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Medical insurance integration and rural-urban benefit disparities, 2006-2021: evidence from quasi-natural experiments
1Shanghai Normal University, Shanghai, China jj.yen@qq.com.
Objectives:
To assess the impact of China's medical insurance integration policy on urban-rural disparities in medical insurance benefit levels, explore its heterogeneous effects in regions with different economic development levels and provide empirical evidence for promoting health equity.
Design:
Retrospective panel data analysis using a quasi-natural experiment. Causal inference was conducted using propensity score matching-staggered difference in differences (PSM-staggered DID) method with time-varying policy variables.
Setting:
Provincial-level analysis covering 31 provinces in China, using administrative data from 2006 to 2021.
Participants:
31 Chinese provinces with complete annual data on medical insurance and economic indicators from 2006 to 2021, yielding 496 province-year observations.
Intervention:
Gradual implementation of the policy of integration of medical insurance (2006-2021), with start-up dates varying from province to province.
Primary And Secondary Outcome Measures:
The primary outcomes are natural logarithm of per capita medical insurance benefits for all residents, urban residents and rural residents. No secondary outcomes were predefined.
Results:
Overall, the policy had a weak positive impact on the per capita benefits of rural residents. Subgroup analyses showed no immediate effect in provinces with a gross domestic product (GDP) per capita of more than 100 000 yuan, but an increase in benefits for rural residents 1 year after implementation; an immediate increase in rural benefits in provinces with a GDP per capita of 60 000-100 000 yuan; and a reduction in overall and rural benefits at the beginning in provinces with a GDP per capita of <60 000 yuan, followed by a restoration of rural benefits after 2 years. Mechanistically, the policy increased medical insurance coverage rates, but higher coverage was associated with short-term reductions in per capita benefits.
Conclusion:
Region-specific strategies need to be developed to provide lessons for developing countries pursuing universal health coverage.
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