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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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    1. E. Xie, 2011. "Income-related inequalities of health and health care utilization," Frontiers of Economics in China, Springer;Higher Education Press, vol. 6(1), pages 131-156, March.
    2. Karthik Muralidharan & Nishith Prakash, 2017. "Cycling to School: Increasing Secondary School Enrollment for Girls in India," American Economic Journal: Applied Economics, American Economic Association, vol. 9(3), pages 321-350, July.
    3. Jens Hougaard & Lars Østerdal & Yi Yu, 2011. "The Chinese healthcare system," Applied Health Economics and Health Policy, Springer, vol. 9(1), pages 1-13, January.
    4. Macintyre, Sally, 1997. "The black report and beyond what are the issues?," Social Science & Medicine, Elsevier, vol. 44(6), pages 723-745, March.
    5. Qin Zhou & Qing He & Karen Eggleston & Gordon G Liu, 2022. "Urban-rural health insurance integration in china: impact on health care utilization, financial risk protection, and health status," Applied Economics, Taylor & Francis Journals, vol. 54(22), pages 2491-2509, May.
    6. E Xie, 2011. "Income-Related Inequalities of Health and Health Care Utilization," Frontiers of Economics in China-Selected Publications from Chinese Universities, Higher Education Press, vol. 6(1), pages 131-156, March.
    7. Ariella Kahn-Lang & Kevin Lang, 2020. "The Promise and Pitfalls of Differences-in-Differences: Reflections on 16 and Pregnant and Other Applications," Journal of Business & Economic Statistics, Taylor & Francis Journals, vol. 38(3), pages 613-620, July.
    8. Huang, Xian & Wu, Bingxiao, 2020. "Impact of urban-rural health insurance integration on health care: Evidence from rural China," China Economic Review, Elsevier, vol. 64(C).
    9. Yip, Winnie & Hsiao, William, 2009. "China's health care reform: A tentative assessment," China Economic Review, Elsevier, vol. 20(4), pages 613-619, December.
    10. Federico Belotti & Partha Deb & Willard G. Manning & Edward C. Norton, 2015. "twopm: Two-part models," Stata Journal, StataCorp LP, vol. 15(1), pages 3-20, March.
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    Cited by:

    1. 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).
    2. 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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