Working Paper: NBER ID: w26100
Authors: Yiwei Chen; Hui Ding; Min Yu; Jieming Zhong; Ruying Hu; Xiangyu Chen; Chunmei Wang; Kaixu Xie; Karen Eggleston
Abstract: Health systems globally face increasing morbidity and mortality from chronic diseases, yet many - especially in low- and middle-income countries - lack strong chronic disease management in primary health care (PHC). We provide evidence on China’s efforts to promote PHC management using unique five-year panel data in a rural county, including health care utilization from medical claims and health outcomes from biomarkers. Utilizing plausibly exogenous variation in management intensity generated by administrative and geographic boundaries, we compare hypertension/diabetes patients in villages within two kilometers distance but managed by different townships. Results show that, compared to patients in townships with median management intensity, patients in high-intensity townships have 4.8% more PHC visits, 5.2% fewer specialist visits, 11.7% fewer inpatient admissions, and 3.6% lower medical spending. They also tend to have better medication adherence and better control of blood pressure. The resource savings from avoided inpatient admissions substantially outweigh the costs of the program.
Keywords: Primary Health Care; Chronic Disease Management; Rural Health; Health Economics
JEL Codes: I11; I18
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| Higher management intensity in PHC (I11) | Significant increases in primary care visits (I11) |
| Higher management intensity in PHC (I11) | Substantial reductions in specialist visits (I11) |
| Higher management intensity in PHC (I11) | Reductions in inpatient admissions (I11) |
| Higher management intensity in PHC (I11) | Decrease in overall medical spending (H51) |
| Higher management intensity in PHC (I11) | Better medication adherence (I18) |
| Higher management intensity in PHC (I11) | Improved blood pressure control (I11) |
| Resource savings from avoided inpatient admissions (I11) | Positive net benefit from enhanced PHC management (I11) |