ArticleThe Lancet regional health. Western Pacific2024
Association between health insurance cost-sharing and choice of hospital tier for cardiovascular diseases in China: a prospective cohort study.
Article in The Lancet regional health. Western Pacific, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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Who cites it
8 citing papers in PubMed.
- Plan-related inequalities in costs, disease progression and mortality among hypertensive patients in China.Nature communications · 2026Article
- Differences in healthcare institution choice among elderly cancer patients: evidence from a cross-sectional study in Shandong Province, China.BMC cancer · 2026Article
- Value-Based Outsourcing Is Associated with Improved Healthcare Outcomes in Low- and Intermediate-Complexity European Hospitals: A Cross-Sectional Study from Spain.Healthcare (Basel, Switzerland) · 2026Article
- Preference for inpatient services among the unemployed with multi-chronic conditions: a discrete choice experiment.BMC health services research · 2026Article
- Association of Income Inequality and Sleep Duration With Cardiovascular Outcomes in China and the UK.JACC. Asia · 2025Article
- Disparities in inpatient treatment and expenditures among lung cancer patients under tiered social health insurance: a population-based study in China.International journal for equity in health · 2025Article
- Inpatient preferences among patients with multiple chronic conditions in China: A discrete choice experiment.BMC primary care · 2025Article
- Changes in patterns of multimorbidity and associated with medical costs among Chinese middle-aged and older adults from 2013 to 2023: an analysis of repeated cross-sectional surveys in Xiangyang, China.Frontiers in public health · 2024Article
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Authors and funding
16 authors.
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Abstract
Background: Hospitals in China are classified into tiers (1, 2 or 3), with the largest (tier 3) having more equipment and specialist staff. Differential health insurance cost-sharing by hospital tier (lower deductibles and higher reimbursement rates in lower tiers) was introduced to reduce overcrowding in higher tier hospitals, promote use of lower tier hospitals, and limit escalating healthcare costs. However, little is known about the effects of differential cost-sharing in health insurance schemes on choice of hospital tiers. Methods: In a 9-year follow-up of a prospective study of 0.5 M adults from 10 areas in China, we examined the associations between differential health insurance cost-sharing and choice of hospital tiers for patients with a first hospitalisation for stroke or ischaemic heart disease (IHD) in 2009-2017. Analyses were performed separately in urban areas (stroke: n = 20,302; IHD: n = 19,283) and rural areas (stroke: n = 21,130; IHD: n = 17,890), using conditional logit models and adjusting for individual socioeconomic and health characteristics. Findings: About 64-68% of stroke and IHD cases in urban areas and 27-29% in rural areas chose tier 3 hospitals. In urban areas, higher reimbursement rates in each tier and lower tier 3 deductibles were associated with a greater likelihood of choosing their respective hospital tiers. In rural areas, the effects of cost-sharing were modest, suggesting a greater contribution of other factors. Higher socioeconomic status and greater disease severity were associated with a greater likelihood of seeking care in higher tier hospitals in urban and rural areas. Interpretation: Patient choice of hospital tiers for treatment of stroke and IHD in China was influenced by differential cost-sharing in urban areas, but not in rural areas. Further strategies are required to incentivise appropriate health seeking behaviour and promote more efficient hospital use. Funding: Wellcome Trust, Medical Research Council, British Heart Foundation, Cancer Research UK, Kadoorie Charitable Foundation, China Ministry of Science and Technology, and National Natural Science Foundation of China.
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