Rethinking Cost-Sharing Policies: Enhancing Chronic Disease Management for Disadvantaged Populations

The increasing prevalence of chronic diseases poses a significant challenge to global efforts to alleviate poverty, promote health equity, and control healthcare costs. This study adopts a structural approach to explore how patients manage chronic diseases by making trade-offs between inpatient care and ambulatory care outpatient services. Specifically, it investigates whether disadvantaged populations make distinct trade-offs compared to the general population and examines the impact of anti-poverty programs that reduce inpatient cost-sharing. Using health insurance claims data from a rural county in China, the study reveals that disadvantaged individuals tend to avoid ambulatory care unless it substantially lowers medical expenses. In contrast, the general population is more likely to prioritize ambulatory care, even at higher costs, to prevent disease progression. The findings also indicate that current anti-poverty insurance policies, which focus predominantly on hospitalization, inadvertently decrease ambulatory care usage by 23\%, resulting in increased healthcare costs and a 46.2\% decline in patient welfare. Counterfactual analysis suggests that reducing cost-sharing for ambulatory care would be a more cost-effective strategy for improving health outcomes and supporting disadvantaged populations than providing travel subsidies.