcare services is an important element in terms of basic socio-economic development of countries. The primary aim of this study is to determine the factors which affect the demand for healthcare services. In that framework, factors related to household’s choice of applying to a healthcare facility because of a health problem and the factors related to household’s healthcare facility choice are investigated using the data collected in Kayseri province with survey method. Within the scope of the study, Nested Logit Model was implemented to the data set using Full Information Maximum Likelihood (FIML) technique which estimates both decision levels simultaneously. According to the results obtained, the factors which affect the choice of applying to the healthcare facility were found as the educational level of the household head, severity of the disease and some health problem complaints. Among the factors which affect healthcare facility choice, educational level of the patient reduces the likelihood of applying to both public and private healthcare facilities. Furthermore, likelihood of applying to public healthcare facilities reduces with the age of the patient.

Utilization of decentralized health facilities and factors influencing women's choice of a delivery site in Gida Ayana Woreda, western Ethiopia.

IntroductionDespite the government’s efforts to decentralize and expand health institutions to promote facility-based child delivery, home delivery and maternal mortality are still widespread problems in Ethiopia. Most mothers continue to give birth at home. This study aims at identifying the socio-cultural practices, perceived benefit or need, and accessibility factors influencing women’s choice of health facilities for delivery services in Gida Ayana Woreda, western Ethiopia.MethodsWe conducted a cross-sectional survey to assess women’s use of delivery care services in Gida Ayana Woreda, from November 2016 to January 2017; 459 women who were selected randomly participated in the study. We evaluated the socio-cultural, perceived benefit or need, and economic and physical accessibility factors in women’s choice of delivery care and used adjusted logistic regression analysis to examine significant predictors of delivery site use decisions.ResultsOver half (56.6%) of the women self-reported using institutional delivery care; 80.9% gave birth at a health center. A socio-cultural variable, maternal education, significantly influenced women’s choice of health facility for delivery care services (AOR 3.4; 95% CI 2.0–5.9). Mothers’ knowledge level of obstetric complications and experience of complications during the last birth were the two perceived benefits or need factors associated with higher odds of receiving delivery care from decentralized local facilities. Utilization of health centers for maternal delivery care was significantly higher than of health posts (AOR 5.0; 95% CI 2.4–10.2). Availability of motorized transportation during labor to nearby delivery site was a significant predictor of institutional delivery.ConclusionThis study demonstrates the under-utilization of decentralized health facilities for maternal delivery care services in Gida Ayana Woreda, which was significantly influenced by socio-cultural, perceived need, and accessibility factors of women during childbirth. This suggests the need for tailored intervention to improve childbirth services use for mothers in this kind of rural settings.

Clinical communication and caregivers\u2019 satisfaction with child healthcare in Nepal; results from Nepal Health Facility Survey 2015

BackgroundPatient satisfaction is an important measure of quality of care and a determinant of health service utilisation and the choice of health facility. Measuring patients’ experiences is important for understanding and improving the quality of care at health facilities. The aim of this study was to assess levels and identify associated factors of caregivers’ satisfaction and provider-caregiver communication within child healthcare in Nepal.MethodsSecondary analysis of Sick Child Exit Interviews (n = 2092) sourced from 2015 Nepal Health Facility Survey data. Satisfaction was measured through caregivers’ satisfaction with services received and their willingness to recommend the health facility visited. Communication indicators were chosen based on the 2014 WHO IMCI guidelines and aggregate communication scores were calculated based on the number of indicators acknowledged during assessments. Logistic regression was used for analysis.ResultsAlthough most respondents (82.1%) reportedly were satisfied with the care provided, only 35.9% experienced good communication with their providers. Caregivers who had ever attended school were more likely to be satisfied with services (1.44, CI 95% 1.04–1.99). Type of provider, sex of child or who the caregiver was had no association with caregivers’ satisfaction. Having been given a diagnosis doubled the chances of satisfaction (AOR 2.04, 95% CI 1.38–3.00), as did discussion of the child’s growth (OR 1.71, 95% CI 1.06–2.76) and having discussed any of the included topics (AOR 1.98, CI 95% 1.14–3.45).ConclusionsInterventions to improve healthcare staff’s communication skills are needed in Nepal to further enhance satisfaction with services and increase quality of care. However, this is an area that need further investigation given the high levels of satisfaction displayed despite poor communication. Other factors in the health care exchange between provider and clients are influencing the level of satisfaction and need to be identified and promoted further. High-quality care is no longer a goal for the future or only for high income settings; it is essential for reaching global health goals.

Bypassing health facilities in rural Mozambique: spatial, institutional, and individual determinants

BackgroundAccess to sexual and reproductive health (SRH) services is critical for such outcomes as pregnancy and birth, prenatal and neonatal mortality, maternal morbidity and mortality, and prevention of vertical transmission of infections like HIV. Health facilities are typically set up where they can efficiently serve the nearby targeted population. However, the actual utilization of health care can be complicated as people sometimes bypass the closest or nearby facilities for various reasons such as service quality. A better understanding of how people actually utilize health services can benefit future health resource allocation as well as health program planning.MethodsIn this study, we use prenatal care as an example of a basic, widely available service to investigate women’s choice and bypassing of SRH facilities as well as potential influencing factors at the geographic, clinic, household, and individual levels. The data come from a population-based survey of women of reproductive age in rural Mozambique. The spatial pattern of utilization of health clinics for prenatal care is explored by geographical information system (GIS)-based spatial analysis. Logistic regression is fitted to test the hypotheses regarding the effect of distance, service quality, and household/individual-level factors on the bypassing of the nearest clinic.ResultsThe results indicate that most women living near clinics tend to utilize the closest facilities for prenatal care and those who travel farther mainly do so to seek better services. Further, for women who live far from a clinic (> 5.5 km), service quality still plays an important role in the facility bypassing while the effect of distance is no longer significant. The bypassing of nearest facility is also affected by individual characteristics such as age, HIV status, and household economic conditions.ConclusionsThe findings help to better understand health facility choice and bypassing in developing settings, in general, and in resource-limited Sub-Saharan settings, in particular. They offer valuable guidance for future health resource allocation and health service planning.

Factors influencing the choice of health system access level in China: a systematic review

BackgroundIn China, patients increasingly choose to access severely overcrowded higher level hospitals, whereas the lower level facilities often have low frequencies of use. This situation undermines effectiveness and efficiency of the health system. Moreover, the situation tends to worsen despite policy measures aimed at improvement. We therefore aimed to systematically review the factors affecting patient choice of health system access in China to synthesise scientific understanding. MethodsWe did a systematic review of peer-reviewed literature that investigated Chinese patients' choice of health-care facilities at different levels. We searched Embase, MEDLINE, Web of Science, and PubMed for English language articles, and three large Chinese databases (CNKI, VIP, and Wanfang) for articles in Chinese between April 1, 2009, and Jan 28, 2016, using search terms related to patients' choice of health-care facility access level, and how these factors affect the choice of level, such as health care access, decision making in health care, and health seeking behaviour. The primary outcome was to identify the factors that influenced patient choices of health system access level in China. Two structured forms were used to extract data from eligible studies, regarding the study characteristics, methodology, and factors. We appraised the methodological quality of the studies using Method Appraisal Tool (MMAT). FindingsWe identified and included 45 studies into our analysis. We identified four types of factors related to patient, provider, context, and composite factors from multiple types. Patient factors are mentioned in 31 (69%) of 45 studies, but the evidence on patient factors is mostly inconclusive. Context factors were the least frequently mentioned, and were reported in four (9%) studies. Evidence suggests that the provider factors, such as drug variety and equipment, and composite factor, such as perceived quality, push patients from lower levels towards higher levels. The MMAT quality score was 100% for 13 studies, 75% for 25 studies, 50% for six studies, and 25% for one study. InterpretationThis systematic review provides an evidence base for measures to redirect patient flow from high level health-care facilities to lower level facilities, thus improving effectiveness and efficiency of the Chinese health system. The underuse of primary care facilities in the Chinese health system compromises the effectiveness and efficiency, and are likely to be amplified by current demographic trends. Evidence suggests that improving the drug availability, equipment, and perceived quality of primary care services can improve the situation. Our evidence suggests that further experimental research is needed, which also considers interactions between factors. FundingThis study was partly funded by the China Scholarship Council (grant number 201507720036).

Factors influencing choice of health system access level in China: A systematic review.

ObjectiveIn China, patients increasingly choose to access already severely overcrowded higher level hospitals, leaving lower level facilities with low utilization rates. This situation undermines the effectiveness and efficiency of the health system. The situation tends to worsen despite policy measures aimed at improvement. We systematically review the factors affecting patient choice to synthesize scientific understanding of health system access in China. The review provides an evidence base for measures to direct patient flow towards lower level facilities.MethodsWe screened the peer-reviewed literature published from April 2009 to January 2016 that investigates Chinese patients’ choice of health care facilities at different levels and assessed 45 studies in total. We applied two structured forms to extract data on each study’s characteristics, methodology, and factors.Results of data synthesisThe results identified four factor types: 1) patient, 2) provider, 3) context and 4) composite: combined patient, provider, and/or context attributes. Patient factors are mentioned the most, but the evidence on patient factors is often inconclusive. Evidence suggests that the provider factors ‘drug variety’ and ‘equipment’, and composite factor ‘perceived quality’, push patients from lower levels towards higher levels.ConclusionUnderuse of primary care facilities and overcrowding of higher level facilities will likely be amplified by current demographic trends. Evidence suggests that improving drug availability, equipment and perceived quality of primary care services can improve the situation. Well-designed research that considers the interactions between factors is called for to better inform future interventions.

Perception of Factors Influencing Primary Health-Care Facility Choice Among National Health Insurance Enrollees of a Northwest Nigerian Hospital.

Background:The National Health Insurance Scheme (NHIS) of Nigeria was designed to eliminate known cultural, physical, and resource-related barriers to quality health-care access. Although choice of primary health-care facility (PHF) remains in the domain of the scheme enrollees, little is known about factors influencing their choice. Hence, the study of the perception of factors influencing PHF choice among NHIS enrollees of a northwest Nigerian hospital becomes imperative.Methods:This was a cross-sectional study of 284 principal enrollees randomly selected from patients attending the NHIS clinic of Aminu Kano Teaching Hospital, Kano, Nigeria, using a designed, pretested, investigator-administered questionnaire. Their sociodemographics and factors influencing their choice of the clinic were assessed.Results:Respondents’ mean age was 40.9 ± 9.0 years and they were predominantly males (83.1%) with tertiary education. Median distance between their homes and PHF was 7.6 ± 12.5 km. Most respondents were aware of other accredited PHFs in the city and believed it was their right to choose a PHF. Among the various factors influencing their choice of index PHF were better functioning equipment (83.5% of respondents), more specialists/trained health workers (78.5%), ease in receiving specialist care (69.4%), and better overall quality of care (78.9%).Conclusion:There are multiple factors associated with enrollee choice of PHF in this study. The NHIS enrollees value the presence of functioning equipment/facilities, ease in receiving specialist care, and overall high quality of care in their choice of PHF. Improving enrollee enrollment at accredited PHF may require addressing these factors.

The impact of cigarette smoking on healthcare utilization among rural residents in China

ABSTRACTObjectives: To assess how cigarette smoking affects health care utilization among rural residents in China and to analyze the choice of health facility among current and former smokers in rural China.Methods: This study employed three waves (2010–2014) of the China Family Panel Studies. The data set included 10,330 adults in each wave. Fixed effect and random effect logistic models and multinomial logistic model were used for data analysis.Results: First, according to the fixed effect logistic model, the results showed that current and former smokers are positively (ORs > 1) and significantly associated with outpatient care. Moreover, former smokers are positively (ORs > 1) and significantly associated with inpatient utilization. Second, based on the random effect logistic model, the results illustrated that heavy smokers and long-term quitters are positively (ORs > 1) and significantly related to outpatient care, and former smokers are positively (ORs > 1) and significantly associated with inpatient utilization.Conclusions: Firstly, the present study found that current and former smokers use more outpatient care than non-smokers. Moreover, former smokers use more inpatient care than non-smokers. Secondly, former smokers use more inpatient care than non-smokers, long-term quitters decrease the probability of using inpatient care compared with recent and moderate-term quitters.

Demand for social health insurance: Evidence from the Chinese New Rural Cooperative Medical Scheme

This paper assesses the determinants of the enrolment in the New Rural Cooperative Medical Scheme (NRCMS), a heavily subsidized voluntary health insurance scheme in rural China. The analyses focus on the relationship between insurance purchase and health facility choice based on data drawn from the China Health and Nutrition Survey (CHNS). The results show that households from villages that reported use of village clinics are more likely to be insured compared with households from villages that reported use of county hospitals. The results indicate that the perception of quality of care is an important factor affecting people's enrolment decisions. The NRCMS is expected to help patients obtain better quality health services from higher-tier of the healthcare system that are unaffordable otherwise. However, given the prevailing fee-for-service payment mechanism for health care, the insurance may also drive up the healthcare cost and direct patients to use more expensive and unnecessary hospital care.