<p>Out-Patient Service and in-Patient Service: The Impact of Health Insurance on the Healthcare Utilization of Mid-Aged and Older Residents in Urban China</p>

Abstract

Purpose: Medical insurance is a disease risk-sharing mechanism that can improve residents' financial access to medical treatment and thus increase their utilization of health services. This paper aims to identify the impact of different kinds of medical insurances on the use of healthcare for Chinese mid-aged and older urban residents from four aspects: outpatient behaviour, outpatient costs, inpatient behaviour and inpatient costs. Materials and Methods: The data used in this study were from 2015 China Health and Retirement Longitudinal Study (CHARLS) conducted by Peking University. Binary logit model and multiple linear regression model were used to analyse the impact of health insurance on the use of healthcare, and the PSM method was used to test the robustness of the results. Results: Participating in either BMIUSE or BMISURR can significantly improve all kinds of healthcare utilization for mid-aged and older urban groups. However, there are huge differences on the healthcare utilization between BMISUE and BMISURR. Specifically, the probability of using inpatient care and inpatient costs of urban residents enrolled in the BMISUE are 4.2% and 45% higher, respectively, than those covered by the BMISURR, but there are no differences in outpatient care utilization and outpatient costs between these two health insurance programs. Conclusion: This paper suggests that the large gaps between BMISUE and BMISURR only reflect on inpatient care and inpatient costs, there is no difference in outpatient services between these two health insurance programs. "Excessive demand", "induced demand" and other moral hazard phenomena in BMISUE should be avoided when receiving hospitalization services.

Effects of Social Participation by Middle-Aged and Elderly Residents on the Utilization of Medical Services: Evidence From China

“…This research included two types of services for medicine utilization: (1) outpatient visits: we asked participants whether they had visited a hospital, public health center, clinic, or were seen by health workers or doctors for outpatient care, last month; (2) inpatient visits: participants who had received inpatient care in the past year ( 22 ). The variables of outpatient and inpatient utilization was the classification variable (1 = yes, 0 = no).…”

“…(2) inpatient visits: participants who had received inpatient care in the past year (22). The variables of outpatient and inpatient utilization was the classification variable (1 = yes, 0 = no).…”

Can supplementary private health insurance further supplement health

“…Therefore, a good insurance system is crucial to obtain high-quality medical services and improve health ( 1 ). China has developed the world's largest medical security system, with government-led SHI covering 1.36 billion people, accounting for over 95% of the country's population ( 2 , 3 ). However, due to the limited pool of SHI funds, the National Healthcare Security Administration haslimited the scope of SHI reimbursement for drugs, treatment items and medical service facilities, and formulated the deductibles, copayments, and maximum allowable costs ( 4 , 5 ), making it difficult for SHI to meet the growing health needs of the population and limiting the ability of SHI to withstand catastrophic health expenditure.…”

Why Not Blow the Whistle on Health Care Insurance Fraud? Evidence from Jiangsu Province, China

“…Under a fee-for-service payment system with third-party payers, the institution or physician may prefer to increase the number of medical services they offer to obtain higher returns through practices such as falsifying patient diagnoses, billing for services not performed, and treating "ghost patients." [8][9][10][11][12] In a new kind of fraud known as conspiracy, insured patients collude with their physicians to co-opt profits by preparing beds for hospitalization and exchanging self-pay items for health care insurance settlement projects. [13][14][15][16] Fraud is not only a gross waste of health care resources but also severely hampers access to quality and safe care for patients with genuine needs, thus making a crackdown on it an urgent necessity.…”