# The Association of Outpatient Cost-Sharing Policy with Health and Economic Outcomes for Rural Children in China: A Cross-Sectional Study

## TL;DR

A policy that helps cover outpatient costs improves health outcomes for rural children in China, likely due to increased healthcare use and better maternal health.

## Contribution

This study provides empirical evidence that outpatient cost-sharing benefits rural children uniquely, without substituting inpatient care as seen in adults.

## Key findings

- The policy is associated with better child health scores and higher reimbursement probability.
- Positive outcomes are linked to increased outpatient use, better maternal health, and school-related expenses.
- Unlike adults, the policy does not reduce hospitalization rates for children, indicating rigid inpatient demand.

## Abstract

What are the main findings?
The outpatient cost-sharing policy is associated with better health outcomes for rural children. This relationship appears to be linked to three potential factors: higher utilization of outpatient services, better health of mothers, and greater school-related food and accommodation expenses.The core value of the policy lies in including high-frequency outpatient expenses in the reimbursement scope. Unlike findings for adults, it is not associated with reduced hospitalization rates, suggesting that pediatric inpatient demand is rigid and non-discretionary.

The outpatient cost-sharing policy is associated with better health outcomes for rural children. This relationship appears to be linked to three potential factors: higher utilization of outpatient services, better health of mothers, and greater school-related food and accommodation expenses.

The core value of the policy lies in including high-frequency outpatient expenses in the reimbursement scope. Unlike findings for adults, it is not associated with reduced hospitalization rates, suggesting that pediatric inpatient demand is rigid and non-discretionary.

What are the implications of the main findings?
The policy’s design is compatible with the specific healthcare needs of children, which may inform policymakers to expand the policy to include more rural children.Policy evaluation may need to be differentiated for children and not assume adult patterns (like inpatient substitution).

The policy’s design is compatible with the specific healthcare needs of children, which may inform policymakers to expand the policy to include more rural children.

Policy evaluation may need to be differentiated for children and not assume adult patterns (like inpatient substitution).

Background/Objectives: Under the urban–rural dual structure, rural children’s health security faces multiple challenges. These stem from geographical disadvantages, inadequate resources, and systemic flaws in medical insurance design. The outpatient cost-sharing policy is a key design to address these issues. Methods: Using data from the 2018 China Household Income Project (CHIP), this study employs Propensity Score Matching, Ordered Probit, Logit, and a Two-Part Model to examine the association between the policy and the health and economic outcomes of rural children. Conclusions: The results show that the policy is significantly associated with better child health scores and a higher probability of reimbursement. These positive associations appear to be connected to three potential factors: higher use of outpatient services, better mother’s health, and greater school-related food and accommodation expenses. In contrast to adult populations, no significant substitution between outpatient and inpatient services was observed for children, suggesting the non-discretionary and rigid nature of pediatric hospitalization decisions. This research provides robust empirical evidence for the policy’s potential benefits, offering important implications for optimizing the child medical security system.