Rural Medical Insurance and Health Equity for the Rural Elderly: Based on China Health and Retirement Longitudinal Study
1. College of Finance and Economics, Sichuan International Studies University, Chongqing 400031, China
2. School of International Studies, Sichuan International Studies University, Chongqing 400031, China
| Abstract: | As China's aging population gradually rises, the health issues of the elderly have attracted public attention. Improving health equity for the rural elderly is of great practical significance for implementing the Healthy China Strategy. The study leverages data obtained from the China Health and Retirement Longitudinal Study (CHARLS) in 2020 to integrate both the health level and the utilization of healthcare services into the research framework of health equity. Subsequently, this paper uses structural equation modeling to explore which factors affect the participation in rural medical insurance, whether rural medical insurance has a positive impact on the health equity of rural elderly people, and how rural medical insurance works through a path diagram. The result shows that rural medical insurance has a positive impact on the health equity of the elderly in terms of health level and medical and health service utilization level. However, factors such as age, living with partner, education level and income remain important, which affect the participation of rural medical insurance and thus health equity. The moderating effect of rural medical insurance is limited. |
| Keywords: | Rural Medical Insurance; Health Equity; Utilization of Medical Services; Health Level; Structural Equation Modeling |
| DOI: | 10.57237/j.wjeb.2026.01.001 |
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Received: 8 February 2025
Accepted: 4 January 2026
Published Online: 14 January 2026
Funding
| 1. | Chongqing Social Science Planning Doctoral Program (grant no. 2021BS082) |
| 2. | Key Discipline Graduate Research Innovation Project of Sichuan International Studies University (grant no. SISU2025XK069) |
References
| [1] | Yu Dachuan, Li Jiaxin, Jiang Fan. Can Rural Medical Insurance Consolidate the Achievements in the Fight Against Extreme Poverty: A Test Based on the Perspective of Poverty Vulnerability [J]. Financial Economics Research, 2022, (02): 122-133. |
| [2] | Peking University China Health and Retirement Longitudinal Study Project Team. China Health and Retirement Report [R]. Beijing: National School of Development at Peking University, 2019. |
| [3] | WHO, The World Health Report: Health System: Improve Performance [R]. Geneva: World Health Organization, 2000. |
| [4] | Braveman P, Gruskin S. Defining Equity in Health [J]. Journal of Epidemiology and Community Health, 2003, 57 (4). https://doi.org/10.1136/jech.57.4.254 |
| [5] | Yang Hua. A Normative Comparison of the Equity of China's Basic Medical Insurance System [J]. Journal of the Party School of CPC Changchun Municipal Committee, 2012, (01): 59-62. https://doi.org/10.13784/j.cnki.22-1299/d.2012.01.007 |
| [6] | Yu Wende. On the Implication and Limitation of Health Fairness [J]. Guihai Tribune, 2012, 28 (04): 69-72. |
| [7] | Chen He, Li Yan, Wu Xiaolan, Qiao Xiaochun. A Comparative Study on the Level of Disability among Older People in China: Based on the Data from 4 National Surveys [J]. South China Population, 2021, 36 (05): 1-12. |
| [8] | Zhu Yali, Zhang Zengxin. Health Status Transferring of the Elderly and Related Labor Demand for Caring [J]. Chinese Journal of Population Science, 2019, (02): 63-74+127. |
| [9] | Chen Siwei, Huo Xinran, Zhang Ning. Analysis of the Impact of Intergenerational Economic Support on the Risk of Disability Among Rural Elderly [J]. Chinese Journal of General Practice, 2024, 22 (08): 1279-1282. https://doi.org/10.16766/j.cnki.issn.1674-4152.003616 |
| [10] | Xie Lanlan. From Inequity to Greater Equity: Research Progress on Healthcare Equity among Rural Residents [J]. Jianghan Academic, 2021, 40 (05): 83-92. https://doi.org/10.16388/j.cnki.cn42-1843/c.2021.05.008 |
| [11] | Cheng Mingwang, Jin Yanhong, Gai Qingen, Shi Qinghua. Focusing on Education or Health Improvement for Anti-poverty in Rural China: Evidence from National Household Panel Data [J]. Economic Research Journal, 2014, 49 (11): 130-144. |
| [12] | Wang Hongliang, Zhu Xingshu. The Influencing Factors of Health Inequality on the Middle- aged and Elderly [J]. Chinese Journal of Population Science, 2018, (03): 109-120+128. |
| [13] | Miao J, Wu X. Urbanization, Socioeconomic Status and Health Disparity in China [J]. Health and Place, 2016, 4287-95. https://doi.org/10.1016/j.healthplace.2016.09.008 |
| [14] | Liu Guoen, Cai Chunguang, Li Lin. Medical Insurance and Medical Care Demand for the Elderly in China [J]. Economic Research Journal, 2011, 46 (03): 95-107+118. |
| [15] | Li Fen. Research on the Health and Security Strategies of the Elderly in Rural China under Life Course Perspective [D]. East China Normal University, 2020. https://doi.org/10.27149/d.cnki.ghdsu.2020.002156 |
| [16] | He Wen. The Health Performance of Social Medical Insurance and Its Regional Heterogeneity [J]. Journal of Jiangxi University of Finance and Economics, 2022, (01): 87-97. https://doi.org/10.13676/j.cnki.cn36-1224/f.2022.01.009 |
| [17] | Zhou Jian, Deng Qilin, Liu Hongyan. How Does the Basic Medical Insurance System Affect Health Equity among Elderly Persons? [J]. Financial Economics Research, 2020 (5): 147－160. |
| [18] | Peng Xiaobo, Wang Tianyu. Does Medical insurance Relive Health Inequality among Children [J]. China Industrial Economics, 2017, (12): 59-77. https://doi.org/10.19581/j.cnki.ciejournal.20171226.001 |
| [19] | Shao Quanquan, Liu Yu, Hao Tianqi. Health, Labor Supply, and Medical insurance [J]. Journal of Insurance Professional College, 2023, 37 (01): 39-50. |
| [20] | Hao Tianqi. Medical insurance, Medical Expenditure and Healthy Ageing: An Empirical Study Based on CHARLS [D]. Nankai University, 2022. https://doi.org/10.27254/d.cnki.gnkau.2022.000080 |
| [21] | Qiu Haozheng, Lin Bifang. Principles and Applications of Structural Equation Modeling (Second Edition) [M]. Beijing: China Light Industry Press, 2019. |
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