Incentivizing primary care utilization in China: the impact of health insurance coverage on health-seeking behaviour.

This article examines the impact of the New Rural Cooperative Medical System (NRCMS), a basic health insurance scheme in China, on rural residents' health-seeking behaviour and primary healthcare utilization. Using data from the China Family Panel Studies (2012–2020) and employing a multi-period difference-in-differences model with Heckman selection correction, the study finds that NRCMS enrollment significantly increases rural residents' likelihood of seeking outpatient care at primary healthcare centres (PHCs), driven largely by higher outpatient reimbursement rates at PHCs compared to tertiary hospitals. In contrast, the Urban Resident Basic Medical Insurance (URBMI) shows no significant effect on urban residents' primary care engagement, highlighting differences in cost sensitivity and healthcare preferences between rural and urban populations. The study also identifies stronger primary care preferences among younger and less-educated rural insured individuals and reveals a synergistic effect between insurance coverage and the availability of primary healthcare resources in promoting PHC utilization. These findings provide empirical evidence for refining health insurance policies to enhance healthcare accessibility and efficiency within China's hierarchical medical system.