Effect of Employees' Medical Insurance Outpatient Pooling on Medical Service Utilization of Middle-Aged and Elderly Patients with Chronic Diseases

doi:10.19546/j.issn.1674-3830.2025.6.009

China Health Insurance ›› 2025, Vol. 0 ›› Issue (6) : 66-75. DOI: 10.19546/j.issn.1674-3830.2025.6.009

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Abstract

Objective: This study aims to evaluate the impact of the outpatient pooling policy of employees’ medical insurance on the choice of medical treatment behavior and the frequency of medical treatment for middle-aged and elderly patients with chronic diseases, providing a scientific basis for optimizing medical insurance policies. Methods: Based on the national data of the China Health and Retirement Longitudinal Study (CHARLS) in 2018 and 2020, a comprehensive assessment was conducted on the specific impact of the outpatient pooling policy of the employees’ medical insurance on the utilization of outpatient and inpatient services by the insured population by empirical research methods. At the same time, the differences of the policy among different disease types and age groups were analyzed. Results: The research finds that the outpatient pooling policy effectively increases the utilization rate of outpatient services by insured employees, but significantly reduces the use of inpatient services. Meanwhile, this policy has a more significant impact on the probability of middle-aged and elderly insured employees with musculoskeletal system diseases choosing outpatient medical services. Conclusion: The outpatient pooling policy of employees’ medical insurance improves the utilization rate of outpatient medical care for middle-aged and elderly employees with chronic diseases and reduces the probability of hospitalization. However, the impact on middle-aged and elderly employees with different diseases and age groups varies. It is suggested to enhance the level of security, optimize accessibility, and establish a stratified and precise security mechanism.

Key words

employees’ medical insurance / outpatient pooling system / chronic diseases / utilization of medical services

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Effect of Employees' Medical Insurance Outpatient Pooling on Medical Service Utilization of Middle-Aged and Elderly Patients with Chronic Diseases[J]. China Health Insurance. 2025, 0(6): 66-75 https://doi.org/10.19546/j.issn.1674-3830.2025.6.009

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