The effect of welfare receipt on unmet health care needs: Evidence from Dibao program in rural China

Unmet health care needs remain a significant challenge among poor adults in low- and middle-income countries, but rigorous evidence on whether unconditional cash transfers can help address this problem is limited. Using data from the 2011-2018 waves of the China Health and Retirement Longitudinal Study (CHARLS) and a fuzzy regression discontinuity (RD) design, this study rigorously evaluated the causal effect of China's rural Dibao, one of the largest social assistance programs in the world, on reducing unmet health care needs among middle-aged and older adults diagnosed with hypertension, stomach diseases, and arthritis. We found that rural Dibao receipt could significantly reduce the probability of unmet health care needs among these individuals. Notably, recipients of high-level Dibao benefits experienced a greater reduction in unmet health care needs compared to those receiving low-level benefits. Mechanism analysis indicated that the program could promote non-financial supports from adult children to their parents, thereby mitigating the parents' unmet health care needs. However, our results revealed that rural Dibao was less effective in addressing unmet health care needs among older women and women living in large households. These findings offer important implications for integrating welfare programs with health promotion policies in China and other developing countries.