In current Chinese health insurance programmes, there are two types of cost-sharing methods: the time-of-service copayment policy and the reimbursement policy. In contrast to the copayment participants, reimbursement participants need to pay for all medical expenses in advance. We study the effect of the reimbursement policy on the utilisation of healthcare services in China. The theoretical analysis indicates that the medical consumption of low income households will be less than the optimal consumption level when enrolled in a reimbursement programme instead of a copayment programme. Empirically, using data from the China Health and Retirement Longitudinal Study (CHARLS), we find that the total inpatient expenditure of the reimbursement participants is 12.7% lower than that of copayment enrolees, and the reimbursement arrangement negatively impacts low-income and rural populations. Therefore, reimbursement participants, those who are financially constrained, are more likely to suffer the up-front payment burden and finally reduce their healthcare needs.

中國現行的醫療保險費用報銷方案中，有兩類型成本分攤方法﹕實時報銷政策和墊付政策。相對實時報銷計劃下的投保人，墊付計劃參加者在使用醫療服務時，需要先行繳納全額醫療費用，在就醫結束後再至相關部門進行醫療費用報銷。本文研究墊付政策對中國參保居民醫療服務利用的影響。理論分析顯示，當投保人參與墊付計劃而非實時報銷計劃時，低收入家庭的醫療消費將低於理想的消費水平。利用中國健康與養老追蹤調查(CHARLS)數據，我們發現墊付計劃投保人的住院總開支比實時結算計劃投保人要低12.7%；墊付計劃對低收入和農村投保人的醫療服務利用有顯著負向影響。因此，醫保墊付制度給經濟水平有限的參保人群造成了明顯的墊支壓力，進而抑制其合理的醫療需求。

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