Is the construction of high-speed rail crowding out the market for medical care services at county? Quasi-experimental evidence from China

Background: Public transportation, including high-speed rail (HSR), exerts a significant influence on people's health and health-related behaviors in various ways around the world. Several studies have investigated the impact of HSR on patients' health-seeking behavior, however, many issues regarding the impact of HSR remain to be investigated in depth. We aim to explore whether the effect of HSR on patients' health-seeking behavior crowds out the market for medical services in county regions based on China's practice. Methods: The opening of two important HSR lines connecting two megacities in western China, Xi'an to Chengdu (opened on December 6, 2017) and Yinchuan to Xi'an (opened on December 26, 2020), were considered as quasi-experimental intervention, and Event Study and Synthetic Difference-in-Differences (DID) research design were applied in this study. A monthly report database about county-level hospitals of the health statistical data collection from 2017 to 2018 and 2020 to 2021 was used. Results: There is no significant change in the total number of visits (TOV) and the number of bed days occupied by discharged persons (BDODP) in county-level hospitals before and after the opening of two major HSR lines being observed. The estimates of TOV from synthetic DID were 319.38 (95% CI, -761.01, 1399.77) and -915.69 (95% CI, -5079.07, 3247.68) for the two HSR lines, respectively. The estimates of BDODP from synthetic DID were -581.34 (95% CI, -1555.27, 392.59) and -960.62 (95% CI, -3932.40, 2011,17) for the two HSR lines, respectively. The results from the event study DID estimates are in line with the synthetic DID. Conclusions: Our findings suggest that the construction of HSR does not substantially modify the utilization of medical services at the county level. Moreover the effect of the construction of HSR on the flow of patients to large hospitals may be an incremental effect. These findings hold important implications for infrastructure policy, suggesting that improvements in transportation can coexist with and perhaps even bolster local healthcare services without compromising their usage.