Effect of Integrated Urban and Rural Residents Medical Insurance on the Utilisation of Medical Services by Residents in China: a Propensity Score Matching with Difference-in-differences Regression Approach

Overview

Journal BMJ Open

Specialty General Medicine

Date 2019 Feb 21

PMID 30782944

Citations 23

Authors

Dai Su

Ying-Chun Chen

Hong-Xia Gao

Hao-Miao Li

Jing-Jing Chang

Di Jiang

Xiao-Mei Hu

Shi-Han Lei

Min Tan

Zhi-Fang Chen

Affiliations

Soon will be listed here.

Abstract

Objectives: In this study, we aim to evaluate the effect of urban and rural resident medical insurance scheme (URRMI) on the utilisation of medical services by urban and rural residents in the four pilot provinces.

Setting And Participants: The sample used in this study is 13 305 individuals, including 2620 in the treatment group and 10 685 in the control group, from the 2011 and 2015 surveys of China Health and Retirement Longitudinal Study.

Outcome Measures: Propensity score matching and difference-in-differences regression approach (PSM-DID) is used in the study. First, we match the baseline data by using kernel matching. Then, the average treatment effect of the four outcome variables are analysed by using the DID model. Finally, the robustness of the PSM-DID estimation is tested by simple model and radius matching.

Results: Kernel matching have improved the overall balance after matching. The URRMI policy has significantly reduced the need-but-not outpatient care and significantly increased outpatient care cost and inpatient care cost for rural residents, with DID value of -0.271, 0.090 and 0.256, respectively. After robustness test, the DID competing results of four outcome variables are consistent.

Conclusions: URRMI has a limited effect on the utilisation of medical and health services by all residents, but the effect on rural residents is obvious. The government should establish a unified or income-matching payment standard to prevent, control the use of medical insurance funds and increase its efforts to implement URRMI integration in more regions to improve overall fundraising levels.

Citing Articles

Patterns of intrinsic capacity trajectory and onset of activities of daily living disability among community-dwelling older adults.

Zhang S, Wu S, Guo R, Ding S, Wu Y J Glob Health. 2024; 14:04159.

PMID: 39392073 PMC: 11467824. DOI: 10.7189/jogh.14.04159.

Impact of urban and rural residents medical insurance on self-rated health of residents in China: a panel study from the China family panel studies national baseline survey.

Si-Yuan Y, Ya-Ting C, Xiao-Yue X, Dan W, Xin-Hao L, Wen L Front Public Health. 2024; 12:1349416.

PMID: 39045157 PMC: 11264337. DOI: 10.3389/fpubh.2024.1349416.

Patients' and Care Professionals' Evaluation of the Effect of a Hospital Group on Integrated Care in Chinese Urban Health Systems: A Propensity Score Matching and Difference-in-differences Regression Approach.

Wang X, Zheng C, Wang Y, Birch S, Huang Y, Valentijn P Int J Health Policy Manag. 2024; 12:7897.

PMID: 38618775 PMC: 10843371. DOI: 10.34172/ijhpm.2023.7897.

Does the integration of urban and rural health insurance influence the functional limitations of the middle-aged and elderly in rural China?.

Hao H, Yeo Y SSM Popul Health. 2023; 23:101439.

PMID: 37287716 PMC: 10241964. DOI: 10.1016/j.ssmph.2023.101439.

Impacts of unifying urban and rural residents' medical insurance on the hospitalisation expenses of rural patients in eastern China: an interrupted time series analysis.

Qin Z, Liu S, Zhou M, Chen L, Huang W, Shen L BMJ Open. 2023; 13(5):e067198.

PMID: 37230522 PMC: 10230915. DOI: 10.1136/bmjopen-2022-067198.

References

Wang Q, Zhang D, Hou Z . Insurance coverage and socioeconomic differences in patient choice between private and public health care providers in China. Soc Sci Med. 2016; 170:124-132. DOI: 10.1016/j.socscimed.2016.10.016. View

You X, Kobayashi Y . The new cooperative medical scheme in China. Health Policy. 2009; 91(1):1-9. DOI: 10.1016/j.healthpol.2008.11.012. View

Baser O . Too much ado about propensity score models? Comparing methods of propensity score matching. Value Health. 2006; 9(6):377-85. DOI: 10.1111/j.1524-4733.2006.00130.x. View

Chi-Man Yip W, Hsiao W, Chen W, Hu S, Ma J, Maynard A . Early appraisal of China's huge and complex health-care reforms. Lancet. 2012; 379(9818):833-42. DOI: 10.1016/S0140-6736(11)61880-1. View

Gebel M, Vossemer J . The impact of employment transitions on health in Germany. A difference-in-differences propensity score matching approach. Soc Sci Med. 2014; 108:128-36. DOI: 10.1016/j.socscimed.2014.02.039. View

Mou J, Cheng J, Zhang D, Jiang H, Lin L, Griffiths S . Health care utilisation amongst Shenzhen migrant workers: does being insured make a difference?. BMC Health Serv Res. 2009; 9:214. PMC: 2788549. DOI: 10.1186/1472-6963-9-214. View

Andersen R . Revisiting the behavioral model and access to medical care: does it matter?. J Health Soc Behav. 1995; 36(1):1-10. View

Wang H, Liu Z, Zhang Y, Luo Z . Integration of current identity-based district-varied health insurance schemes in China: implications and challenges. Front Med. 2012; 6(1):79-84. DOI: 10.1007/s11684-012-0179-5. View

Ding L, Wu J . The Impact of China's National Essential Medicine Policy and Its Implications for Urban Outpatients: A Multivariate Difference-in-Differences Study. Value Health. 2017; 20(3):412-419. DOI: 10.1016/j.jval.2016.10.018. View

10.

Chen W, Zhang Q, Renzaho A, Zhou F, Zhang H, Ling L . Social health insurance coverage and financial protection among rural-to-urban internal migrants in China: evidence from a nationally representative cross-sectional study. BMJ Glob Health. 2017; 2(4):e000477. PMC: 5652549. DOI: 10.1136/bmjgh-2017-000477. View

11.

Lin X, Cai M, Tao H, Liu E, Cheng Z, Xu C . Insurance status, inhospital mortality and length of stay in hospitalised patients in Shanxi, China: a cross-sectional study. BMJ Open. 2017; 7(7):e015884. PMC: 5642755. DOI: 10.1136/bmjopen-2017-015884. View

12.

Pan X, Xu J, Meng Q . Integrating social health insurance systems in China. Lancet. 2016; 387(10025):1274-5. DOI: 10.1016/S0140-6736(16)30021-6. View

13.

Zhu K, Zhang L, Yuan S, Zhang X, Zhang Z . Health financing and integration of urban and rural residents' basic medical insurance systems in China. Int J Equity Health. 2017; 16(1):194. PMC: 5678764. DOI: 10.1186/s12939-017-0690-z. View

14.

Meng Q, Fang H, Liu X, Yuan B, Xu J . Consolidating the social health insurance schemes in China: towards an equitable and efficient health system. Lancet. 2015; 386(10002):1484-92. DOI: 10.1016/S0140-6736(15)00342-6. View

15.

Eggleston K, Ling L, Qingyue M, Lindelow M, Wagstaff A . Health service delivery in China: a literature review. Health Econ. 2007; 17(2):149-65. DOI: 10.1002/hec.1306. View

16.

Basu S, Andrews J, Kishore S, Panjabi R, Stuckler D . Comparative performance of private and public healthcare systems in low- and middle-income countries: a systematic review. PLoS Med. 2012; 9(6):e1001244. PMC: 3378609. DOI: 10.1371/journal.pmed.1001244. View

17.

Wagstaff A, Lindelow M, Jun G, Ling X, Juncheng Q . Extending health insurance to the rural population: an impact evaluation of China's new cooperative medical scheme. J Health Econ. 2008; 28(1):1-19. DOI: 10.1016/j.jhealeco.2008.10.007. View

18.

Lei X, Lin W . The New Cooperative Medical Scheme in rural China: does more coverage mean more service and better health?. Health Econ. 2009; 18 Suppl 2:S25-46. DOI: 10.1002/hec.1501. View

19.

Qiu P, Yang Y, Zhang J, Ma X . Rural-to-urban migration and its implication for new cooperative medical scheme coverage and utilization in China. BMC Public Health. 2011; 11:520. PMC: 3142513. DOI: 10.1186/1471-2458-11-520. View

20.

Meng Q, Xu L, Zhang Y, Qian J, Cai M, Xin Y . Trends in access to health services and financial protection in China between 2003 and 2011: a cross-sectional study. Lancet. 2012; 379(9818):805-14. DOI: 10.1016/S0140-6736(12)60278-5. View