The macroeconomic and welfare implications of rural health insurance and pension reforms in China

We assess the potential impact of rural health insurance and pension reforms on macroeconomic outcomes and social welfare in a dynamic general equilibrium model calibrated to the Chinese economy. We analyze transition paths as well as steady state responses to the new policies. The current reforms in China provide modest rural pensions and reimbursement of a portion of healthcare costs, but at rates that are substantially lower than are already in place in the urban sector. We investigate the potential effect of raising the rural benefit rates to those enjoyed in the urban sector. While both reforms reduce income per capita, we show that the health insurance reforms are potentially welfare improving if they are implemented in a way that leads to reduced out-of-pocket health spending. The welfare gains are driven by rural health insurance providing relief from the risk of catastrophic medical expenditures that can wipe out household savings and force long working hours. A pay-as-you-go rural pension results in a welfare gain in the short-run but welfare loss in the long-run due to the distorting effects of taxes. Despite an increase in required financing due to an aging population, the welfare impact of rural health insurance remains positive when incorporating the projected old-age dependency ratio for the year 2050. However, a pay-as-you-go rural pension creates large income and welfare losses with 2050 demographics.