Interregional reimbursement reform in China lowers administrative barriers to healthcare utilization

Geographic segmentation of health insurance creates administrative barriers that limit patients’ access to out-of-network healthcare, particularly in underserved regions. We assess the impact of a reimbursement reform removing interregional administrative barriers on patient healthcare utilization. We conduct a quantitative quasi-experimental study using longitudinal administrative data from a representative city with limited high-tier medical resources. The causal effects of the reform are estimated based on patient visit records from January 2021 to November 2022 using a regression discontinuity of time (RDiT) design. The reform significantly increases intercity healthcare visits by up to 11.2%, especially among low-income patients and women. While patients with severe conditions benefit, increased utilization for minor ailments also occurs. This surge in demand strains medical resources, leading to increased readmission rates without reducing hospital stays. Removing administrative barriers enhances equity but may reduce healthcare efficiency if demand management is neglected. Policymakers should combine expanded access with investments in local healthcare capacity and demand-side controls to ensure sustainable and equitable service delivery. Public health insurance systems often require many administrative steps for patients to receive reimbursement when seeking care outside their home region, limiting their freedom to choose hospitals. We study what happens when the world’s largest public health insurance market makes it easier for people to use their insurance across regions. We compare patient behavior immediately before and after these administrative barriers are relaxed. We find that simpler reimbursement procedures increase intercity healthcare visits, especially for low-income patients and women. However, some people also travel for minor illnesses, which increases pressure on hospitals and raises readmission rates. The findings show that lowering administrative barriers improves equity in access to care, but future policies also need to manage demand and strengthen local medical services. Cui et al. compare patient behavior before and after China’s Interregional Reimbursement Reform. They find that simpler reimbursement procedures increase intercity doctor visits, especially for low-income patients and women, but that some people also travel for minor illnesses, which increases pressure on hospitals and raises readmission rates.