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Impact of urban-rural health insurance integration on health care: Evidence from rural China

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  • Huang, Xian
  • Wu, Bingxiao

Abstract

In recent years, Chinese local governments have experimented with integrating the social health insurance system segmented between rural and urban areas to unify the administration, policy, and funds of various health insurance programs. In this study, we take advantage of the staggered implementation of the urban-rural health insurance integration across cities over time to examine the impacts of the integration on rural residents' health care utilization and health outcomes. Based on an original city-year level policy dataset and the China Health and Retirement Longitudinal Study (CHARLS) for the years 2011, 2013, and 2015, we find that the integration significantly increases the middle-aged and older rural residents' inpatient care utilization and this positive effect is particularly salient in poor areas. Moreover, we find that the positive policy effect of integration is attributed to enhanced health insurance benefits, such as a higher reimbursement rate for inpatient care. However, the integration has limited impacts on the middle-aged and older rural residents' health outcomes. This study reveals the partial success of urban-rural health insurance integration to reduce health care inequality in China.

Suggested Citation

  • 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).
    • Handle: RePEc:eee:chieco:v:64:y:2020:i:c:s1043951x20301401
    DOI: 10.1016/j.chieco.2020.101543
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    3. Yayun Ren & Jian Yu & Guanglai Zhang & Chang Zhang & Wenmei Liao, 2023. "The Short- and Long-Run Impacts of Air Pollution on Human Health: New Evidence from China," IJERPH, MDPI, vol. 20(3), pages 1-23, January.
    4. Xinxin Ma, 2022. "Social Insurances and Risky Financial Market Participation: Evidence from China," Emerging Markets Finance and Trade, Taylor & Francis Journals, vol. 58(10), pages 2957-2975, August.
    5. Li, Zhong-Ping & Chang, Aichih (Jasmine) & Zou, Zongbao, 2023. "Design mechanism to coordinate a hierarchical healthcare system: Patient subsidy vs. capacity investment," Omega, Elsevier, vol. 118(C).
    6. 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).
    7. Lin Lin & Xianhua Zai, 2022. "The role of supply responses in public insurance expansion: evidence from China's New Cooperative Medical Scheme," MPIDR Working Papers WP-2022-025, Max Planck Institute for Demographic Research, Rostock, Germany.
    8. Zhang, Yan & Zhao, Guangchuan & Gu, Hai, 2022. "Investing in health capital: Does medical insurance matter?," Research in International Business and Finance, Elsevier, vol. 61(C).
    9. Caiyao Xu & Chen Qian & Wencai Yang & Bowei Li & Lingqian Kong & Fanbin Kong, 2022. "Spatiotemporal Pattern of Urban-Rural Integration Development and Its Driving Mechanism Analysis in Hangzhou Bay Urban Agglomeration," IJERPH, MDPI, vol. 19(14), pages 1-21, July.
    10. Chen, Hua & Ding, Yugang & Tang, Lin & Wang, Lizhen, 2022. "Impact of urban–rural medical insurance integration on consumption: Evidence from rural China," Economic Analysis and Policy, Elsevier, vol. 76(C), pages 837-851.
    11. Bencheng Liu & Yangang Fang, 2021. "The Nexus between Rural Household Livelihoods and Agricultural Functions: Evidence from China," Agriculture, MDPI, vol. 11(3), pages 1-19, March.
    12. 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).
    13. Lin, Lin & Zai, Xianhua, 2022. "The Power of Public Insurance With Limited Benefits: Evidence from China's New Cooperative Medical Scheme," GLO Discussion Paper Series 1180, Global Labor Organization (GLO).
    14. 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.
    15. Li, Zhong-Ping & Wang, Jian-Jun, 2021. "Effects of healthcare quality and reimbursement rate in a hospital association," Socio-Economic Planning Sciences, Elsevier, vol. 76(C).
    16. Chen, Hua & Ding, Yugang & Wang, Xiangnan & Yang, Yifei, 2023. "The effect of public insurance policy on the private insurance market: New evidence from a quasi-experiment in China," Economic Analysis and Policy, Elsevier, vol. 78(C), pages 937-953.

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    More about this item

    Keywords

    Urban-rural health insurance integration; Health care utilization; Health care reform in China;
    All these keywords.

    JEL classification:

    • O12 - Economic Development, Innovation, Technological Change, and Growth - - Economic Development - - - Microeconomic Analyses of Economic Development
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private

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