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Prescribing behaviour of village doctors under China's New Cooperative Medical Scheme

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  • Sun, Xiaoyun
  • Jackson, Sukhan
  • Carmichael, Gordon A.
  • Sleigh, Adrian C.

Abstract

In 2003, China introduced a new community-based rural health insurance called the New Cooperative Medical Scheme (NCMS). In 2005, to assess the NCMS effects on village doctors' prescribing behaviour, we compared an NCMS county and a non-NCMS county in Shandong Province. We collected information from a representative total of 2271 patient visits in 30 village health stations (15 per county). The average number of drugs prescribed (4.6 in the NCMS county vs. 3.1 in the non-NCMS county) and use of antibiotics (72.4% vs. 59.3%) and injections (65.1% vs. 56.3%) were high in both counties, and higher in the NCMS county. Within NCMS villages, prescribing for insured vs. uninsured patients showed a similar pattern with more drugs, antibiotics and injections for those insured. Overall, for NCMS patients, the prescription excess was about equal in value to their 20% fee discount. We conclude that over-prescribing is common in villages and worse with NCMS health insurance, raising concerns for health service quality and drug-use safety. We propose that the NCMS should be redesigned with incentives for service quality improvement. A stricter regulatory environment for doctors' prescriptions is needed in rural China to counter irrational drug use.

Suggested Citation

  • Sun, Xiaoyun & Jackson, Sukhan & Carmichael, Gordon A. & Sleigh, Adrian C., 2009. "Prescribing behaviour of village doctors under China's New Cooperative Medical Scheme," Social Science & Medicine, Elsevier, vol. 68(10), pages 1775-1779, May.
    • Handle: RePEc:eee:socmed:v:68:y:2009:i:10:p:1775-1779
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    1. Xiaoyun Sun & Sukhan Jackson & Gordon Carmichael & Adrian C. Sleigh, 2009. "Catastrophic medical payment and financial protection in rural China: evidence from the New Cooperative Medical Scheme in Shandong Province," Health Economics, John Wiley & Sons, Ltd., vol. 18(1), pages 103-119, January.
    2. Fang, Jing, 2008. "The Chinese health care regulatory institutions in an era of transition," Social Science & Medicine, Elsevier, vol. 66(4), pages 952-962, February.
    3. Dong, Hengjin & Bogg, Lennart & Rehnberg, Clas & Diwan, Vinod, 1999. "Association between health insurance and antibiotics prescribing in four counties in rural China," Health Policy, Elsevier, vol. 48(1), pages 29-45, July.
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    1. Faden, Laura & Vialle-Valentin, Catherine & Ross-Degnan, Dennis & Wagner, Anita, 2011. "Active pharmaceutical management strategies of health insurance systems to improve cost-effective use of medicines in low- and middle-income countries: A systematic review of current evidence," Health Policy, Elsevier, vol. 100(2), pages 134-143.
    2. Currie, Janet & Lin, Wanchuan & Zhang, Wei, 2011. "Patient knowledge and antibiotic abuse: Evidence from an audit study in China," Journal of Health Economics, Elsevier, vol. 30(5), pages 933-949.
    3. Kimberly Singer Babiarz & Hongmei Yi & Renfu Luo, 2013. "Meeting the Health-care Needs of the Rural Elderly: The Unique Role of Village Doctors," China & World Economy, Institute of World Economics and Politics, Chinese Academy of Social Sciences, vol. 21(3), pages 44-60, May.
    4. Currie, Janet & Lin, Wanchuan & Meng, Juanjuan, 2014. "Addressing antibiotic abuse in China: An experimental audit study," Journal of Development Economics, Elsevier, vol. 110(C), pages 39-51.
    5. Guan, Xiaodong & Tian, Ye & Song, Jiafang & Zhu, Dawei & Shi, Luwen, 2019. "Effect of physicians' knowledge on antibiotics rational use in China's county hospitals," Social Science & Medicine, Elsevier, vol. 224(C), pages 149-155.
    6. Qin, Xuezheng & Li, Lixing & Hsieh, Chee-Ruey, 2013. "Too few doctors or too low wages? Labor supply of health care professionals in China," China Economic Review, Elsevier, vol. 24(C), pages 150-164.
    7. Janet Currie & Wanchuan Lin & Juanjuan Meng, 2012. "Using Audit Studies to Test for Physician Induced Demand: The Case of Antibiotic Abuse in China," NBER Working Papers 18153, National Bureau of Economic Research, Inc.
    8. Zhang, Xuan & Nie, Huihua, 2021. "Public health insurance and pharmaceutical innovation: Evidence from China," Journal of Development Economics, Elsevier, vol. 148(C).
    9. Hongmei Yi & Paiou Wu & Xiaoyuan Zhang & Dirk E Teuwen & Sean Sylvia, 2020. "Market competition and demand for skills in a credence goods market: Evidence from face-to-face and web-based non-physician clinician training in rural China," PLOS ONE, Public Library of Science, vol. 15(6), pages 1-17, June.
    10. repec:bla:glopol:v:8:y:2017:i::p:110-116 is not listed on IDEAS
    11. Dongxiao Gu & Xuejie Yang & Xingguo Li & Changyong Liang & Jinhong Zhong & Nanping Feng, 2018. "Innovating New Rural Cooperative Medical Scheme (NCMS) for Better Patient Satisfaction in Rural China," IJERPH, MDPI, vol. 15(9), pages 1-14, September.
    12. Yiqiu, Wang & Maria, Porter & Songqing, Jin, 2016. "Estimating Effects of Health Insurance Coverage on Medical Service Utilization and Health in Rural China," 2016 Annual Meeting, July 31-August 2, Boston, Massachusetts 235470, Agricultural and Applied Economics Association.
    13. Currie, Janet & Lin, Wanchuan & Meng, Juanjuan, 2013. "Social networks and externalities from gift exchange: Evidence from a field experiment," Journal of Public Economics, Elsevier, vol. 107(C), pages 19-30.
    14. Chen, Yi & Shi, Julie & Zhuang, Castiel Chen, 2019. "Income-dependent impacts of health insurance on medical expenditures: Theory and evidence from China," China Economic Review, Elsevier, vol. 53(C), pages 290-310.
    15. 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.
    16. Mingsheng Chen & Lijie Wang & Wen Chen & Luying Zhang & Hongli Jiang & Wenhui Mao, 2014. "Does Economic Incentive Matter for Rational Use of Medicine? China’s Experience from the Essential Medicines Program," PharmacoEconomics, Springer, vol. 32(3), pages 245-255, March.
    17. Yu, Xuan & Li, Cheng & Shi, Yuhua & Yu, Min, 2010. "Pharmaceutical supply chain in China: Current issues and implications for health system reform," Health Policy, Elsevier, vol. 97(1), pages 8-15, September.

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