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

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  • 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
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    3. 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.
    4. 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).
    5. 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).
    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. 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.
    8. 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.

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