The Impact of Urban and Rural Resident Basic Medical Insurance on Health and Health Inequality Among Adults Aged 45 or Above: Evidence from China

Background and purpose: In China, although the basic medical insurance system covers all citizens, urban and rural residents were previously covered by separate schemes. The integration of these schemes into the Urban and Rural Resident Basic Medical Insurance (URRBMI) marked a key step toward providing equitable healthcare and benefits. Therefore, assessing the effect of URRBMI on health inequality is crucial for finding reasons for and solutions to health inequality. Guided by health economics theory, this study examined: (1) the impact of URRBMI on the health of Chinese adults aged 45 and older; and (2) URRBMI’s role in reducing health inequality.

Methods: Data were drawn from the China Health and Retirement Longitudinal Study (CHARLS) for the years 2011, 2013, and 2015. After excluding records with missing key information, 34,389 valid samples remained. The independent variable was URRBMI participation, and the dependent variable was self-rated health. To examine the first research question, Probit and ordinary least squares (OLS) models were used to estimate URRBMI's effect on health. To address the second question, the concentration index (CI) was used to assess health inequality, and CI decomposition was conducted to evaluate URRBMI's contribution. Analyses controlled for individual and family characteristics.

Results: Both Probit and OLS models showed that although the estimated effect size of URRBMI declined over time, its impact on health remained statistically significant at the 1% or 5% level. The decomposition results of health inequality revealed that the main contributor to pro-rich health inequality was income, followed by education. CI decomposition also indicated that URRBMI increasingly covered low-income adults aged 45+, contributing positively to their health. Urban residents in this age group were more responsive to URRBMI than their rural counterparts. The distribution of URRBMI in rural area was more favorable to low-income adults aged 45 or above than that in urban area. Moreover, URRBMI’s contribution to reducing health inequality was -9.82% in 2013 and -11.15% in 2015, reflecting its growing role in narrowing health disparities.

Conclusions and implications: This study offers new evidence that URRBMI improves health and reduces health inequality among Chinese adults aged 45 and above. To sustain and enhance these outcomes, continued efforts are needed to ensure a more equitable and sustainable insurance system, fairer income distribution and access to education, and more efficient allocation of healthcare resources.