An evaluation experiment on the causal effects of differentiated medical insurance reimbursement on medical choice and medical expenses.
- 1Affiliated Stomatological Hospital of Nanchang University, Nanchang, Jiangxi, China.
Abstract
Introduction
Uneven distribution of health-care resources and rising medical spending have kept medical-insurance reform high on China's policy agenda. This study examines whether differentiated reimbursement can redirect patients toward lower-level providers and moderate the cost of care.Methods
We used provincial health-insurance claims, institutional operating records, and a patient-behavior survey covering December 2022 to August 2024. A difference-indifferences model was used to estimate policy effects, followed by mechanism and heterogeneity analyses.Results
Higher reimbursement rates for primary and secondary institutions increased the probability of choosing these providers. The association operated mainly through a lower out-of-pocket share and improved primary-care service capacity. Responses were stronger among patients with chronic conditions, older patients, and lower-income groups, whereas acute and severe cases continued to rely largely on tertiary hospitals. The policy also reduced average per-visit costs and individual payment burdens, although provider responses at some tertiary hospitals may attenuate the cost-control effect.Discussion
Differentiated reimbursement appears useful for supporting hierarchical care, but it is unlikely to establish a mature hierarchical medical system by itself. It should be combined with primary-care capacity building, clearer referral pathways, and payment-system reform.
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BibTeX
@article{zhao2026evaluation,
title = {{An evaluation experiment on the causal effects of differentiated medical insurance reimbursement on medical choice and medical expenses.}},
author = {Zihan Zhao},
journal = {Frontiers in public health},
year = {2026},
month = oct,
doi = {10.3389/fpubh.2026.1907092},
url = {https://europepmc.org/article/MED/42903309},
note = {CC BY},
}
RIS
TY - JOUR
TI - An evaluation experiment on the causal effects of differentiated medical insurance reimbursement on medical choice and medical expenses.
AU - Zihan Zhao
PY - 2026
DA - 2026/10/06
JO - Frontiers in public health
DO - 10.3389/fpubh.2026.1907092
UR - https://europepmc.org/article/MED/42903309
AB - Introduction Uneven distribution of health-care resources and rising medical spending have kept medical-insurance reform high on China's policy agenda. This study examines whether differentiated reimbursement can redirect patients toward lower-level providers and moderate the cost of care.Methods We used provincial health-insurance claims, institutional operating records, and a patient-behavior survey covering December 2022 to August 2024. A difference-indifferences model was used to estimate policy effects, followed by mechanism and heterogeneity analyses.Results Higher reimbursement rates for primary and secondary institutions increased the probability of choosing these providers. The association operated mainly through a lower out-of-pocket share and improved primary-care service capacity. Responses were stronger among patients with chronic conditions, older patients, and lower-income groups, whereas acute and severe cases continued to rely largely on tertiary hospitals. The policy also reduced average per-visit costs and individual payment burdens, although provider responses at some tertiary hospitals may attenuate the cost-control effect.Discussion Differentiated reimbursement appears useful for supporting hierarchical care, but it is unlikely to establish a mature hierarchical medical system by itself. It should be combined with primary-care capacity building, clearer referral pathways, and payment-system reform.
SN - 2296-2565
ER -