Data source and study sample
Data came from the 2013 and 2018 National Health Services Survey (NHSS)
waves in China13, 14. The NHSS is a nationally
representative sample conducted every five years by the Center for
Health Statistics and Information, National Health Commission of China.
The NHSS covers 31 provinces/autonomous regions/ municipalities and
adopts a multistage cluster random sampling method to ensure
representativeness for different regions and the whole country. The NHSS
is the largest comprehensive investigation of information on operational
characteristics of county hospitals and PHC facilities (i.e., township
health centers and village clinics) and on health status, healthcare
need and demand, healthcare utilization, and financial burden of
healthcare services in China. In 2013 and 2018, the NHSS sampled 156
counties with two county hospitals and five township health centers in
each county, respectively. The NHSS received ethical approval from the
National Statistics Bureau of China15.
In this study, we focus on a subsample of patients
with chronic diseases aged 15 or
older in rural areas from the 2013 and 2018 NHSS waves. People who
answered yes to at least one of the following three questions were
defined as having a chronic disease: 1) Have you been diagnosed
hypertension? 2) Have you been diagnosed with diabetes mellitus? 3) Do
you have other diagnosed chronic diseases? Rural patients were
identified by hukou status (i.e., the Chinese household registration
method). We excluded counties that did not match between the 2013 and
2018 waves because their status of pairing assistance cannot be
identified. People under 15 years of age were excluded to reduce the
heterogeneity of the sample. We also dropped observations with missing
values in important variables. Finally, the study sample included 13893
and 22725 patients with chronic diseases in rural areas who lived in the
sampling counties in 2013 and 2018, respectively.