Multi-dimensional impacts of healthcare-based poverty alleviation policy on low-income middle-aged and older adults in China

• In Event: Student Panel: Insurance and poverty alleviation

Abstract

Illness is a leading cause of poverty in China. To eliminate health-incurred poverty, the Chinese government introduced the Health Poverty Alleviation policy (HPAP) in 2016, as a crucial component of its national Targeted Poverty Alleviation Project. HPAP constitutes a comprehensive health policy initiative encompassing three domains: health financing (insurance subsidies and medical assistance programs), service delivery (healthcare access and quality enhancement) and public health (disease preventive measures and health education). While previous studies have evaluated the poverty reduction effects of health policies, most of which focuses on single policy programs, such as social health insurance. There remains a notable lack of national-level evaluation that comprehensively encompass multiple policy domains of healthcare-based poverty alleviation policy.

This study utilizes both macro-level policy data containing detailed city-level information on HPAP across different policy domains and micro-level survey data derived from the Chinese Health and Retirement Longitudinal Study (CHARLS) of 2013, 2015, 2018 and 2020. The policy data were constructed by authors through a policy coding approach. For each policy domain (i.e., health financing, service delivery and public health), we evaluated local government policy efforts by coding affiliated policy tools based on four policy attributes: policy comprehensiveness (breadth of policy areas covered), policy specificity (level of detail), policy ambition (level of intended targets) and policy adaptability (the extent to which policies are tailored to local conditions). We calculated standardized scores for each policy attribute and summed them to obtain domain-specific scores and overall policy scores, with higher scores indicating greater policy effort by local governments. We employed a difference-in-differences (DID) design to evaluate local HPAP’s effects on low-income middle-aged and older adults’ healthcare utilization, financial outcome, health behaviors and health status, and satisfaction with healthcare services. To account for potential confounding factors, we included individual control variables (i.e., age, gender, hukou status, education level, and marital status), and city-level control variables (i.e., GDP per capita, fiscal revenue per capita, and population size). Next, we conducted several additional robustness tests to verify the main findings and examined heterogeneous effects across subgroups defined by hukou status, gender, age, and income.

The findings reveal that the HPAP positively influenced health behaviors—reducing drinking, increasing physical exercise, and improving healthcare utilization and satisfaction. However, it did not significantly reduce individuals’ medical burden or improve self-rated health status. When examining specific policy domains, health financing policies and service delivery policies significantly increased outpatient utilization but showed no impact on other outcomes. Public health interventions significantly promoted physical exercise. The findings also reveal distinct HPAP impacts across population subgroups.

China’s HPAP demonstrate both the achievements and challenges. Our evaluation also reveals the differential contributions of various HPAP policy domains to these multiple outcomes, providing valuable insights that can guide targeted reforms in the future. The policy implications derived from this study are also valuable for developing countries striving to eliminate health-related poverty and improve the health well-being among low-income populations.

Author

• Qian Zhang, University of Hong Kong
  Presenting Author