Investigators at Chongqing Medical University Zero in on Science (The impact of China’s employee basic medical insurance outpatient pooling scheme on outpatient healthcare utilization among middle-aged adults): Science

2026 JUN 11 (NewsRx) -- By a News Reporter-Staff News Editor at Insurance Daily News -- A new study on Science is now available. According to news reporting originating in Chongqing, People’s Republic of China, by NewsRx journalists, research stated, “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.”

The news reporters obtained a quote from the research from Chongqing Medical University, “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. Although the analysis relies on 2018 pilot data, the core institutional mechanisms of outpatient pooling were retained in the post-2021 national framework, suggesting that behavioral responses observed in pilot regions may still be informative under the current reform framework. Implementation of the outpatient pooling policy was associated with a 5.0 percentage points higher probability of outpatient visits (p < 0.05) and a significantly higher visit frequency (IRR = 1.80, p< 0.01). Predictive estimates indicate that expected out-of-pocket expenditure in policy regions was approximately 48% higher than in non-policy regions (p < 0.05). Regions with higher levels of outpatient benefit coverage exhibited stronger utilization responses. In addition, individuals with multiple chronic conditions demonstrated significantly greater outpatient healthcare utilization. The EBMI outpatient pooling policy was associated with higher outpatient service utilization, suggesting improved access to previously unmet outpatient healthcare needs.”

According to the news reporters, the research concluded: “However, additional adjustments may be required to better address the needs of patients with chronic conditions and to strengthen primary healthcare resources, thereby contributing to improvements in equity and efficiency.”

For more information on this research see: The impact of China’s employee basic medical insurance outpatient pooling scheme on outpatient healthcare utilization among middle-aged adults. PLOS One, 2026;21(5). PLOS One can be contacted at: Public Library Science, 1160 Battery Street, Ste 100, San Francisco, CA 94111, USA. (Public Library of Science - www.plos.org; PLOS One - www.plosone.org)

Our news correspondents report that additional information may be obtained by contacting Xinrui Li, Dept. of Public Administration, College of Public Health, Chongqing Medical University, Chongqing, People’s Republic of China. Additional authors for this research include Xinjuan Zhou, Haiyi Chen and Jing Deng.

The direct object identifier (DOI) for that additional information is: https://doi.org/10.1371/journal.pone.0350183. This DOI is a link to an online electronic document that is either free or for purchase, and can be your direct source for a journal article and its citation.

The publisher of the journal PLOS One can be contacted at: Public Library Science, 1160 Battery Street, Ste 100, San Francisco, CA 94111, USA.

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