NDLI: The effects of unified pooling arrangement on health inequity in China: a DID-RIF approach

Content Provider	Springer Nature : BioMed Central
Author	Wu, Jing Liu, Yuqing Wang, Chuncheng Liu, Lianjie Lu, Jiaqian
Abstract	Background To address the health inequity caused by decentralized management, China has introduced a provincial pooling system for urban employees’ basic medical insurance. This paper proposes a research framework to evaluate similar policies in different contexts. This paper adopts a mixed-methods approach to more comprehensively and precisely capture the causal effects of the policy. Ultimately, this paper aims to assess the impact of the UPA policy on health inequity. Methods This study takes the provincial unified reform of basic medical insurance for urban employees in China as an example, uses the China Family Panel Studies (CFPS) data and related policy documents, and adopts the DID-RIF hybrid method to test the impact of the equalization of the medical insurance system on health inequity, by using the interaction term in the DID (Difference-in-Differences) model as the independent variable in the RIF (Recentered Influence Function) to exclude the influence of other interfering variables. In addition, the DID method explores the effects of UPA on medical expenditures, which can guide the improvement of the policy. Results The empirical results show that the UPA policy increases the likelihood of patients developing chronic diseases within six months. Although factors such as age, gender, and marital status influence the probability of chronic disease, health inequity between income groups after the policy’s implementation primarily stems from the rise in outpatient and reimbursement expenses. Conclusions Although the gap in medical reimbursement expenses between participants of different socioeconomic statuses narrowed after the provincial medical insurance pooling reform, health inequity among the insured population increased. The equalized health insurance reform failed to address health inequities based on socioeconomic status. Additionally, the reverse reallocation of medical resources and outpatient arbitrage driven by moral hazard warrant close attention. This paper recommends that, in advancing the provincial pooling of UEBMI, greater focus should be placed on strengthening digital oversight and improving the hierarchical diagnosis and treatment system to promote social equity.
Related Links	https://bmchealthservres.biomedcentral.com/counter/pdf/10.1186/s12913-025-12304-9.pdf
Ending Page	16
Page Count	16
Starting Page	1
File Format	HTM / HTML
ISSN	14726963
DOI	10.1186/s12913-025-12304-9
Journal	BMC Health Services Research
Issue Number	1
Volume Number	25
Language	English
Publisher	BioMed Central
Publisher Date	2025-01-25
Access Restriction	Open
Subject Keyword	Public Health Health Administration Health Informatics Nursing Research Health insurance reform Health equity Chronic disease group Socioeconomic status Reimbursement expense DID-RIF approach I10 I14 I30
Content Type	Text
Resource Type	Article
Subject	Health Policy

Sl.	Authority	Responsibilities	Communication Details
1	Ministry of Education (GoI), Department of Higher Education	Sanctioning Authority	https://www.education.gov.in/ict-initiatives
2	Indian Institute of Technology Kharagpur	Host Institute of the Project: The host institute of the project is responsible for providing infrastructure support and hosting the project	https://www.iitkgp.ac.in
3	National Digital Library of India Office, Indian Institute of Technology Kharagpur	The administrative and infrastructural headquarters of the project	Dr. B. Sutradhar bsutra@ndl.gov.in
4	Project PI / Joint PI	Principal Investigator and Joint Principal Investigators of the project	Dr. B. Sutradhar bsutra@ndl.gov.in Prof. Saswat Chakrabarti will be added soon
5	Website/Portal (Helpdesk)	Queries regarding NDLI and its services	support@ndl.gov.in
6	Contents and Copyright Issues	Queries related to content curation and copyright issues	content@ndl.gov.in
7	National Digital Library of India Club (NDLI Club)	Queries related to NDLI Club formation, support, user awareness program, seminar/symposium, collaboration, social media, promotion, and outreach	clubsupport@ndl.gov.in
8	Digital Preservation Centre (DPC)	Assistance with digitizing and archiving copyright-free printed books	dpc@ndl.gov.in
9	IDR Setup or Support	Queries related to establishment and support of Institutional Digital Repository (IDR) and IDR workshops	idr@ndl.gov.in

Inequity under equality: research on the benefits equity of Chinese basic medical insurance

What impact do chronic disease self-management support interventions have on health inequity gaps related to socioeconomic status: a systematic review

The effect of health insurance reform on the number of cataract surgeries in Chongqing, China

Can integration reduce inequity in healthcare utilization? Evidence and hurdles in China

High-risk pooling for mitigating risk selection incentives in health insurance markets with sophisticated risk equalization: an application based on health survey information

Changes in health care utilization and financial protection after integration of the rural and urban social health insurance schemes in Beijing, China

Outcome-based health equity across different social health insurance schemes for the elderly in China

Socioeconomic inequity in inpatient service utilization based on need among internal migrants: evidence from 2014 national cross-sectional survey in China

Effects of changes in health insurance reimbursement level on outpatient service utilization of rural diabetics: evidence from Jiangsu Province, China

The effects of unified pooling arrangement on health inequity in China: a DID-RIF approach

Similar Documents

Inequity under equality: research on the benefits equity of Chinese basic medical insurance

What impact do chronic disease self-management support interventions have on health inequity gaps related to socioeconomic status: a systematic review

The effect of health insurance reform on the number of cataract surgeries in Chongqing, China

Can integration reduce inequity in healthcare utilization? Evidence and hurdles in China

High-risk pooling for mitigating risk selection incentives in health insurance markets with sophisticated risk equalization: an application based on health survey information

Changes in health care utilization and financial protection after integration of the rural and urban social health insurance schemes in Beijing, China

Outcome-based health equity across different social health insurance schemes for the elderly in China

Socioeconomic inequity in inpatient service utilization based on need among internal migrants: evidence from 2014 national cross-sectional survey in China

Effects of changes in health insurance reimbursement level on outpatient service utilization of rural diabetics: evidence from Jiangsu Province, China

The effects of unified pooling arrangement on health inequity in China: a DID-RIF approach