Health‐seeking behavior and hospital choice in China's New Cooperative Medical System

Abstract

Since the dissolution of the Rural Cooperative Medical System at the end of the commune period, illness has emerged as a leading cause of poverty in rural China. To address the poor state of health care, the Chinese government unveiled the New Cooperative Medical System in 2002. Because local governments have been given significant control over program design, fundamental characteristics of the program vary from one county to the next. These differences may influence the decision to seek health care as well as the choice of hospital conditional on that initial decision. In this paper, we use a nested logit model to analyze household survey data from 25 counties to analyze the determinants of such health-seeking behavior. We find that age, the share of household expenditures allocated to food consumption (a measure of relative income), and the presence of other sick people in the household negatively affect the decision to seek health care while disability has a positive influence. Further, conditional on seeking treatment, the reimbursement scheme in place in each county and the average daily expenditure associated with hospitalization strongly influence hospital choice.

China's Health Reform Update

“…Because there are minimal, if any, gatekeepers to services in hospitals, it is common for tertiary hospitals to provide basic outpatient services on top of broader research and advanced medical services. This expansive service provision, combined with greater public trust in larger public hospitals over local health clinics (4,16,17,60,87), overburdened public hospitals, creating significant systemic inefficiencies. At the same time as China's economy transitioned away from the planned economy beginning in the early 1980s, the government retreated from the financing of services throughout the 1990s (Figure 1) (84).…”

“…Since 2000, many hospitals have consolidated, creating more larger hospitals and fewer township and village clinics (3). Larger hospitals, because of their wider purview including comprehensive primary care and research, are seen by the general public as providing higher-quality services (4,16,17,60,87), which increases demand for their services. This perception creates a vicious cycle of supply and demand that concentrates at the top of the supply hierarchy and overburdens large hospitals.…”

Patient choice modelling: how do patients choose their hospitals?

“…Other authors have employed NL models for hospital choice, e.g. [32] who use a two-level nested multinomial logit model to distinguish between hospital and clinic-based care in rural Tanzania; [8] who have a similar structure with the first decision being made between seeking inpatient care or not and the second level decision being the choice of hospital. A more complex decision process is presented by [28], where there are three levels to the decision process: the first decision is between self-care and formal care, the second between GP, emergency room visit and specialised clinic and the third between NHS, direct payment and private insurance.…”

The Impact of the eHealth Technologies on the Chronically-ill Patient�s choice of Same Hospital Again (Preprint)

“…Chodosh et al [14] and Liu et al [15] found that rather than going to hospital in urban areas, patients with chronic diseases in rural areas are more likely to choose self-treatment by buying medicine themselves, with the objective being to control the disease instead of attempting to cure it, thus reducing the utilisation of health services. Brown and Theoharides [16] used a nested logit model to identify that hospital choice is related to the age of the patient considered, their household income, as well as the expenditure incurred.…”