The Effect of Integrating the Basic Medical Insurance System for Urban and Rural Residents on the Health Equity of Residents: Evidence from the China Family Panel Studies Survey

Abstract

Background: The fragmentation of the medical insurance system is a major challenge to achieving health equity. In response to this problem, the Chinese government is pushing to establish a unified Urban and Rural Residents Basic Medical Insurance (URRBMI) by integrating New Rural Cooperation Medical Scheme (NRCMS) and Urban Residents Basic Medical Insurance (URBMI). By the end of 2020, URRBMI had been implemented almost entirely across China. Has URRBMI integration promoted health equity for urban and rural residents? Objectives: This study aimed to examine the effect of URRBMI integration on health level of residents, and whether the integration can contribute to reducing health disparities and promoting health equity. Methods: We used the staggered difference-in-differences method (Staggered DID) based on the China Family Panel Studies survey (CFPS) from 2014 to 2018, and a nationally-representative sample of 27,408 individuals and 98 cities were our study subjects. We chose self-rated health as the measurement of health status. In order to more accurately discern whether the sample was covered by URRBMI, we obtained the exact integration time of URRBMI according to the official documents issued by local governments. Finally, we grouped the sample by urban/rural, region and household income to examine the impact of the integration on health equity. Results: We found that overall, URRBMI integration has improved the health level of Chinese residents (Coef.=0.066, 95%CI: 0.014-0.123; P=.01). In terms of health equity, the results showed that: first, integration has improved the health level of rural residents (Coef.=0.070, 95%CI: 0.012-0.128; P=.02), residents in western China (Coef.=0.159, 95%CI: 0.064-0.255; P