Multilevel medical insurance mitigate health cost inequality due to air pollution: Evidence from China

Abstract Background Air pollution affects residents’ health to varying extents according to differences in socioeconomic status. However, there has been a lack of research on whether air pollution contributes to unfair health costs. Methods In this research, data from the China Labour Force Dynamics Survey are matched with data on PM2.5 average concentration and precipitation, and the influence of air pollution on the health expenditures of residents is analysed with econometric methods involving a two-part model, instrument variables and moderating effects. Results The findings reveal that air pollution significantly impacts Chinese residents’ health costs and leads to low-income people face health inequality. Specifcally, the empirical evidence shows that air pollution has no significant influence on the probability of residents’ health costs (β = 0.021, p = 0.770) but that it increases the amount of residents’ total outpatient costs (β = 0.379, p