IDEAS home Printed from https://ideas.repec.org/a/spr/hecrev/v15y2025i1d10.1186_s13561-025-00606-x.html
   My bibliography  Save this article

The effect of health insurance reimbursement rates on middle-aged and elderly people’s hospital choices: evidence from China

Author

Listed:
  • Biao Li

    (Zhengzhou University)

  • Xiang Liang

    (Xiamen University)

  • Xiulin Qi

    (Northeast Forestry University)

Abstract

Background Adjusting the health insurance reimbursement rate is essential to optimize the allocation of medical resources. This paper investigates the effect of health insurance reimbursement rates on middle-aged and elderly people’s choice of hospitals in China. Methods This study is conducted using the China Health and Retirement Longitudinal Study (CHARLS) database. This paper uses the widely used ordered logit model for estimation. We build three types of instrumental variables, Bartik instrumental variable, per capita financial income, and health risk perception bias, with the help of the propensity score matching method, aiming at the cleanest possible identification of causal relationship. Furthermore, we use a mediating effects model to investigate the specific mechanism by which the reimbursement rate influences patients’ choice of hospitals. Results Our findings reveal that the higher a hospital’s reimbursement rate, the more likely a patient is to choose to seek care. This paper further calculates the marginal effects based on the benchmark regression. For every 1% increase in health insurance reimbursement rates, the probability of patients choosing primary hospitals decreases by 5.75%, choosing secondary hospitals decreases by 1.47%, and choosing tertiary hospitals increases by 7.22%. According to mechanistic analysis, this paper reveals for the first time that health signals from medical checkups significantly impact patients’ health care choices. In addition, we discuss the heterogeneity of hospital choices by region, age, and health status. Conclusions The results mean that when individuals are faced with a multitude of hospitals and are overwhelmed with choices, some small institutional designs can act as a nudge to help policymakers achieve a desirable outcome. The government should fully utilize health insurance’s benefit adjustment role and implement a differentiated reimbursement strategy.

Suggested Citation

  • Biao Li & Xiang Liang & Xiulin Qi, 2025. "The effect of health insurance reimbursement rates on middle-aged and elderly people’s hospital choices: evidence from China," Health Economics Review, Springer, vol. 15(1), pages 1-20, December.
  • Handle: RePEc:spr:hecrev:v:15:y:2025:i:1:d:10.1186_s13561-025-00606-x
    DOI: 10.1186/s13561-025-00606-x
    as

    Download full text from publisher

    File URL: http://link.springer.com/10.1186/s13561-025-00606-x
    File Function: Abstract
    Download Restriction: no

    File URL: https://libkey.io/10.1186/s13561-025-00606-x?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
    ---><---

    References listed on IDEAS

    as
    1. Timothy J. Bartik, 1991. "Who Benefits from State and Local Economic Development Policies?," Books from Upjohn Press, W.E. Upjohn Institute for Employment Research, number wbsle.
    Full references (including those not matched with items on IDEAS)

    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. Leah Platt Boustan & Matthew E. Kahn & Paul W. Rhode, 2012. "Moving to Higher Ground: Migration Response to Natural Disasters in the Early Twentieth Century," American Economic Review, American Economic Association, vol. 102(3), pages 238-244, May.
    2. Crown, Daniel & Faggian, Alessandra & Corcoran, Jonathan, 2020. "Foreign-Born graduates and innovation: Evidence from an Australian skilled visa program✰,✰✰,★,★★," Research Policy, Elsevier, vol. 49(9).
    3. Colas, Mark & Saulnier, Emmett, 2023. "Vertical migration externalities," Regional Science and Urban Economics, Elsevier, vol. 101(C).
    4. Matias Busso & Patrick Kline, 2008. "Do Local Economic Development Programs Work? Evidence from the Federal Empowerment Zone Program," Cowles Foundation Discussion Papers 1639, Cowles Foundation for Research in Economics, Yale University.
    5. Innocenti, Federico & McCormick, Barry & Nicodemo, Catia, 2025. "Gatekeeping in primary care: Analysing GP referral patterns and specialist consultations in the NHS," Economic Modelling, Elsevier, vol. 142(C).
    6. Fang, Mingyue & Nie, Huihua & Shen, Xinyi, 2023. "Can enterprise digitization improve ESG performance?," Economic Modelling, Elsevier, vol. 118(C).
    7. Timothy J. Bartik & Nathan Sotherland, 2019. "Local Job Multipliers in the United States: Variation with Local Characteristics and with High-Tech Shocks," Upjohn Working Papers 19-301, W.E. Upjohn Institute for Employment Research.
    8. Peydró, José-Luis & Jiménez, Gabriel & Kenan, Huremovic & Moral-Benito, Enrique & Vega-Redondo, Fernando, 2020. "Production and financial networks in interplay: Crisis evidence from supplier-customer and credit registers," CEPR Discussion Papers 15277, C.E.P.R. Discussion Papers.
    9. Kirill Borusyak & Peter Hull & Xavier Jaravel, 2025. "A Practical Guide to Shift-Share Instruments," Journal of Economic Perspectives, American Economic Association, vol. 39(1), pages 181-204, Winter.
    10. Michael J. Hicks, 2006. "Transportation and infrastructure, retail clustering, and local public finance: evidence from Wal-Mart's expansion," Regional Economic Development, Federal Reserve Bank of St. Louis, issue Oct, pages 100-114.
    11. Lídia Farré & Francesco Fasani & Hannes Mueller, 2018. "Feeling useless: the effect of unemployment on mental health in the Great Recession," IZA Journal of Labor Economics, Springer;Forschungsinstitut zur Zukunft der Arbeit GmbH (IZA), vol. 7(1), pages 1-34, December.
    12. Amuedo-Dorantes, Catalina & Arenas-Arroyo, Esther & Sevilla, Almudena, 2018. "Immigration enforcement and economic resources of children with likely unauthorized parents," Journal of Public Economics, Elsevier, vol. 158(C), pages 63-78.
    13. Arne Henningsen & Guy Low & David Wuepper & Tobias Dalhaus & Hugo Storm & Dagim Belay & Stefan Hirsch, 2024. "Estimating Causal Effects with Observational Data: Guidelines for Agricultural and Applied Economists," IFRO Working Paper 2024/03, University of Copenhagen, Department of Food and Resource Economics.
    14. Miquel-Àngel Garcia-López & Ilias Pasidis & Elisabet Viladecans-Marsal, 2022. "Congestion in highways when tolls and railroads matter: evidence from European cities [The congestion relief benefit of public transit: evidence from Rome]," Journal of Economic Geography, Oxford University Press, vol. 22(5), pages 931-960.
    15. Joyendu Bhadury & Samuel P. Troy, 2014. "Staid," Economic Development Quarterly, , vol. 28(4), pages 364-376, November.
    16. Lin, Boqiang & Xu, Chongchong, 2024. "The effects of industrial robots on firm energy intensity: From the perspective of technological innovation and electrification," Technological Forecasting and Social Change, Elsevier, vol. 203(C).
    17. Nicholas Kacher & Luke Petach, 2021. "Boon or Burden? Evaluating the Competing Effects of House-Price Shocks on Regional Entrepreneurship," Economic Development Quarterly, , vol. 35(4), pages 287-304, November.
    18. Teresa Garcia-Milà & Therese J. McGuire, 2001. "Tax incentives and the city," Economics Working Papers 631, Department of Economics and Business, Universitat Pompeu Fabra, revised Dec 2001.
    19. Grau, Nicolas & Hojman, Daniel & Mizala, Alejandra, 2018. "School closure and educational attainment: Evidence from a market-based system," Economics of Education Review, Elsevier, vol. 65(C), pages 1-17.
    20. Bruce Weber & Leif Jensen & Kathleen Miller & Jane Mosley & Monica Fisher, 2005. "A Critical Review of Rural Poverty Literature: Is There Truly a Rural Effect?," International Regional Science Review, , vol. 28(4), pages 381-414, October.

    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:spr:hecrev:v:15:y:2025:i:1:d:10.1186_s13561-025-00606-x. 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: Sonal Shukla or Springer Nature Abstracting and Indexing (email available below). General contact details of provider: http://www.springer.com/economics/journal/13561 .

    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.