IDEAS home Printed from https://ideas.repec.org/a/gam/jijerp/v16y2019i22p4316-d284115.html
   My bibliography  Save this article

The Effect of the Full Coverage of Essential Medicines Policy on Utilization and Accessibility of Primary Healthcare Service for Rural Seniors: A Time Series Study in Qidong, China

Author

Listed:
  • Ying Wang

    (Department of Health Policy, School of Health Policy and Management, Nanjing Medical University, Nanjing 211166, China)

  • Yulei Zhu

    (Department of Health Policy, School of Health Policy and Management, Nanjing Medical University, Nanjing 211166, China)

  • Hang Shi

    (Department of Health Policy, School of Health Policy and Management, Nanjing Medical University, Nanjing 211166, China)

  • Xiaoluan Sun

    (Department of Health Policy, School of Health Policy and Management, Nanjing Medical University, Nanjing 211166, China)

  • Na Chen

    (School of Health Economics and Management, Nanjing University of Chinese Medicine, Nanjing 211166, China)

  • Xin Li

    (Department of Health Policy, School of Health Policy and Management, Nanjing Medical University, Nanjing 211166, China
    Department of Clinical Pharmacy, School of Pharmacy, Nanjing Medical University, Nanjing 211166, China
    Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing 211166, China)

Abstract

Background : Since 2015, in order to handle the increasing prevalence of age-related diseases and escalating health expenditures arising from the aging population, the full coverage of essential medicines (FCEMs) policy for rural seniors has been implemented in primary healthcare institutions of Qidong County of Jiangsu, China. The purpose of this study is to examine the long-term effects of the introduction of FCEMs’ policy on the utilization and accessibility of primary healthcare service for elderly beneficiaries. Methods : The retrospective study was conducted in Qidong County in the Jiangsu province, China. A 47-month longitudinal dataset involving 91,444 health insurance claims records of inpatients aged 70 and older in primary healthcare institutions was analyzed. Changes in health service utilization (average length of stay), patient copayments (out-of-pocket expenses), New Rural Cooperative Medical System (NRCMS) reimbursement rate and daily hospitalization costs per patient were analyzed using interrupted time series analysis. Augment Dicky-Fuller unit root method was used to test the stationarity of the series alongside the Durbin Watson method to test autocorrelation. Results : Average length of stay increased at 0.372 bed-days per month before the implementation of FCEMs policy, whereas the increasing trend was slowed down at 0.003 bed-days per month after the implementation of FCEMs policy ( p < 0.001). The average out-of-pocket expenses increased by 38.035 RMB monthly in pre-implementation of the policy period, but it decreased at the rate of 5.180 RMB per month after the implementation of the FCEMs policy ( p = 0.006). The NRCMS reimbursement rate increased at 0.066% per month in pre-implementation of policy and the increasing trend was sharper at 0.349% in post-implementation of policy ( p = 0.135). The daily hospitalization costs per patient decreased by 6.263 RMB ( p = 0.030) per month, whereas it increased at the rate of 3.119 RMB ( p = 0.002) per month afterwards. Conclusions : Based on interrupted time series analyses, we concluded that FCEMs policy was associated with positive changes of average LOS and average OOP expenses. The FCEMs policy has alleviated the financial burden of the rural seniors and slightly improved the efficiency of primary health service utilization. However, it had no positive effect on daily hospitalization costs. Therefore, in the general framework of FCEMs policy, the Chinese health policy-maker should take necessary supporting measures to curb climbing hospitalization expenditures and promote the rational drug use in primary healthcare institutions.

Suggested Citation

  • Ying Wang & Yulei Zhu & Hang Shi & Xiaoluan Sun & Na Chen & Xin Li, 2019. "The Effect of the Full Coverage of Essential Medicines Policy on Utilization and Accessibility of Primary Healthcare Service for Rural Seniors: A Time Series Study in Qidong, China," IJERPH, MDPI, vol. 16(22), pages 1-14, November.
    • Handle: RePEc:gam:jijerp:v:16:y:2019:i:22:p:4316-:d:284115
    as

    Download full text from publisher

    File URL: https://www.mdpi.com/1660-4601/16/22/4316/pdf
    Download Restriction: no
    File URL: https://www.mdpi.com/1660-4601/16/22/4316/
    Download Restriction: no
    ---><---

    References listed on IDEAS

    as
    1. Jaume Puig‐Junoy & Pilar García‐Gómez & David Casado‐Marín, 2016. "Free Medicines Thanks to Retirement: Impact of Coinsurance Exemption on Pharmaceutical Expenditures and Hospitalization Offsets in a national health service," Health Economics, John Wiley & Sons, Ltd., vol. 25(6), pages 750-767, June.
    2. repec:aph:ajpbhl:10.2105/ajph.2017.303962_9 is not listed on IDEAS
    3. Chalmers, N.I. & Compton, R.D., 2017. "Children's access to dental care affected by reimbursement rates, dentist density, and dentist participation in medicaid," American Journal of Public Health, American Public Health Association, vol. 107(10), pages 1612-1614.
    4. Choi, Chi-Young & Hu, Ling & Ogaki, Masao, 2008. "Robust estimation for structural spurious regressions and a Hausman-type cointegration test," Journal of Econometrics, Elsevier, vol. 142(1), pages 327-351, January.
    5. Shaofei Su & Han Bao & Xinyu Wang & Zhiqiang Wang & Xi Li & Meiqi Zhang & Jiaying Wang & Hao Jiang & Wenji Wang & Siyang Qu & Meina Liu, 2017. "The quality of invasive breast cancer care for low reimbursement rate patients: A retrospective study," PLOS ONE, Public Library of Science, vol. 12(9), pages 1-13, September.
    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. Xiang Jing & Lingzhong Xu & Wenzhe Qin & Jiao Zhang & Lu Lu & Yali Wang & Yu Xia & An’an Jiao & Yaozu Li, 2020. "The Willingness for Downward Referral and Its Influencing Factors: A Cross-Sectional Study among Older Adults in Shandong, China," IJERPH, MDPI, vol. 17(1), pages 1-13, January.
    2. 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).
    3. Qian Xing & Wenxi Tang & Mingyang Li & Shuailong Li, 2022. "Has the Volume-Based Drug Purchasing Approach Achieved Equilibrium among Various Stakeholders? Evidence from China," IJERPH, MDPI, vol. 19(7), pages 1-22, April.
    4. Lei Chen & Ying Yang & Mi Luo & Borui Hu & Shicheng Yin & Zongfu Mao, 2020. "The Impacts of National Centralized Drug Procurement Policy on Drug Utilization and Drug Expenditures: The Case of Shenzhen, China," IJERPH, MDPI, vol. 17(24), pages 1-11, December.
    5. Zhigang Guo & Lin Bai & Zhenhuan Luo & Mengyuan Fu & Liguang Zheng & Xiaodong Guan & Luwen Shi, 2021. "Factors Associated with Free Medicine Use in Patients with Hypertension and Diabetes: A 4-Year Longitudinal Study on Full Coverage Policy for Essential Medicines in Taizhou, China," IJERPH, MDPI, vol. 18(22), pages 1-10, November.

    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. Francesca Iorio & Stefano Fachin, 2014. "Savings and investments in the OECD: a panel cointegration study with a new bootstrap test," Empirical Economics, Springer, vol. 46(4), pages 1271-1300, June.
    2. Stijn Baert & Bas van der Klaauw & Gijsbert van Lomwel, 2018. "The effectiveness of medical and vocational interventions for reducing sick leave of self‐employed workers," Health Economics, John Wiley & Sons, Ltd., vol. 27(2), pages 139-152, February.
    3. Fisayo Fagbemi & Babafemi Oladejo & Opeoluwa A. Adeosun, 2020. "The Effectiveness of Poverty Alleviation Policy: Why is the Quality of Institutions the Bane in Nigeria?," Research Africa Network Working Papers 20/099, Research Africa Network (RAN).
    4. Hao Jin & Si Zhang & Jinsuo Zhang, 2017. "Spurious regression due to neglected of non-stationary volatility," Computational Statistics, Springer, vol. 32(3), pages 1065-1081, September.
    5. Camacho-Gutiérrez, Pablo, 2010. "Dynamic OLS estimation of the U.S. import demand for Mexican crude oil," MPRA Paper 30608, University Library of Munich, Germany.
    6. Marie Kobayashi & Yusuke Matsuyama & Nobutoshi Nawa & Aya Isumi & Satomi Doi & Takeo Fujiwara, 2022. "Association between Community Social Capital and Access to Dental Check-Ups among Elementary School Children in Japan," IJERPH, MDPI, vol. 20(1), pages 1-7, December.
    7. repec:wyi:journl:002203 is not listed on IDEAS
    8. doğru, bülent, 2013. "Dynamic Analysis of Money Demand Function: Case of Turkey," MPRA Paper 48402, University Library of Munich, Germany.
    9. Yuanyuan Ma & Anne Nolan, 2017. "Public Healthcare Entitlements and Healthcare Utilisation among the Older Population in Ireland," Health Economics, John Wiley & Sons, Ltd., vol. 26(11), pages 1412-1428, November.
    10. Trapani, Lorenzo, 2021. "Inferential theory for heterogeneity and cointegration in large panels," Journal of Econometrics, Elsevier, vol. 220(2), pages 474-503.
    11. Chi-Young Choi & Soojin Jo, 2020. "How Do Housing Markets Affect Local Consumer Prices? – Evidence from U.S. Cities," Globalization Institute Working Papers 398, Federal Reserve Bank of Dallas.
    12. Javier Fernandez-Macho, 2013. "A Test for the Null of Multiple Cointegrating Vectors," Economics Series Working Papers 657, University of Oxford, Department of Economics.
    13. Havi, Emmanuel Dodzi Kutor, 2021. "The impact of exchange rate volatility on foreign direct investment inflows in Ghana," African Journal of Economic Review, African Journal of Economic Review, vol. 9(4), September.
    14. Alessandro Calza & Andrea Zaghini, 2016. "Shoe-Leather Costs in the Euro Area and the Foreign Demand for Euro Banknotes," International Journal of Central Banking, International Journal of Central Banking, vol. 12(1), pages 231-246, March.
    15. Trapani, Lorenzo, 2012. "On the asymptotic t-test for large nonstationary panel models," Computational Statistics & Data Analysis, Elsevier, vol. 56(11), pages 3286-3306.
    16. Randolph Beard, T. & Ford, George S. & Kim, Hyeongwoo, 2014. "Capital investment and employment in the information sector," Telecommunications Policy, Elsevier, vol. 38(4), pages 371-382.
    17. M. de Carvalho & K. F. Turkman & A. Rua, 2013. "Dynamic threshold modelling and the US business cycle," Journal of the Royal Statistical Society Series C, Royal Statistical Society, vol. 62(4), pages 535-550, August.
    18. Chen, Haiqiang, 2015. "Robust Estimation And Inference For Threshold Models With Integrated Regressors," Econometric Theory, Cambridge University Press, vol. 31(4), pages 778-810, August.
    19. Zhigang Guo & Lin Bai & Zhenhuan Luo & Mengyuan Fu & Liguang Zheng & Xiaodong Guan & Luwen Shi, 2021. "Factors Associated with Free Medicine Use in Patients with Hypertension and Diabetes: A 4-Year Longitudinal Study on Full Coverage Policy for Essential Medicines in Taizhou, China," IJERPH, MDPI, vol. 18(22), pages 1-10, November.
    20. Laura Policardo & Lionello F. Punzo & Edgar J. Sánchez Carrera, 2016. "Brazil and China: Two Routes of Economic Development?," Review of Development Economics, Wiley Blackwell, vol. 20(3), pages 651-669, August.
    21. Wang Cindy Shin-Huei & Hafner Christian M., 2018. "A simple solution of the spurious regression problem," Studies in Nonlinear Dynamics & Econometrics, De Gruyter, vol. 22(3), pages 1-14, June.

    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:gam:jijerp:v:16:y:2019:i:22:p:4316-:d:284115. 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: MDPI Indexing Manager (email available below). General contact details of provider: https://www.mdpi.com .

    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.