How does insurance coverage affect unclaimed prescription rates and physicians' prescribing behaviors? Evidence from Liaoning, China

National Healthcare Security Administration (NHSA) of China routinely evaluates and adjusts insurance coverage rates for drugs and services within the Basic Medical Insurance (BMI) system to balance patient access to care with budget constraints. This study examines how insurance coverage affects patient behaviors and physicians' decision-making. Using outpatient data from a major hospital in Liaoning, China, we apply logistic regression to examine how insurance coverage rates impact unclaimed prescriptions, which indicate medication nonadherence. Additionally, we use multivariate regression to assess how physicians adjust prescribing practices in response to changes in insurance coverage rates. Our findings indicate that patients are less likely to leave drug prescriptions unclaimed than service prescriptions, as they often prioritize symptom-relief medications over diagnostic tests when their insurance allowances are nearly exhausted. Higher total prescription charges generally increase the likelihood of unclaimed prescriptions, except among rural patients with service prescriptions. Furthermore, the effect of insurance coverage changes on prescription volumes varies depending on the location of the medical center (urban or rural), drug category, and patient insurance status. These results underscore the need for context-specific insurance policies and tailored strategies to optimize the healthcare budget–simply increasing coverage rates may not effectively address all patient needs.