Does the trans-provincial immediate reimbursement reduce health gap between urban and rural floating population? Evidence from China.

BACKGROUND: One of the critical components of public health policy globally is to enhance population health and mitigate health disparities. In 2017, China launched the reform of immediate reimbursement for trans-provincial treatments, aimed at increasing healthcare utilization among the floating population. This study aims to evaluate the impact of this policy reform on the health status of the urban-rural floating population. METHODS: This study utilizes individual-level data from the 2017 and 2018 China Migrants Dynamic Survey (CMDS) and administrative hospital data at the city level. The sample includes 47,803 individuals and 66 cities. Treating the direct reimbursement policy as a quasi-natural experiment, we employ a generalized difference-in-differences model for our quantitative analysis. To control for the effects of urban-rural medical insurance integration-to ensure that both urban and rural residents are covered by the same basic medical insurance policy-our analysis of rural health status from 2016 to 2018 is limited to cities that fully implemented this policy integration before January 1, 2017. RESULTS: The policy of immediate reimbursement for trans-provincial treatments has a significant positive impact on the health of the urban-rural floating population. The health benefits of trans-provincial treatments are less pronounced than those of trans-urban treatment, with primary hospitals showing the most notable improvements. Increased household income and consumer spending significantly amplify the health benefits of this policy for the floating population. The effects of the policy are especially pronounced in the female floating population, middle-aged and young adults, individuals with lower levels of education, those desiring long-term residency, and the unmarried groups. CONCLUSION: This paper presents theoretical evidence that the policy of immediate reimbursement for trans-regional treatments narrows the health disparities of the urban-rural floating population and elucidates the mechanisms of this impact for the first time. These results suggest that in order to achieve health equality between urban and rural residents and equitable access to medical services, China is building a more effective medical security system.