School of Health Policy and Management, Nanjing Medical University, 101 Longmian Avenue, Nanjing, 211166, Jiangsu, China.
School of Finance, Nankai University, 38 Tongyan Avenue, Tianjin, 300350, China.
Int J Equity Health. 2024 Aug 6;23(1):153. doi: 10.1186/s12939-024-02238-9.
Air pollution affects residents' health to varying extents according to differences in socioeconomic status. However, there has been a lack of research on whether air pollution contributes to unfair health costs.
In this research, data from the China Labour Force Dynamics Survey are matched with data on PM2.5 average concentration and precipitation, and the influence of air pollution on the health expenditures of residents is analysed with econometric methods involving a two-part model, instrument variables and moderating effects.
The findings reveal that air pollution significantly impacts Chinese residents' health costs and leads to low-income people face health inequality. Specifcally, the empirical evidence shows that air pollution has no significant influence on the probability of residents' health costs (β = 0.021, p = 0.770) but that it increases the amount of residents' total outpatient costs (β = 0.379, p < 0.006), reimbursed outpatient cost (β = 0.453, p < 0.044) and out-of-pocket outpatient cost (β = 0.362, p < 0.048). The heterogeneity analysis of income indicates that low-income people face inequality due to health cost inflation caused by air pollution, their total and out-of-pocket outpatient cost significantly increase with PM2.5 (β = 0.417, p = 0.013; β = 0.491, p = 0.020). Further analysis reveals that social basic medical insurance does not have a remarkable positive moderating effect on the influence of air pollution on individual health inflation (β = 0.021, p = 0.292), but supplementary medical insurance for employees could reduce the effect of air pollution on low-income residents' reimbursed and out-of-pocket outpatient cost (β=-1.331, p = 0.096; β=-2.211, p = 0.014).
The study concludes that air pollution increases the amount of Chinese residents' outpatient cost and has no significant effect on the incidence of outpatient cost. However, air pollution has more significant impact on the low-income residents than the high-income residents, which indicates that air pollution leads to the inequity of medical cost. Additionally, the supplementary medical insurance reduces the inequity of medical cost caused by air pollution for the low-income employees.
空气污染对居民健康的影响因社会经济地位的不同而有所差异。然而，关于空气污染是否会导致不公平的健康成本，目前还缺乏研究。
本研究将中国劳动力动态调查数据与 PM2.5 平均浓度和降水数据相匹配，并采用双部分模型、工具变量和调节效应的计量经济学方法分析空气污染对居民健康支出的影响。
研究结果表明，空气污染显著影响中国居民的健康成本，导致低收入人群面临健康不平等。具体而言，实证结果表明，空气污染对居民健康成本的发生概率没有显著影响（β=0.021，p=0.770），但会增加居民总门诊费用（β=0.379，p<0.006）、报销门诊费用（β=0.453，p<0.044）和自付门诊费用（β=0.362，p<0.048）。收入的异质性分析表明，由于空气污染导致健康成本膨胀，低收入人群面临不平等，其总门诊费用和自付门诊费用均显著增加（β=0.417，p=0.013；β=0.491，p=0.020）。进一步分析表明，社会基本医疗保险对空气污染对个人健康通胀影响的调节作用不显著（β=0.021，p=0.292），但职工补充医疗保险可以降低空气污染对低收入居民报销和自付门诊费用的影响（β=-1.331，p=0.096；β=-2.211，p=0.014）。
本研究表明，空气污染增加了中国居民门诊费用的支出，对门诊费用的发生没有显著影响。然而，空气污染对低收入居民的影响比高收入居民更为显著，这表明空气污染导致了医疗费用的不公平。此外，补充医疗保险减轻了空气污染对低收入职工医疗费用不公平的影响。
