IDEAS home Printed from https://ideas.repec.org/a/eee/socmed/v268y2021ics0277953620305918.html
   My bibliography  Save this article

Evaluating the effect of hierarchical medical system on health seeking behavior: A difference-in-differences analysis in China

Author

Listed:
  • Zhou, Zhongliang
  • Zhao, Yaxin
  • Shen, Chi
  • Lai, Sha
  • Nawaz, Rashed
  • Gao, Jianmin

Abstract

The unbalanced allocation of healthcare resources and the underutilization of primary care facilities are the core problems that restrict the current healthcare reforms in China. In order to encourage residents to go to primary care facilities, China implemented the Hierarchical Medical System (HMS) in 2015. This study aims to evaluate the effect of HMS on health seeking behavior in China using panel data. Statistics for the study were derived from China Family Panel Studies (CFPS) 2012, 2014, 2016 and 2018, and China health and family planning statistical yearbook 2012, 2014, 2016 and 2018. We employed the difference-in-differences (DID) model with multiple periods. In total, 61,932 residents were incorporated for a final sample covered 25 provinces. The results indicated that the implementation of HMS had a significantly positive effect on the probability of urban residents going to primary care facilities for contact. However, the effect of HMS was not significant for rural residents. Basic health insurance was a significant factor for directing residents to primary care facilities. Self-assessed health, chronic disease, economic level and educational status were also found to be focal factors of health seeking behavior. In conclusion, the introduction of HMS has led to improved health seeking behavior and is worth putting more effort into. For policy makers, basic medical insurance is still an important health policy that enables systematic health seeking behavior. Initiatives to continue to expand the adjustment range of economic incentives should be adopted to promote the implementation of HMS. However, the effect of HMS in chronic disease is poor and efforts to formulate chronic disease as a breakthrough to HMS should be carried out. Moreover, the government should increase the publicity of HMS.

Suggested Citation

  • Zhou, Zhongliang & Zhao, Yaxin & Shen, Chi & Lai, Sha & Nawaz, Rashed & Gao, Jianmin, 2021. "Evaluating the effect of hierarchical medical system on health seeking behavior: A difference-in-differences analysis in China," Social Science & Medicine, Elsevier, vol. 268(C).
    • Handle: RePEc:eee:socmed:v:268:y:2021:i:c:s0277953620305918
    DOI: 10.1016/j.socscimed.2020.113372
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0277953620305918
    Download Restriction: Full text for ScienceDirect subscribers only
    File URL: https://libkey.io/10.1016/j.socscimed.2020.113372?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Dündar, Cihad, 2017. "Health-seeking behavior and medical facility choice in Samsun, Turkey," Health Policy, Elsevier, vol. 121(9), pages 1015-1019.
    2. Thorsten Beck & Ross Levine & Alexey Levkov, 2010. "Big Bad Banks? The Winners and Losers from Bank Deregulation in the United States," Journal of Finance, American Finance Association, vol. 65(5), pages 1637-1667, October.
    3. Herberholz, Chantal & Phuntsho, Sonam, 2018. "Social capital, outpatient care utilization and choice between different levels of health facilities in rural and urban areas of Bhutan," Social Science & Medicine, Elsevier, vol. 211(C), pages 102-113.
    4. Moscelli, Giuseppe & Siciliani, Luigi & Gutacker, Nils & Gravelle, Hugh, 2016. "Location, quality and choice of hospital: Evidence from England 2002–2013," Regional Science and Urban Economics, Elsevier, vol. 60(C), pages 112-124.
    5. Luyu Zhang & Gang Cheng & Suhang Song & Beibei Yuan & Weiming Zhu & Li He & Xiaochen Ma & Qingyue Meng, 2017. "Efficiency performance of China's health care delivery system," International Journal of Health Planning and Management, Wiley Blackwell, vol. 32(3), pages 254-263, July.
    6. Qian, Dongfu & Lucas, Henry & Chen, Jiaying & Xu, Ling & Zhang, Yaoguang, 2010. "Determinants of the use of different types of health care provider in urban China: A tracer illness study of URTI," Health Policy, Elsevier, vol. 98(2-3), pages 227-235, December.
    7. Timothy Powell‐Jackson & Winnie Chi‐Man Yip & Wei Han, 2015. "Realigning Demand and Supply Side Incentives to Improve Primary Health Care Seeking in Rural China," Health Economics, John Wiley & Sons, Ltd., vol. 24(6), pages 755-772, June.
    8. Haque, Md Rabiul & Parr, Nick & Muhidin, Salut, 2019. "Parents' healthcare-seeking behavior for their children among the climate-related displaced population of rural Bangladesh," Social Science & Medicine, Elsevier, vol. 226(C), pages 9-20.
    9. Zhang, Yi & Zhou, Zhongliang & Si, Yafei, 2019. "When more is less: What explains the overuse of health care services in China?," Social Science & Medicine, Elsevier, vol. 232(C), pages 17-24.
    10. Giuseppe Moscelli & Luigi Siciliani & Nils Gutacker & Hugh Gravelle, 2016. "Location, quality and choice of hospital: Evidence from England 2002/3 - 2012/13," Working Papers 123cherp, Centre for Health Economics, University of York.
    11. Yun Liu & Qingxia Kong & Shasha Yuan & Joris van de Klundert, 2018. "Factors influencing choice of health system access level in China: A systematic review," PLOS ONE, Public Library of Science, vol. 13(8), pages 1-21, August.
    12. Zhang, Dayong & Li, Jiajia & Han, Phoumin, 2019. "A multidimensional measure of energy poverty in China and its impacts on health: An empirical study based on the China family panel studies," Energy Policy, Elsevier, vol. 131(C), pages 72-81.
    13. Lu, Chen & Zhang, Zixiao & Lan, Xiuting, 2019. "Impact of China's referral reform on the equity and spatial accessibility of healthcare resources: A case study of Beijing," Social Science & Medicine, Elsevier, vol. 235(C), pages 1-1.
    14. He Chen & Tianguang Meng, 2015. "Bonding, Bridging, and Linking Social Capital and Self-Rated Health among Chinese Adults: Use of the Anchoring Vignettes Technique," PLOS ONE, Public Library of Science, vol. 10(11), pages 1-15, November.
    15. Ling Li & Hongqiao Fu, 2017. "China's health care system reform: Progress and prospects," International Journal of Health Planning and Management, Wiley Blackwell, vol. 32(3), pages 240-253, July.
    16. Karan, Anup & Yip, Winnie & Mahal, Ajay, 2017. "Extending health insurance to the poor in India: An impact evaluation of Rashtriya Swasthya Bima Yojana on out of pocket spending for healthcare," Social Science & Medicine, Elsevier, vol. 181(C), pages 83-92.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Zhao, Jie & Zheng, Jianzhong, 2024. "Effective policy research of county and township health sector integration in China: Empirical evidence from the difference-in-differences model," Social Science & Medicine, Elsevier, vol. 348(C).
    2. Si, Yafei & Bateman, Hazel & Chen, Shu & Hanewald, Katja & Li, Bingqin & Su, Min & Zhou, Zhongliang, 2023. "Quantifying the financial impact of overuse in primary care in China: A standardised patient study," Social Science & Medicine, Elsevier, vol. 320(C).
    3. Wei, Zhongyu & Bai, Jianjun & Feng, Ruitao, 2023. "Optimization referral rate design for hierarchical diagnosis and treatment system based on accessibility-utilization efficiency bi-objective collaboration: A case study of China," Social Science & Medicine, Elsevier, vol. 322(C).
    4. Fangye Du & Jiaoe Wang & Haitao Jin, 2021. "Whether Public Hospital Reform Affects the Hospital Choices of Patients in Urban Areas: New Evidence from Smart Card Data," IJERPH, MDPI, vol. 18(15), pages 1-14, July.
    5. Xixi Tao & Jianchu Li & Yang Gu & Li Ma & Wen Xu & Ruojiao Wang & Luying Gao & Rui Zhang & Hongyan Wang & Yuxin Jiang, 2022. "A National Quality Improvement Program on Ultrasound Department in China: A Controlled Cohort Study of 1297 Public Hospitals," IJERPH, MDPI, vol. 20(1), pages 1-11, December.
    6. Lu Chen & Miaoting Cheng, 2022. "Exploring Chinese Elderly’s Trust in the Healthcare System: Empirical Evidence from a Population-Based Survey in China," IJERPH, MDPI, vol. 19(24), pages 1-16, December.
    7. Wang, Tianyu & Wen, Ke & Gao, Qiuming & Sun, Ruochen, 2023. "Small money, big change: The distributional impact of differentiated doctor's visit fee on healthcare utilization," Social Science & Medicine, Elsevier, vol. 339(C).
    8. Awijen, Haithem & Ben Zaied, Younes & Nguyen, Duc Khuong, 2022. "Covid-19 vaccination, fear and anxiety: Evidence from Google search trends," Social Science & Medicine, Elsevier, vol. 297(C).
    9. Shujuan Chen & Yue Li & Yi Zheng & Binglun Wu & Ronita Bardhan & Liqun Wu, 2023. "Technical Efficiency Evaluation of Primary Health Care Institutions in Shenzhen, China, and Its Policy Implications under the COVID-19 Pandemic," IJERPH, MDPI, vol. 20(5), pages 1-21, March.
    10. Xiaojing Hu & Ping Wang, 2022. "Has China’s Healthcare Reform Reduced the Number of Patients in Large General Hospitals?," IJERPH, MDPI, vol. 19(9), pages 1-11, April.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Moscone, Francesco & Siciliani, Luigi & Tosetti, Elisa & Vittadini, Giorgio, 2020. "Do public and private hospitals differ in quality? Evidence from Italy," Regional Science and Urban Economics, Elsevier, vol. 83(C).
    2. Daniel Avdic & Tugba Bueyuekdurmus & Giuseppe Moscelli & Adam Pilny & Ieva Sriubaite, 2018. "Subjective and objective quality reporting and choice of hospital: Evidence from maternal care services in Germany," CINCH Working Paper Series 1803, Universitaet Duisburg-Essen, Competent in Competition and Health.
    3. Christoph Strumann & Alexander Geissler & Reinhard Busse & Christoph Pross, 2022. "Can competition improve hospital quality of care? A difference-in-differences approach to evaluate the effect of increasing quality transparency on hospital quality," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 23(7), pages 1229-1242, September.
    4. Lippi Bruni, Matteo & Ugolini, Cristina & Verzulli, Rossella, 2021. "Should I wait or should I go? Travelling versus waiting for better healthcare," Regional Science and Urban Economics, Elsevier, vol. 89(C).
    5. Martini, Gianmaria & Levaggi, Rosella & Spinelli, Daniele, 2022. "Is there a bias in patient choices for hospital care? Evidence from three Italian regional health systems," Health Policy, Elsevier, vol. 126(7), pages 668-679.
    6. Giuseppe Moscelli & Hugh Gravelle & Luigi Siciliani, 2016. "Market structure, patient choice and hospital quality for elective patients," Working Papers 139cherp, Centre for Health Economics, University of York.
    7. Giuseppe Moscelli & Hugh Gravelle & Luigi Siciliani, 2018. "Effects of Market Structure and Patient Choice on Hospital Quality for Planned Patients," School of Economics Discussion Papers 1118, School of Economics, University of Surrey.
    8. Moscelli, Giuseppe & Gravelle, Hugh & Siciliani, Luigi & Santos, Rita, 2018. "Heterogeneous effects of patient choice and hospital competition on mortality," Social Science & Medicine, Elsevier, vol. 216(C), pages 50-58.
    9. Carrie Colla & Julie Bynum & Andrea Austin & Jonathan Skinner, 2016. "Hospital Competition, Quality, and Expenditures in the U.S. Medicare Population," NBER Working Papers 22826, National Bureau of Economic Research, Inc.
    10. Moscelli, Giuseppe & Siciliani, Luigi & Gutacker, Nils & Cookson, Richard, 2018. "Socioeconomic inequality of access to healthcare: Does choice explain the gradient?," Journal of Health Economics, Elsevier, vol. 57(C), pages 290-314.
    11. Roos, Anne-Fleur & O’Donnell, Owen & Schut, Frederik T. & Van Doorslaer, Eddy & Van Gestel, Raf & Varkevisser, Marco, 2020. "Does price deregulation in a competitive hospital market damage quality?," Journal of Health Economics, Elsevier, vol. 72(C).
    12. Wei, Zhongyu & Bai, Jianjun & Feng, Ruitao, 2023. "Optimization referral rate design for hierarchical diagnosis and treatment system based on accessibility-utilization efficiency bi-objective collaboration: A case study of China," Social Science & Medicine, Elsevier, vol. 322(C).
    13. Moscelli, Giuseppe & Gravelle, Hugh & Siciliani, Luigi & Gutacker, Nils, 2018. "The effect of hospital ownership on quality of care: Evidence from England," Journal of Economic Behavior & Organization, Elsevier, vol. 153(C), pages 322-344.
    14. Mak, Henry Y., 2018. "Managing imperfect competition by pay for performance and reference pricing," Journal of Health Economics, Elsevier, vol. 57(C), pages 131-146.
    15. Avdic, Daniel & Moscelli, Giuseppe & Pilny, Adam & Sriubaite, Ieva, 2019. "Subjective and objective quality and choice of hospital: Evidence from maternal care services in Germany," Journal of Health Economics, Elsevier, vol. 68(C).
    16. Levaggi, Laura & Levaggi, Rosella, 2020. "Is there scope for mixed markets in the provision of hospital care?," Social Science & Medicine, Elsevier, vol. 247(C).
    17. Yan, Hong & Yi, Xing & Jiang, Jiachen & Bai, Caiquan, 2024. "Can information technology construction alleviate household energy poverty? Empirical evidence from the “broadband China” Pilot Policy," Energy Policy, Elsevier, vol. 185(C).
    18. Yun Liu & Qingxia Kong & Shasha Yuan & Joris van de Klundert, 2018. "Factors influencing choice of health system access level in China: A systematic review," PLOS ONE, Public Library of Science, vol. 13(8), pages 1-21, August.
    19. Balia, Silvia & Brau, Rinaldo & Moro, Daniela, 2020. "Choice of hospital and long-distances: Evidence from Italy," Regional Science and Urban Economics, Elsevier, vol. 81(C).
    20. Jureviciene Daiva & Pupelyte Laura, 2013. "Forecasting of the Influence of Financial Institutions Loan Portfolio Change for the Economic Sectors of the Country," Creative and Knowledge Society, Sciendo, vol. 3(1), pages 1-16, July.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:socmed:v:268:y:2021:i:c:s0277953620305918. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.