Tian Jun, Chen Zuopeng, Wang Yu, Zhu Yue
School of Economics and Business Administration, Heilongjiang University, Harbin, China.
Law School, Heilongjiang University, Harbin, China.
BMC Public Health. 2025 May 17;25(1):1826. doi: 10.1186/s12889-025-23027-1.
One of the critical components of public health policy globally is to enhance population health and mitigate health disparities. In 2017, China launched the reform of immediate reimbursement for trans-provincial treatments, aimed at increasing healthcare utilization among the floating population. This study aims to evaluate the impact of this policy reform on the health status of the urban-rural floating population.
This study utilizes individual-level data from the 2017 and 2018 China Migrants Dynamic Survey (CMDS) and administrative hospital data at the city level. The sample includes 47,803 individuals and 66 cities. Treating the direct reimbursement policy as a quasi-natural experiment, we employ a generalized difference-in-differences model for our quantitative analysis. To control for the effects of urban-rural medical insurance integration-to ensure that both urban and rural residents are covered by the same basic medical insurance policy-our analysis of rural health status from 2016 to 2018 is limited to cities that fully implemented this policy integration before January 1, 2017.
The policy of immediate reimbursement for trans-provincial treatments has a significant positive impact on the health of the urban-rural floating population. The health benefits of trans-provincial treatments are less pronounced than those of trans-urban treatment, with primary hospitals showing the most notable improvements. Increased household income and consumer spending significantly amplify the health benefits of this policy for the floating population. The effects of the policy are especially pronounced in the female floating population, middle-aged and young adults, individuals with lower levels of education, those desiring long-term residency, and the unmarried groups.
This paper presents theoretical evidence that the policy of immediate reimbursement for trans-regional treatments narrows the health disparities of the urban-rural floating population and elucidates the mechanisms of this impact for the first time. These results suggest that in order to achieve health equality between urban and rural residents and equitable access to medical services, China is building a more effective medical security system.
全球公共卫生政策的关键组成部分之一是增进人口健康并减少健康差距。2017年，中国启动了跨省就医即时报销改革，旨在提高流动人口的医疗服务利用率。本研究旨在评估这项政策改革对城乡流动人口健康状况的影响。
本研究利用了2017年和2018年中国流动人口动态监测调查（CMDS）的个人层面数据以及城市层面的行政医院数据。样本包括47803个人和66个城市。将直接报销政策视为一项准自然实验，我们采用广义差分模型进行定量分析。为了控制城乡医疗保险一体化的影响——确保城乡居民都被纳入相同的基本医疗保险政策——我们对2016年至2018年农村健康状况的分析仅限于在2017年1月1日前全面实施这项政策一体化的城市。
跨省就医即时报销政策对城乡流动人口的健康有显著的积极影响。跨省就医的健康益处不如跨市就医明显，其中基层医院的改善最为显著。家庭收入和消费支出的增加显著放大了这项政策对流动人口的健康益处。该政策的影响在女性流动人口、中青年、受教育程度较低者、希望长期居留者和未婚群体中尤为明显。
本文提供了理论证据，表明跨地区就医即时报销政策缩小了城乡流动人口的健康差距，并首次阐明了这种影响的机制。这些结果表明，为了实现城乡居民之间的健康平等和公平获得医疗服务，中国正在构建一个更有效的医疗保障体系。
