Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Jun 3, 2023
Date Accepted: Nov 7, 2023
Effects of transport-driven poverty alleviation on healthcare seeking behavior and medical expenditure of the rural elderly: a quasi-experimental study
ABSTRACT
Background:
Improving the rural residents’ accessibility and affordability of healthcare is recognized to be a common target globally.
Objective:
Health in all policies from the Declaration of Helsinki to a decade of healthy ageing all strengthened the far-reaching effect of large-scale public policies on healthcare seeking behavior; however, the effects of national transport policy on healthcare seeking behavior is unclear.
Methods:
We focused on the transport-driven poverty alleviation (TPA) policy and designed a quasi-experiment to estimate the effects of TPA policy on healthcare seeking behavior and medical expenditure of the rural elderly through a difference-in-differences (DID) analysis based on the data from the 2011, 2013, 2015 and 2018 China Health and Retirement Longitudinal Study.
Results:
Our finding validated positive contribution of TPA policy on healthcare seeking behavior of rural elderly. After the implementation of TPA policy, the number of inpatient visits increased by annually 0.48 times per person, outpatient medical expenditure increased by 192% per month and inpatient medical expenditure increased by 52% annually compared with the rural elderly without TPA policy. Further, there was significant group heterogeneity in above relationship, with an enhancement effect for the poor household, the elderly with better health status and the 60~80-year-old elderly. Additionally, the policy improved the patients’ capabilities to seek long-distance (95%CI 0.99-45.33) and high-level hospitals (95%CI 0.02-0.13), and increased individual their income to acquire more medical service (95%CI 4.46-4.68).
Conclusions:
These findings validated positive contribution of TPA policy on healthcare seeking behavior of rural elderly, but more medical expenditure was also incurred. Concerted efforts are needed to address healthcare-seeking dilemmas in rural areas and increasing medical expenditure for rural elderly should also be paid more attention during TPA policy implementation.
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