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Heterogeneous effects of decreasing the cost-sharing for outpatient care on health outcomes in China: A propensity score matching and causal machine learning approach
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  • Tao Zhang,
  • Meiteng Yu,
  • Jing Liu,
  • Yang Song
Tao Zhang
Hangzhou Normal University School of Public Health
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Meiteng Yu
Hangzhou Normal University School of Public Health
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Jing Liu
Yuebei People's Hospital Affiliated to Shantou University School of Medicine

Corresponding Author:jliu19871st@163.com

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Yang Song
Huazhong University of Science and Technology Tongji Medical College
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Abstract

Background: To improve accessibility and financial support for outpatient services, China introduced a scheme to decrease cost-sharing for outpatient care under the Urban Employee Basic Medical Insurance. This study evaluates the health impacts of this policy and examines its heterogeneous effects. Methods: Utilizing data from the 2018 China Health and Retirement Longitudinal Study, we analyzed 2,896 individual-level observations across 105 prefectures. Propensity score matching and a causal forest model were applied to evaluate the effects on chronic disease status, body pain, self-rated health, and hospitalization, while accounting for various demographic, socioeconomic, residential, health-related behaviors, and prefecture-specific factors. Results: The reduction in cost-sharing was significantly linked to decreased probabilities of chronic disease (Average Treatment Effect (ATE) = -0.0619, p < 0.01), body pain (ATE = -0.0715, p < 0.05), and hospitalization (ATE = -0.0592, p < 0.001), as well as improved self-rated health (ATE = 0.1557, p < 0.001). These benefits may be attributed to reduced out-of-pocket payments for outpatient care (ATE = -287.6112, p < 0.01) and increased outpatient visits (ATE = 0.0414 visits, p < 0.05). Causal forest analyses revealed that older individuals, those with higher educational attainment, higher household income, urban residents, and those engaging in healthier behaviors exhibited larger treatment effects. Conclusions: Decreasing outpatient cost-sharing in China has beneficial health outcomes, with variations in its impact based on socio-economic status and health behaviors. It is advisable to further increase reimbursement rates and broaden benefit packages for outpatient care, while addressing the unequal distribution of benefits.
03 Dec 2024Submitted to International Journal of Health Planning and Management
04 Dec 2024Review(s) Completed, Editorial Evaluation Pending
04 Dec 2024Submission Checks Completed
04 Dec 2024Assigned to Editor
11 Dec 2024Reviewer(s) Assigned
11 Dec 2024Reviewer(s) Assigned