The inequity of healthcare utilization in rural China is serious, and the urban-rural segmentation of the medical insurance system intensifies this problem. To guarantee that the rural population enjoys the same medical insurance benefits, China began to establish Urban and Rural Resident Basic Medical Insurance (URRBMI) nationwide in 2016. Against this backdrop, this paper aims to compare the healthcare utilization inequity between URRBMI and New Cooperative Medical Schemes (NCMS) and to analyze whether the inequity is reduced under URRBMI in rural China. Using the data from a national representative survey, the China Health and Retirement Longitudinal Study (CHARLS), which was conducted in 2015, a binary logistic regression model was applied to analyze the influence of income on healthcare utilization, and the decomposition of the concentration index was adopted to compare the Horizontal inequity index (HI index) of healthcare utilization among the individuals insured by URRBMI and NCMS. There is no statistically significant difference in healthcare utilization between URRBMI and NCMS, but in outpatient utilization, there are significant differences among different income groups in NCMS; high-income groups utilize more outpatient care. The Horizontal inequity indexes (HI indexes) in outpatient utilization for individuals insured by URRBMI and NCMS are 0.024 and 0.012, respectively, indicating a pro-rich inequity. Meanwhile, the HI indexes in inpatient utilization under the two groups are − 0.043 and − 0.028, respectively, meaning a pro-poor inequity. For both the outpatient and inpatient care, the inequity degree of URRBMI is larger than that of NCMS. This paper shows that inequity still exists in rural areas after the integration of urban-rural medical insurance schemes, and there is still a certain gap between the actual and the expected goal of URRBMI. Specifically, compared to NCMS, the pro-rich inequity in outpatient care and the pro-poor inequity in inpatient care are more serious in URRBMI. More chronic diseases should be covered and moral hazard should be avoided in URRBMI. For the vulnerable groups, special policies such as reducing the deductible and covering these groups with catastrophic medical insurance could be considered.

This study aims to explore the trajectories of health inequalities induced by childhood SES across the life course in China. There are two competing theories on this subject. Cumulative disadvantage theory contends that health gaps induced by childhood SES tend to widen across the life course as adulthood SES compound or multiply the negative effects of early SES disadvantage. Age-neutral theory draws the opposite inference that the physiological decline due to aging offsets the health gaps at older ages. Based on the data of the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2018, a two-level mixed-effects model was used to analyze the trajectories of health inequalities induced by childhood SES among Chinese individuals aged 45 and above and further distinguished the age and cohort effects in the overall trajectories. Unlike previous studies that unilaterally supported one of these theories, our findings support both of them. In this study, health gaps induced by childhood SES gradually widened before entering old age, which supports the cumulative disadvantage theory. In contrast, the health gaps in older adults gradually converged with age, thus supporting the age-neutral theory. The age effect shows that in the same birth cohort, health gaps induced by childhood SES first increased and then decreased during the survey time. The cohort effect shows that, at the same age, childhood SES has a greater impact on the health of those with later birth cohorts than on those with earlier birth cohorts. The findings of this study support the importance of policy and practices to reduce health inequalities among adolescents for long-term healthy aging in China.

The low retirement age has imposed a heavy economic burden on the pension system in China, leading to an ongoing debate about raising the retirement age. To understand the potential costs of raising the retirement age, we need to consider the health effects of retirement policies. Using the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2015, this study employs the statutory retirement age as the exogenous variable of retirement and applies a fuzzy regression discontinuity design (RDD) to examine the effect of retirement on the health of Chinese elderly people. We find that retirement has a non-significant effect on health with respect to a series of health indicators, different bandwidths of RDD and sub-sample groups. The finding is also robust across different retirement definitions and retirement ages. This result may be attributed to the minimal changes in income and lifestyles before and after retirement. Moreover, the findings of this study provide important evidence for policy makers to increase retirement ages in China.