Health Poverty Alleviation Project in Rural China: Impact on Poverty Vulnerability, Health Status, Healthcare Utilization, Health Expenditures

Abstract

Background China has lead to the inception of the Health Poverty Alleviation Project (HPAP) in 2015. While the previous studies suggest that, despite its apparent reduction in patients’ financial strain, the long-term poverty reduction effects are yet to be fully elucidated. This study explores HPAP’s enduring impact on poverty reduction and the potential moral hazards. Methods Data were obtained from four waves of the China Health and Retirement Longitudinal Study (CHARLS) spanning 2011–2018. We employed difference-in-differences (DID) models to gauge HPAP’s influence on participants’ poverty vulnerability, health outcomes, and healthcare utilization. The dynamic DID model is employed to test the robustness of HPAP policy effects. The mediation effect models were used to understand HPAP policy outcomes through physical examinations and inpatient care. Results Our dataset encompassed 40,384 participants, of which 5946 (14.72%) had been exposed to HPAP and 34,438 (85.28%) had not access. Our findings reveal that HPAP decreases poverty vulnerability by 3.3% (p < 0.01) and attenuates health deterioration by 1.84% (p < 0.01). Furthermore, HPAP enhances inpatient care utilization by 9.34% (p < 0.01) and self-treatment behaviors by 4.1% (p < 0.01) while significantly slashing outpatient and inpatient expenses (p < 0.05). The implementation of HPAP has significantly reduced healthcare costs by 72.8% (p < 0.05) out-of-pocket (OOP) payments of outpatient care during the past month for the last time, and 89.39% (p < 0.05) out-of-pocket (OOP) payments of inpatient care during past the year for the last time. Mechanistic analyses have shown that the indirect effect of the HPAP policy decreases poverty vulnerability by −0.132% (p < 0.05) physical examinations and −0.309% (p < 0.05) inpatient care. Conclusion The HPAP initiative markedly attenuates poverty vulnerability and forestalls health decline among the rural populace. Moreover, HPAP bolsters healthcare service use, such as physical examinations and inpatient care, primarily attributed to the release of pent-up demand rather than moral hazards.

Response to: Health Poverty Alleviation Project in Rural China: Impact on Poverty Vulnerability, Health Status, Healthcare Utilization, Health Expenditures [Response to Letter]

“…We are grateful to the readers' interest in our article, "Health Poverty Alleviation Project in Rural China: Impact on Poverty Vulnerability, Health Status, Healthcare Utilization, Health Expenditures" 1 and we also appreciate the readers for recognizing our academic research contributions in five ways, as well as for giving insightful comments. The fact that we have just published the research article noticed by the academic community is very encouraging for our endeavor.…”

Response to: Health Poverty Alleviation Project in Rural China: Impact on Poverty Vulnerability, Health Status, Healthcare Utilization, Health Expenditures [Letter]

“…Fifth, the HPAP policy impact assessment uses The China Health and Retirement Longitudinal Survey (CHARLS) approach so that the HPAP impact analysis provides comprehensive evidence of the policy's cost-benefit. 1 However, we highlight several areas that require further explanation. First, although not substantive, there is a need for consistency in the approach used in this research because analysis and policy evaluation overlap.…”

Medical insurance, livelihood capital and public health in China

“…Specifically, in the context of China's poverty alleviation efforts, medical coverage has played a pivotal role. Consequently, the approach to poverty reduction in basic healthcare has shifted its emphasis from resource concentration towards supporting registered impoverished households [ 1 ]. Specifically, this shift involves achieving tiered burden reduction through the foundational medical security system, ultimately aiming to mitigate residents' medical expenditures.…”