Care Utilization with China's New Rural Cooperative Medical Scheme: Updated Evidence from the China Health and Retirement Longitudinal Study 2011-2012

China's New Rural Cooperative Medical Scheme (NRCMS), a healthcare financing system for rural residents in China, underwent significant enhancement since 2008. Studies based on pre-2008 NRCMS data showed an increase in inpatient care utilization after NRCMS coverage. However evidence was mixed for the relationship between outpatient care use and NRCMS coverage. We assessed whether enrollment in the enhanced NRCMS was associated with less delaying or foregoing medical care, as a reduction in foregoing needed care signals about removing liquidity constraint among the enrollees. Using a national sample of rural residents (N = 12,740) from the 2011-2012 wave of China Health and Retirement Longitudinal Study, we examined the association between NRCMS coverage and the likelihood of delaying or foregoing medical care (outpatient and inpatient) by survey-weighted regression models controlling for demographics, education, geographic regions, household expenditures, pre-existing chronic diseases, and access to local healthcare facilities. Zero-inflated negative binomial model was used to estimate the association between NRCMS coverage and number of medical visits. NRCMS coverage was significantly associated with lower odds of delaying or foregoing inpatient care (OR: 0.42, 95 % CI: 0.22-0.81). A negative but insignificant association was found between NRCMS coverage and delaying/foregoing outpatient care when ill. Among those who needed health care, the expected number of outpatient visits for NRCMS enrollees was 1.35 (95 % CI: 1.03-1.77) times of those uninsured, and the expected number of inpatient visits for NRCMS enrollees was 1.83 (95 % CI: 1.16-2.88) times of those uninsured. This study shows that the enhanced NRCMS coverage was associated with less delaying or foregoing inpatient care deemed as necessary by health professionals, which is likely to result from improved financial reimbursement of the NRCMS.