title: Insurance coverage and socioeconomic differences in patient choice between private and public health care providers in China.
abstract: The private health care sector has become an increasingly important complement to China's health care system. During the health care reform in 2009, China's central government established multiple initiatives to relax constraints on the growth of the private health care sector. However, private health services have not been growing as rapidly as private health care facilities. Using data from the China Health and Retirement Longitudinal Study collected between 2011 and 2013, this study investigated patient choice between private and public providers for outpatient care and estimated its relationship with health insurance and socioeconomic status (SES). The Heckman sample selection model was applied to address the problem of selection bias caused by a lack of awareness of provider ownership. We found that 82.1% of the outpatient care users were aware of their provider's ownership, and 23.8% chose private health care providers. Although patients with health insurance and higher SES were more likely to be aware of their provider's ownership, they preferred public providers over private providers. For example, having Urban Employee Basic Medical Insurance was associated with a 16.5% lower probability of choosing private providers than no health insurance. Respondents with the highest level of household expenditure had a 7.5% lower probability of choosing private providers than those with the lowest level of expenditure. The probability of choosing private providers were significantly lower by 4.0% among respondents with an education level of junior high school and above than those with no formal education. For private providers to play an effective role in the health care system, policies that have constrained the growth of the private sector should be changed, and more effort should be directed toward equalizing health insurance coverage for both types of providers.
authors: School of Business, Dalian University of Technology, 2 Dagong Road, Panjin 124221, Liaoning, China. Electronic address: qingwang@dlut.edu.cn.
authors: Qing
authors: Q
authors: Wang
authors: Department of Health Policy and Management, College of Public Health, University of Georgia, 100 Foster Road, Wright Hall, Athens, GA 30602, USA. Electronic address: stacyzdl@gmail.com.
authors: Donglan
authors: D
authors: Zhang
authors: Department of Social Medicine, School of Public Health, Fudan University, PO Box 250, 138 Yi Xue Yuan Road, Shanghai 200032, China; National Key Laboratory of Health Technology Assessment, Ministry of Health, Fudan University, PO Box 250, 138 Yi Xue Yuan Road, Shanghai 200032, China; Collaborative Innovation Center of Social Risks Governance in Health, Fudan University, PO Box 250, 138 Yi Xue Yuan Road, Shanghai 200032, China. Electronic address: zyhou@fudan.edu.cn.
authors: Zhiyuan
authors: Z
authors: Hou
mesh_terms: D000368:Aged; D002681:China; D002755:Choice Behavior; D005260:Female; D018166:Health Care Reform / Q000379:methods / Q000639:trends; D006282:Health Personnel / Q000706:statistics & numerical data; D006801:Humans; D019458:Insurance Coverage / Q000191:economics / Q000592:standards* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017149:Private Sector / Q000191:economics / Q000706:statistics & numerical data*; D017150:Public Sector / Q000191:economics / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors
keywords: China; Health insurance; Outpatient utilization; Ownership; Private providers; Socioeconomic status