Table 3.
Determinants of patient cost-sharing for outpatient and inpatient services from multilevel regression analysis
| Outpatient | Inpatient | |||||||
|---|---|---|---|---|---|---|---|---|
| Overall | Medicines only | Overall | Medicines only | |||||
| Regression coefficient | P value | Regression coefficient | P value | Regression coefficient | P value | Regression coefficient | P value | |
| Insurance type (ref: no insurance) | ||||||||
| NCMS | − 0.089 (− 0.127, − 0.051) | < 0.001 | − 0.054(− 0.086, − 0.023) | 0.001 | − 0.281(− 0.334, − 0.229) | < 0.001 | − 0.111(− 0.164, − 0.058) | < 0.001 |
| URBMI | − 0.094 (− 0.144, − 0.043) | < 0.001 | − 0.063(− 0.105, − 0.02) | 0.004 | − 0.316(− 0.382, − 0.25) | < 0.001 | − 0.134(− 0.2, − 0.067) | < 0.001 |
| UEBMI | −0.205 (− 0.252, − 0.158) | < 0.001 | −0.171(− 0.211, − 0.131) | < 0.001 | −0.453(− 0.513, − 0.393) | < 0.001 | − 0.172(− 0.233, − 0.111) | < 0.001 |
| Others | −0.282 (− 0.352, − 0.211) | < 0.001 | −0.278(− 0.34, − 0.215) | < 0.001 | −0.508(− 0.598, − 0.418) | < 0.001 | −0.167(− 0.259, − 0.076) | < 0.001 |
| PCE (ref: lowest 20%) | ||||||||
| Lower 20% | − 0.022 (− 0.048, 0.004) | 0.094 | 0.003(− 0.019, 0.025) | 0.804 | 0.004(− 0.036, 0.044) | 0.840 | − 0.025(− 0.065, 0.015) | 0.221 |
| Middle 20% | −0.025 (− 0.05, 0) | 0.053 | − 0.015(− 0.036, 0.007) | 0.185 | − 0.036(− 0.074, 0.003) | 0.071 | − 0.021(− 0.06, 0.018) | 0.297 |
| Higher 20% | −0.015 (− 0.041, 0.01) | 0.236 | − 0.002(− 0.023, 0.02) | 0.885 | 0.002(− 0.035, 0.039) | 0.929 | − 0.026(− 0.064, 0.011) | 0.166 |
| Highest 20% | − 0.02 (− 0.046, 0.006) | 0.128 | − 0.007(− 0.029, 0.015) | 0.540 | 0.016(− 0.02, 0.053) | 0.382 | −0.055(− 0.092, − 0.018) | 0.004 |
| Employment status (ref: not working) | ||||||||
| Retired | −0.091 (− 0.177, − 0.005) | 0.038 | −0.045(− 0.118, 0.028) | 0.228 | 0.056(− 0.037, 0.15) | 0.236 | −0.033(− 0.128, 0.062) | 0.495 |
| Working | −0.064 (− 0.15, 0.021) | 0.140 | −0.026(− 0.099, 0.047) | 0.488 | 0.046(− 0.048, 0.14) | 0.335 | −0.031(− 0.127, 0.064) | 0.518 |
| Education (ref: primary school or below) | ||||||||
| Secondary school | −0.009 (− 0.03, 0.011) | 0.369 | −0.004(− 0.021, 0.013) | 0.652 | −0.028(− 0.055, − 0.002) | 0.036 | 0.002(− 0.024, 0.029) | 0.866 |
| College and above | −0.164 (− 0.24, − 0.089) | < 0.001 | −0.155(− 0.221, − 0.089) | < 0.001 | 0.005(− 0.086, 0.096) | 0.913 | −0.104(− 0.197, − 0.012) | 0.027 |
| Age (ref: 45–54 years) | ||||||||
| 55–64 | − 0.025 (− 0.045, − 0.005) | 0.013 | −0.013(− 0.03, 0.004) | 0.125 | − 0.031(− 0.061, − 0.002) | 0.035 | −0.012(− 0.042, 0.017) | 0.411 |
| 65–74 | − 0.054 (− 0.078, − 0.03) | < 0.001 | −0.037(− 0.058, − 0.017) | < 0.001 | −0.053(− 0.086, − 0.02) | 0.002 | −0.028(− 0.061, 0.006) | 0.105 |
| 75 and above | −0.078 (− 0.117, − 0.04) | < 0.001 | −0.074(− 0.107, − 0.04) | < 0.001 | −0.082(− 0.126, − 0.037) | < 0.001 | −0.053(− 0.099, − 0.008) | 0.022 |
| Gender (ref: male) | ||||||||
| Female | 0.008 (−0.008, 0.025) | 0.324 | 0.019 (0.004, 0.033) | 0.010 | 0.031 (0.009, 0.053) | 0.006 | 0.031 (0.009, 0.053) | 0.007 |
| Marital (ref: single or divorce or widowed) | ||||||||
| Married or cohabitated | 0.004 (−0.019, 0.027) | 0.716 | −0.018(− 0.037, 0.002) | 0.076 | 0.038 (0.008, 0.069) | 0.014 | 0.004(− 0.027, 0.035) | 0.784 |
| Comorbidity (ref: none) | ||||||||
| 1 NCD | 0.004 (−0.023, 0.031) | 0.763 | 0.005(−0.019, 0.028) | 0.694 | 0.031(−0.01, 0.071) | 0.138 | −0.004(− 0.045, 0.037) | 0.851 |
| 2 NCDs | 0 (−0.027, 0.027) | 0.995 | 0.011(− 0.013, 0.034) | 0.364 | 0.015(− 0.024, 0.054) | 0.452 | −0.008(− 0.048, 0.032) | 0.682 |
| > 2 NCDs | −0.005 (− 0.032, 0.021) | 0.702 | 0(− 0.023, 0.022) | 0.976 | 0.007(− 0.03, 0.044) | 0.696 | − 0.014(− 0.051, 0.023) | 0.464 |
| Location (ref: urban) | ||||||||
| Rural | 0.013 (−0.011, 0.038) | 0.290 | 0.003(− 0.017, 0.022) | 0.774 | 0.045 (0.016, 0.073) | 0.002 | −0.018(− 0.046, 0.01) | 0.210 |
| GDP per capita (ref: low) | ||||||||
| Middle | −0.015 (− 0.043, 0.013) | 0.295 | − 0.017(− 0.04, 0.007) | 0.162 | 0.029(− 0.007, 0.065) | 0.117 | − 0.006(− 0.04, 0.028) | 0.713 |
| High | −0.09 (− 0.161, − 0.019) | 0.013 | −0.057(− 0.114, 0) | 0.050 | 0.064(− 0.018, 0.145) | 0.128 | − 0.002(− 0.081, 0.076) | 0.953 |
| Year (ref: 2011) | ||||||||
| 2013 | −0.019 (− 0.041, 0.003) | 0.092 | − 0.002(− 0.021, 0.017) | − 0.09(− 0.122, − 0.059) | < 0.001 | 0.013(− 0.018, 0.044) | 0.399 | |
| 2015 | − 0.011 (− 0.035, 0.013) | 0.372 | − 0.018(− 0.039, 0.002) | − 0.079(− 0.112, − 0.046) | < 0.001 | 0.031(− 0.001, 0.064) | 0.060 | |
| VPC, % | ||||||||
| Province | 1.5% | 0.6% | 0.0% | 0.0% | ||||
| City | 1.6% | 1.6% | 2.7% | 0.5% | ||||
| Community | 2.9% | 1.4% | 0.7% | 1.8% | ||||
| Individual | 94.0% | 96.3% | 96.6% | 97.7% | ||||
Note:
95% CI was displayed in parentheses after the regression coefficient
Respondents categorised in other insurance group were enrolled in insurance program other than the three major social health insurance, such as private insurance, government-funded insurance (Gong Fei) etc
Abbreviation: UEBMI Urban Employee Basic Medical Insurance, URBMI Urban Resident Basic Medical Insurance, NCMS New Rural Cooperative Medical Scheme, Others government health care, private medical insurance and others, PCE Per capita expenditure (Chinese Yuan), NCD Non-communicable disease, VPC Variance partition coefficient
A likelihood ratio test was conducted to compare the fully adjusted model with null model with only random intercept and multivariable linear model. Fully adjusted multilevel model is preferred (P < 0.01)