JMIR Publications

ABSTRACT

Background:

The fragmentation of the medical insurance system is a major challenge to achieving health equity. The Chinese government has established a unified basic medical insurance system for urban and rural residents(BMISURR) by integrating the new rural cooperative medical care system(NRCMCS) and the basic medical insurance system for urban residents(BMISUR).

Objective:

This research aimed to examine the effect of the BMISURR on health level, and whether 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 and obtains the exact integration time of the BMISURR according to the official documents issued by local governments. In order to examine the impact of the integration on health equity, we grouped the sample by urban/rural, region and household income.

Results:

We found that the integration increases residents' self-rated health scores (Coef.=0.066, 95%CI: 0.014, 0.123), especially for rural residents (Coef.=0.070, 95%CI: 0.012, 0.128), so the health gap between urban and rural areas was narrowed. In terms of regions and populations, the integration contributed to the improvement of health in western regions that were relatively poor in terms of health and economic development (Coef.=0.159,95%CI: 0.064, 0.255) and lower-middle income groups (Coef.=0.113, 95%CI: 0.004, 0.222). However, integration did not improve the health of the central region and low-income groups, and the lack of access to health care for low-income groups was not effectively reduced.

Conclusions:

The role of integration in promoting health equity in urban and rural residents was significant, but in regions and different income groups was limited. Focusing on the rational allocation of medical resources between regions and increasing the policy tilt towards low-income groups could help improve the equity of health insurance integration.