Insurance Coverage for Chronic Diseases and Healthcare of Low-Income People: Evidence From Chinese Administrative Data.

Patient cost-sharing can lead to delays in necessary care, especially among low-income populations. In this study, we examine the impact of health insurance coverage for chronic disease treatments in outpatient care, using recent administrative insurance claims dataset from a low-income population in an underdeveloped city in China. Employing a propensity score matching and difference-in-differences approach, we find that outpatient coverage for certain chronic diseases increased outpatient utilization and expenses among patients with these conditions. Interestingly, these patients also increased their use of inpatient services, despite no changes in the cost-sharing for inpatient care. Our findings suggest the presence of delayed care, where outpatient visits helped patients recognize the severity of their diseases and increased the demand for inpatient care. These results have important implications for the implementation of universal health coverage and the dynamics of healthcare costs in low- and middle-income countries.