Bay Area International Business School, Beijing Normal University, Zhuhai, 519087, China.
School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191, China.
Int J Equity Health. 2023 Nov 23;22(1):245. doi: 10.1186/s12939-023-02063-6.
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.
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.
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).
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.
财务保护是全民健康覆盖（UHC）的一个关键维度，而社会医疗保险是提供财务保护的有效措施。本研究旨在探讨中国城乡医疗保险整合对医疗贫困的影响。
我们收集了中国 337 个地级市的整合政策时间，结合 2012-2016 年中国劳动力动态调查（CLDS）的纵向数据库，采用城市层面的多时间期差分法（DID）研究城乡医疗保险整合对医疗贫困的影响。此外，为了探讨政策效果在人群中的异质性，我们根据受访者的年龄、户籍和是否为城乡流动人口进行了亚组分析。
共有 8397 个样本纳入研究。整合政策显著降低了医疗贫困的发生率（平均处理效应（ATT）=-0.055，p<0.05）。亚组分析表明，医疗贫困的影响因年龄组而异，整合政策对老年人的影响大于对年轻人的影响（年龄 15-34 岁的 ATT=-0.018，p>0.05；年龄 35-54 岁的 ATT=-0.042，p<0.05；年龄 55-64 岁的 ATT=-0.163，p<0.01）。此外，影响也因户籍而异。整合政策对农村居民的影响更为显著（农村居民的 ATT=-0.067，p<0.05），而对城镇居民的影响较小（城镇居民的 ATT=-0.007，p>0.05）。此外，该政策对农村-城市流动人口的影响更大（农村-城市流动人口的 ATT=-0.086，p<0.05），而对未流动人口的影响较小（农村-城市未流动人口的 ATT=-0.071，p<0.05）。
中国城乡医疗保险整合政策在减轻医疗贫困方面取得了成功，特别是对老年人口、农村人口和农村-城市流动人口。可以推测，该整合政策可能适用于发展中国家的其他类似情况，以减轻医疗贫困。
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