The impact of China’s employee basic medical insurance outpatient pooling scheme on outpatient healthcare utilization among middle-aged adults

by Xinjuan Zhou, Xinrui Li, Haiyi Chen, Jing Deng Background This study evaluates the association between China’s Employees’ Basic Medical Insurance (EBMI) outpatient pooling policy and outpatient service utilization among middle-aged insured individuals (aged 45–60). By analyzing outpatient service use, visit frequency, and out-of-pocket (OOP) expenditures, the study documents utilization patterns associated with the policy and explores their implications for healthcare-seeking behavior among middle-aged enrollees, providing evidence that may inform future adjustments to outpatient coverage design.

Methods Using cross-sectional data from the 2018 wave of the China Health and Retirement Longitudinal Study (CHARLS), this study employed a logistic regression model to examine the effect of the outpatient pooling policy and different levels of outpatient benefit coverage on the probability of outpatient visits. A zero-inflated negative binomial regression model was used to analyze the impact on the frequency of outpatient visits, and a Tobit model was applied to assess its effect on out-of-pocket outpatient expenditures.