Does the New Rural Cooperative Medical Scheme Provincial Pooling Policy Improve Health Equity Among Older Adults? - Evidence From China Longitudinal Healthy Longevity Survey Data.

Background: As global aging increases, health inequalities are becoming more prominent. The purpose of this study is to examine whether increasing the level of fund pooling of the New Rural Cooperative Medical Scheme (NRCMS) helps to improve health and health inequalities among older adults.

Methods: Data from four periods of the China Longitudinal Healthy Longevity Survey (CLHLS) in 2008, 2011, 2014, and 2018 were used, the population for this paper was a sample of the older adults participating in the NRCMS. A sample of 955 treated participants and 13 477 control participants were included in the analysis after excluding samples with missing information. Time-varying difference-in-differences (DID) model was used to analyze the impact of the NRCMS Provincial Pooling Policy (NRCMS-PPP) on participants' health and health inequalities.

Results: The results of the study showed that the NRCMS-PPP had a significant effect on the self-rated health (SH) (estimated coefficient = 0.149, P<.01) and health relative deprivation index (HRDI) (estimated coefficient = -0.018, P=.02). Further exploration of the heterogeneous effect of it revealed that implementation is more effective in improving the health and reducing health inequalities for older population with primary education or living in rural areas. The mediation mechanism suggests that NRCMS-PPP partially mediates through total out-of-pocket medical expenses (TOME) and catastrophic health expenditure (CHE).

Conclusion: The NRCMS-PPP reduces the probability of the older adults experiencing CHE and reduces their burden of disease costs, thus improving their health and reducing their health inequality. Policy effects vary in terms of educational status and areas of residence.