Department of Health Policy and Administration, The Pennsylvania State University, 601L Ford Building, University Park, PA, 16801, USA.
School of Public Affairs, Zhejiang University, 310058, China.
Soc Sci Med. 2022 Sep;308:115200. doi: 10.1016/j.socscimed.2022.115200. Epub 2022 Jul 8.
Universal health care is a long-term policy goal for health care reform in China. In 2016, China consolidated its urban and rural resident social health insurance programs into one program with a goal to reduce disparities between rural and urban populations. Using a nationally-representative sample of 14,967 individuals from the China Family Panel Studies surveys (2012-2018), we investigate whether the consolidation reduced gaps in total and out-of-pocket medical expenditure, and reimbursement between rural and urban residents. Our identification approach relies on an augmented difference-in-differences analysis whereby we compare the two programs that were consolidated to a different program that was not consolidated, before and after the consolidation. We find no evidence that the urban-rural gaps in these measures have narrowed as a result of the consolidation, at least in the near term. This surprising result may be partly explained by urban-rural inequality in access to care and provincial fiscal spending on health care. While these findings need to be confirmed with additional data and research, we call for continued efforts on addressing supply-side challenges, particularly in under-served areas.
全民健康覆盖是中国医疗改革的长期政策目标。2016 年，中国将城乡居民社会医疗保险制度整合为一个制度，旨在缩小城乡居民之间的差距。本研究利用中国家庭追踪调查（CFPS）2012-2018 年的 14967 个个体的全国代表性样本，考察了整合是否缩小了城乡居民总医疗支出和自付医疗支出以及报销方面的差距。我们的识别方法依赖于增强的双重差分分析，即我们在整合前后将两个被整合的项目与另一个未被整合的项目进行比较。我们没有发现整合缩小了这些措施城乡差距的证据，至少在短期内是如此。这一令人惊讶的结果可能部分可以解释为城乡在获得医疗服务和省级卫生支出方面的不平等。尽管这些发现需要更多的数据和研究来证实，但我们呼吁继续努力解决供应方面的挑战，特别是在服务不足的地区。
