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The moral dilemma of healthcare service utilization: a perspective from the consolidation of urban and rural resident health insurance policy in China

Author

Listed:
  • Hui Yuan

    (Zhongnan University of Economics and Law)

  • Jubo Han

    (Zhongnan University of Economics and Law)

  • Ruifeng Luo

    (Zhongnan University of Economics and Law)

Abstract

Patient moral hazard is a significant issue in healthcare system reform and a prominent factor affecting the efficiency of healthcare services in China. Based on the consolidation of urban and rural resident health insurance, this paper employs a staggered DID model to analyze the impact of patient moral hazard on the healthcare service utilization. The findings are as follows. First, the healthcare service utilization significantly increases after the consolidation of urban and rural resident health insurance. This conclusion remains robust when subjected to the placebo test, the mitigation of non-random policy effects, and the exclusion of other insurance type interference. Second, after considering the effects of patient healthcare demand release, supplier-induced demand, and collusion between doctors and patients, we find the evidence of patient moral hazard leading to increased healthcare service utilization. Third, patient moral hazard is mainly manifested in the heightened utilization of patients with general illnesses and middle income, indicating the phenomena of “over-treatment for minor ailments”. The study is limited by its focus on expanded reimbursement in urban and rural insurance consolidation, excluding details like fund management changes. Future research should incorporate more policy details and longer time horizons.

Suggested Citation

  • Hui Yuan & Jubo Han & Ruifeng Luo, 2025. "The moral dilemma of healthcare service utilization: a perspective from the consolidation of urban and rural resident health insurance policy in China," Health Economics Review, Springer, vol. 15(1), pages 1-13, December.
    • Handle: RePEc:spr:hecrev:v:15:y:2025:i:1:d:10.1186_s13561-025-00591-1
    DOI: 10.1186/s13561-025-00591-1
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    References listed on IDEAS

    as
    1. Wong, Irene O.L. & Lindner, Michael J. & Cowling, Benjamin J. & Lau, Eric H.Y. & Lo, Su-Vui & Leung, Gabriel M., 2010. "Measuring moral hazard and adverse selection by propensity scoring in the mixed health care economy of Hong Kong," Health Policy, Elsevier, vol. 95(1), pages 24-35, April.
    2. Yip, Winnie C. & Lee, Yue-Chune & Tsai, Shu-Ling & Chen, Bradley, 2019. "Managing health expenditure inflation under a single-payer system: Taiwan's National Health Insurance," Social Science & Medicine, Elsevier, vol. 233(C), pages 272-280.
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    More about this item

    Keywords

    Patient moral hazard; Healthcare service utilization; Consolidation of urban and rural health insurance; Staggered DID;
    All these keywords.

    JEL classification:

    • G22 - Financial Economics - - Financial Institutions and Services - - - Insurance; Insurance Companies; Actuarial Studies
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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