Search

Health insurance coverage and the risk protection it provides may improve enrollees' subjective well-being (SWB), as demonstrated, e.g. by Oregon Medicaid's randomized expansion significantly improving enrollees' mental health and happiness. Yet little evidence from low- and middle-income countries documents the link between insurance coverage and SWB. We analyse individual-level data on a large natural experiment in China: the integration of the rural and urban resident health insurance programmes. This reform, expanded nationally since 2016, is recognized as a vital step towards attaining the goal of providing affordable and equitable basic healthcare in China, because integration raises the level of healthcare coverage for rural residents to that enjoyed by their urban counterparts. This study is the first to investigate the impact of urban–rural health insurance integration on the SWB of the Chinese population. Analysing 2011–18 data from the China Health and Retirement Longitudinal Study in a difference-in-difference framework with variation in the treatment timing, we find that the integration policy significantly improved the life satisfaction of rural residents, especially among low-income and elderly individuals. The positive impact of the integration on SWB appears to stem from the improvement of rural residents' mental health (decrease in depressive symptoms) and associated increases in some health behaviours, as well as a mild increase in outpatient care utilization and financial risk protection. There was no discernible impact of the integration on SWB among urban residents, suggesting that the reform reduced inequality in healthcare access and health outcomes for poorer rural residents without negative spillovers on their urban counterparts. [ABSTRACT FROM AUTHOR]

Zhen Yuan,1,2 Fan Zhang,3 Zhiguang Li,1,2 Hua Wei1,2 1School of Economics and Management, Anhui University of Chinese Medicine, Hefei, Anhui, People’s Republic of China; 2Key Laboratory of Data Science & Innovative Development of Traditional Chinese Medicine, Philosophy and Social Sciences of Anhui Province, Hefei, Anhui, People’s Republic of China; 3School of Finance, Nanjing Agricultural University, Nanjing, Jiangsu, People’s Republic of ChinaCorrespondence: Zhiguang Li; Hua Wei, Email lizhiguang0731@163.com; weihua@ahtcm.edu.cnBackground: A linchpin to realizing the internal circulation (referring to the domestic cycle of production, distribution and consumption) is reducing residents’ saving rate and expanding the domestic needs. However, rural residents in China demonstrate a strong propensity to save money.Methods: In light of practical characteristics of urban-rural health integration promoted in different places, the three-phase data (from 2014 to 2018) and the dual difference-in-differences model of the China Labor-force Dynamics Survey (CLDS) are used to empirically investigate the impact of urban-rural health insurance integration on rural household savings.Results: Research reveals that urban-rural health integration can reduce the health risks and medical risks facing rural households, thus weakening the motivation of precautionary savings. The analysis of heterogeneity reveals that the integration of urban-rural health insurance significantly influences the savings rates of households headed by older individuals, particularly women, with lower levels of educational attainment. Besides, the single-tier health insurance system can have a more significant impact, whereas the multi-tier insurance system may not significantly affect the savings rate.Conclusion: Based on the aforesaid research conclusions, this article believes that in order to reduce the savings rate of rural households and expand consumption, the health insurance system should be further improved.Keywords: urban-rural health insurance integration, rural household, savings rate, health risks, medical risks

BackgroundIn 2016, the Chinese government introduced an integration reform of the health insurance system with the aim to enhance equity in healthcare coverage and reduce disparities between urban and rural sectors. The gradual introduction of the policy integrating urban and rural medical insurance in pilot cities provides an opportunity to evaluate the policy impact. This study attempts to assess the policy impact of urban–rural health insurance integration on the chronic poverty of rural residents and to analyze the mechanisms.MethodBased on the four waves of data from the China Health and Retirement Longitudinal Study (CHARLS) conducted in 2011, 2013, 2015, and 2018, we employed a staggered difference-in-differences (staggered DID) model to assess the impact of integrating urban–rural health insurance on poverty vulnerability among rural inhabitants and a mediation model to analyze the mechanism channel of the policy impact.Results(1) Baseline regression analysis revealed that the urban–rural health insurance integration significantly reduced the poverty vulnerability of rural residents by 6.32% (p

China has been making efforts to establish a universal health care coverage system through multiple social health insurance schemes. As these insurance schemes cover different populations with different financing and reimbursement levels, large disparities remain in health care access and health outcomes among people covered. The government has launched an urban-rural integration policy for social health insurance to reduce disparities in access and health outcomes. We adopt a difference-in-differences propensity score matching approach to estimate the effects of this integration policy on health care utilization, financial risk protection, and health status, using nationally representative Chinese household survey data. The results show that the integration policy has significantly improved financial risk protection and self-assessed health of rural residents in China, which could be attributed to a decline in out-of-pocket payment. The low-income rural residents benefit most from this policy. There is no evidence that it has pronounced effects among urban residents. Greater efforts to increase reimbursement rates and to expand beneficiary populations could help to mitigate remaining urban-rural disparities. The findings in this study would contribute to a better understanding of the impacts of health insurance expansion in low- and middle-income countries. JEL code: I18, I10 [ABSTRACT FROM AUTHOR]

Background: In 2016, the Chinese government introduced an integration reform of the health insurance system with the aim to enhance equity in healthcare coverage and reduce disparities between urban and rural sectors. The gradual introduction of the policy integrating urban and rural medical insurance in pilot cities provides an opportunity to evaluate the policy impact. This study attempts to assess the policy impact of urban-rural health insurance integration on the chronic poverty of rural residents and to analyze the mechanisms., Method: Based on the four waves of data from the China Health and Retirement Longitudinal Study (CHARLS) conducted in 2011, 2013, 2015, and 2018, we employed a staggered difference-in-differences (staggered DID) model to assess the impact of integrating urban-rural health insurance on poverty vulnerability among rural inhabitants and a mediation model to analyze the mechanism channel of the policy impact., Results: (1) Baseline regression analysis revealed that the urban-rural health insurance integration significantly reduced the poverty vulnerability of rural residents by 6.32% ( p  < 0.01). The one health insurance system with one unified scheme of contributions and benefits package (OSOS, 6.27%, p  < 0.01) is more effective than the transitional one health insurance system with multiple schemes (OSMS, 3.25%, p  < 0.01). (2) The heterogeneity analysis results showed that the urban-rural health insurance integration had a more significant impact on vulnerable groups with relatively poor health (7.84%, p  < 0.1) than those with fairly good health (6.07%, p  < 0.01), and it also significantly reduced the poverty vulnerability of the group with chronic diseases by 9.59% ( p  < 0.01). The integration policy can significantly reduce the poverty vulnerability of the low consumption and low medical expenditure groups by 8.6% ( p  < 0.01) and 7.64% ( p  < 0.01), respectively, compared to their counterparts. (3) The mechanism analysis results showed that the urban-rural health insurance integration can partially enhance labor supply (14.23%, p  < 0.01) and physical examinations (6.28%, p  < 0.01). The indirect effects of labor supply and physical examination in reducing poverty vulnerability are 0.14%, 0.13% respectively., Conclusion: The urban-rural health insurance integration policy significantly reduced poverty vulnerability, and the OSOS is more effective than the OSMS. The urban-rural health insurance integration policy can significantly reduce poverty vulnerability for low consumption and poor health groups. Labor supply and physical examination are indirect channels of the impact. Both channels potentially increase rural household income and expectations of investment in human health capital to achieve the policy objective of eliminating chronic poverty., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Li, Chen and Ding.)