Urban-rural health insurance integration in china: impact on health care utilization, financial risk protection, and health status

Qin Zhou, Qing He, Karen Eggleston and Gordon G Liu

Applied Economics, 2022, vol. 54, issue 22, 2491-2509

Abstract: 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

Date: 2022
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DOI: 10.1080/00036846.2021.1998323

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