Effects of decreasing the out-of-pocket expenses for outpatient care on health-seeking behaviors, health outcomes and medical expenses of people with diabetes: evidence from China

• Published in: International journal for equity in health Vol. 21; no. 1; pp. 162 - 10
• Main Authors: Du, Wenwen, Liu, Ping, Xu, Wei
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 16.11.2022; BioMed Central; BMC
• Subjects: Ambulatory Care; Ambulatory medical care; China; Chronic illnesses; Complications; Costs; Decreasing the out-of-pocket expenses for outpatient care; Dependent variables; Diabetes; Diabetes mellitus; Diabetes Mellitus - therapy; Diabetes patients; Diabetes therapy; Disease; Evaluation; Expenditures; Funds; Health Expenditures; Health insurance; Health outcomes; Health services; Health-seeking behaviors; Humans; Hypertension; Insurance; Insurance claims; Insurance coverage; Medical care, Cost of; Medical expenses; Outcome Assessment, Health Care; Outpatient care facilities; Patient Acceptance of Health Care; Patients; Reimbursement; China; Health-seeking behaviors; Health outcomes; Medical expenses; Decreasing the out-of-pocket expenses for outpatient care; Diabetes patients
• ISSN: 1475-9276; 1475-9276
• DOI: 10.1186/s12939-022-01775-5

To improve access to outpatient services and provide financial support in outpatient expenses for the insured, China has been establishing its scheme of decreasing the out-of-pocket expenses for outpatient care in recent years. There are 156 million diabetes patients in China which almost accounts for a quarter of diabetes population worldwide. Outpatient services plays an important role in diabetes treatment. The study aims to clarify the effects of decreasing the out-of-pocket expenses for outpatient care on health-seeking behaviors, health outcomes and medical expenses of people with diabetes. This study constructed a two-way fixed effect model, utilized 5,996 diabetes patients' medical visits records from 2019 to 2021, to ascertain the influence of decreasing the out-of-pocket expenses for outpatient care on diabetes patients. The dependent variables were diabetes patients' health-seeking behaviors, health outcomes, medical expenses and expenditure of the basic medical insurance funds for them; the core explanatory variable was the out-of-pocket expenses for outpatient care expressed by the annual outpatient reimbursement ratio. With each increase of 1% in the annual outpatient reimbursement ratio: (1) for health-seeking behaviors, a diabetes patient's annual number of outpatient visits and annual number of medical visits increased by 0.021 and 0.014, while the annual number of hospitalizations decreased by 0.006; (2) for health outcomes, a diabetes patient's annual length of hospital stays and average length of a hospital stay decreased by 1.2% and 1.1% respectively, and the number of diabetes complications and Diabetes Complications Severity Index (DCSI) score both decreased by 0.001; (3) for medical expenses, a diabetes patient's annual outpatient expenses, annual inpatient expenses, annual medical expenses and annual out-of-pocket expenses decreased by 2.2%, 4.6%, 2.6% and 4.0%; (4) for expenditure of the basic medical insurance funds for a diabetes patient, the annual expenditure on outpatient services increased by 1.1%, and on inpatient services decreased by 4.4%, but on healthcare services didn't change. Decreasing the out-of-pocket expenses for outpatient care appropriately among people with diabetes could make patients have a more rational health-seeking behaviors, a better health status and a more reasonable medical expenses while the expenditure of the basic medical insurance funds is stable totally.