From coverage to care: how basic medical insurance shapes patients' experiences of primary care in China

With the intensifying trend of population aging in China, the number of middle-aged and older adults continues to rise, and their demand for medical services is also increasing. Middle-aged and older adults can benefit from the convenience and protection provided by the hierarchical diagnosis and treatment system through medical insurance policies.

This study draws on Andersen's health service utilization model to examine how basic medical insurance shapes healthcare experiences among middle-aged and older adults with a primary-care orientation under China's hierarchical diagnosis and treatment system.

This study merges data from the 2016 and 2018 Chinese Family Panel Studies (CFPS) to create a balanced panel, with a total sample size of 6,114. This study uses fixed-effects models and panel ordered Logit models to examine the association between basic health insurance and satisfaction with healthcare facility conditions and healthcare service levels. Additionally, propensity score matching was used within the primary-care-oriented sample to improve comparability between insured and uninsured respondents, followed by fixed-effects estimation as a robustness check.

Descriptive analysis shows that, compared with 2016, the medical expenditure rate in 2018 decreased by 1.16%, while the hospitalization rate and the proportion of doctor visits increased modestly. The two-way fixed-effects results suggest that basic health insurance is positively associated with satisfaction with healthcare facility conditions, corresponding to an average within-person increase of 0.112 points on the observed 1-5 evaluation scale. By contrast, no statistically significant association is found between basic health insurance and healthcare service level. The ordered-model results and the PSM-based robustness checks are broadly consistent with the benchmark estimates. In addition, the strength of the association varies across subgroups defined by health status, age, gender, region, and household registration.

Basic health insurance is associated with more favorable evaluations of healthcare facility conditions among middle-aged and older adults with a primary-care orientation, whereas its association with healthcare service level is not statistically robust. These findings suggest that the relationship between insurance coverage and patient-reported primary care experience may differ across dimensions of healthcare evaluation and across population subgroups.

This study has important practical significance for promoting the hierarchical diagnosis and treatment system, optimizing the allocation of medical resources, and alleviating the problem of medical order. Through in-depth research and exploration of relevant issues, it can provide useful references for policy makers and bring more convenient and efficient medical services to patients.