The Mixed Effect of China's New Health Care Reform on Health Insurance Coverage and the Efficiency of Health Service Utilisation: A Longitudinal Approach
The Mixed Effect of China's New Health Care Reform on Health Insurance Coverage and the Efficiency of Health Service Utilisation: A Longitudinal Approach
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DOI：
10.3390/ijerph17051782
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发表时间：
2020-03-01
影响因子：
--
通讯作者：
Gao, Jing
中科院分区：
文献类型：
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作者：
Chen, Jiaqi;Xu, Song;Gao, Jing
2009年，中国启动了新一轮医疗改革，努力建立分级诊疗制度，促进医疗资源整合。这对提高服务能力和建立医疗联盟至关重要，最终将提高卫生服务的利用效率。然而，尽管2009年的改革旨在为所有公民提供全民医疗保险，但其对医疗服务利用效率的总体影响仍不清楚。本研究采用中国健康与营养调查（CHNS）数据，通过纵向研究，采用差异中差异（DID）方法估计新医改对医疗保险覆盖率的影响，检验新医改的混合效应。在此基础上，研究了医疗保险覆盖率的提高是否会影响中国的卫生服务利用效率。我们的研究结果表明，保险覆盖率的提高确实使低收入者能够获得昂贵的医疗服务。然而，这也增加了使用医院而不是初级保健设施的可能性，因为门诊有更多的保险，这导致对优质服务的需求增加。这种影响对医疗保健的利用产生了负面影响，直接关系到系统效率低下。因此，这项研究表明，中国最新的卫生改革需要进一步的政策，以提高其整体效率。
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.