Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Nov 23;22(1):245.
doi: 10.1186/s12939-023-02063-6.

The impact of urban-rural medical insurance integration on medical impoverishment: evidence from China

Jinkang Huo #  1 , Mingzheng Hu #  2   3 , Shaojie Li  4   5
Affiliations

The impact of urban-rural medical insurance integration on medical impoverishment: evidence from China

Jinkang Huo et al. Int J Equity Health. .

Abstract

Background: Financial protection is a key dimension of Universal Health Coverage (UHC), and social medical insurance is an effective measure to provide financial protection. The aim of this study is to examine the impact of urban-rural medical insurance integration on medical impoverishment in China.

Methods: We collected the time of integration policy in 337 prefecture-level cities across China, combined with the longitudinal database of China Labor-force Dynamics Survey (CLDS) from 2012-2016, and used a difference-in-differences (DID) method with multiple time periods at the city level to study the effect of urban-rural medical insurance integration on the medical impoverishment. Besides, to explore the heterogeneity of policy effects across populations, we conducted subgroup analyses based on respondents' age, household registration, and whether they were rural-urban migrants.

Findings: A total of 8,397 samples were included in the study. The integration policy has significantly reduced the incidence of medical impoverishment (average treatment effect on the treated (ATT) = - 0.055, p < 0.05). Subgroup analysis showed that the impacts on medical impoverishment varied by age group, and the integration policy has more effect on older people than on younger people (ATT for age 15-34 = - 0.018, p > 0.05; ATT for age 35-54 = - 0.042, p < 0.05; ATT for age 55-64 = - 0.163, p < 0.01). Moreover, the impacts also varied by household registration. The integration policy has a more significant impact on rural residents (ATT for rural = - 0.067, p < 0.05) compared to urban residents (ATT for urban = - 0.007, p > 0.05). Additionally, the policy has a bigger influence on rural-urban migrants (ATT for rural-urban migrated = - 0.086, p < 0.05) than on those who have not migrated (ATT for rural-urban unmigrated = - 0.071, p < 0.05).

Conclusion: China's policy of integrating urban-rural medical insurance has been successful in reducing medical impoverishment, especially for older age, rural, and rural-urban migrated people. It can be speculated that the integrating policy may be adapted to other similar settings in developing countries to reduce medical impoverishment.

Keywords: China; City policy evaluation; Medical impoverishment; Medical insurance; Rural; Urban.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Parallel trend test. The standard errors in parentheses are clustered by city
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. World Health Organization. Distribution of health payments and catastrophic expenditures methodology. Geneva: World Health Organization; 2005. https://iris.who.int/bitstream/handle/10665/69030/EIP_?sequence=1.
    1. World Health Organization. The world health report: health systems financing: the path to universal coverage: executive summary. Geneva: World Health Organization; 2010. https://iris.who.int/bitstream/handle/10665/70496/WHO_IER_WHR_10.1_chi.pdf. - PMC - PubMed
    1. Liu Y, Rao K, Hsiao WC. Medical expenditure and rural impoverishment in China. J Health Popul Nutr 2003; 216–22. - PubMed
    1. Devadasan N, Criel B, Van Damme W, Ranson K, Van der Stuyft P. Indian community health insurance schemes provide partial protection against catastrophic health expenditure. BMC Health Serv Res. 2007;7:1–11. doi: 10.1186/1472-6963-7-43. - DOI - PMC - PubMed
    1. Mekonen AM, Gebregziabher MG, Teferra AS. The effect of community based health insurance on catastrophic health expenditure in Northeast Ethiopia: a cross sectional study. PLoS One. 2018;13:e0205972. doi: 10.1371/journal.pone.0205972. - DOI - PMC - PubMed

LinkOut - more resources