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Social health insurance consolidation and urban-rural inequality in utilization and financial risk protection in China

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  • Yang, Di
  • Acharya, Yubraj
  • Liu, Xiaoting

Abstract

Universal health care is a long-term policy goal for health care reform in China. In 2016, China consolidated its urban and rural resident social health insurance programs into one program with a goal to reduce disparities between rural and urban populations. Using a nationally-representative sample of 14,967 individuals from the China Family Panel Studies surveys (2012–2018), we investigate whether the consolidation reduced gaps in total and out-of-pocket medical expenditure, and reimbursement between rural and urban residents. Our identification approach relies on an augmented difference-in-differences analysis whereby we compare the two programs that were consolidated to a different program that was not consolidated, before and after the consolidation. We find no evidence that the urban-rural gaps in these measures have narrowed as a result of the consolidation, at least in the near term. This surprising result may be partly explained by urban-rural inequality in access to care and provincial fiscal spending on health care. While these findings need to be confirmed with additional data and research, we call for continued efforts on addressing supply-side challenges, particularly in under-served areas.

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  • Yang, Di & Acharya, Yubraj & Liu, Xiaoting, 2022. "Social health insurance consolidation and urban-rural inequality in utilization and financial risk protection in China," Social Science & Medicine, Elsevier, vol. 308(C).
    • Handle: RePEc:eee:socmed:v:308:y:2022:i:c:s0277953622005068
    DOI: 10.1016/j.socscimed.2022.115200
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    References listed on IDEAS

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    Cited by:

    1. Wang, Xinfeng & Ye, Xin, 2024. "Impact of the targeted poverty alleviation policy on older adults’ healthcare utilization: A quasi-experimental analysis from China," Social Science & Medicine, Elsevier, vol. 356(C).
    2. Li, Yao & Li, Lei & Liu, Junxia, 2023. "The efficient moral hazard effect of health insurance: Evidence from the consolidation of urban and rural resident health insurance in China," Social Science & Medicine, Elsevier, vol. 324(C).
    3. Tang, Yingqian & Fu, Rong & Noguchi, Haruko, 2024. "Impact of medical insurance integration on reducing urban-rural health disparity: Evidence from China," Social Science & Medicine, Elsevier, vol. 357(C).
    4. He, Wen, 2023. "Social medical insurance integration and health care disparities in China: Evidence from an administrative claim dataset," Economic Analysis and Policy, Elsevier, vol. 79(C), pages 20-39.

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