title: Health insurance utilization and its impact: observations from the middle-aged and elderly in China.
abstract: OBJECTIVE
  In China, despite a high coverage rate, health insurance is not used for all illness episodes. Our goal is to identify subjects' characteristics associated with insurance utilization and the association between utilization and medical expenditure.
  
  
  METHODS
  A survey was conducted in January and February of 2012. 2093 middle-aged and elderly subjects (45 years old and above) were surveyed.
  
  
  RESULTS
  Heath insurance was not utilized for 12.6% (inpatient), 53.3% (outpatient), and 72.6% (self-treatment) of disease episodes. Subjects' characteristics were associated with insurance utilization. Inpatient and outpatient treatments were expensive. In the multivariate analysis of outpatient treatment expenditure, insurance utilization was significantly associated with higher treatment cost, lost income, and gross total cost.
  
  
  CONCLUSIONS
  Utilization of health insurance may need to be improved. Insurance utilization can reduce out-of-pocket medical expenditure. However, the amount paid by the insured is still high. Policy intervention is needed to further improve the effectiveness of health insurance.
authors: School of Statistics and The Center for Applied Statistics, Renmin University of China, Beijing, China ; School of Public Health, Yale University, New Haven Connecticut, United States of America.
authors: Yu
authors: Y
authors: Wang
authors: Yan
authors: Y
authors: Jiang
authors: Yang
authors: Y
authors: Li
authors: Xiaojun
authors: X
authors: Wang
authors: Chi
authors: C
authors: Ma
authors: Shuangge
authors: S
authors: Ma
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002681:China; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006801:Humans; D007182:Income; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged