Research

Over the past three decades, China has made significant progress in achieving universal health coverage through social health insurance schemes. These efforts have increased healthcare access and reduced out-of-pocket expenditures, leading to notable improvements in health outcomes and financial risk protections. However, China’s rapidly aging population is driving up demand for intensive and costly care services, placing considerable pressure on the financial sustainability of its social health insurance funds. Additionally, low fertility rates and a rising dependency ratio have raised new challenges in providing long-term care. Recent initiatives include integrating healthcare with long-term care services and introducing long-term care insurance programs, though these efforts remain in the experimental phase. Further research and evaluation of ongoing pilot programs will be essential in refining these strategies and achieving a more resilient and equitable healthcare and elderly care framework.

China began relaxing its One-Child Policy in 2014, gradually allowing urban families to have two children. After the policy change, urban mothers of firstborn girls were 53.8% more likely to have a second child and allocated less to leisure time or cosmetics expenditures than those with firstborn boys, despite similar fertility intentions across both groups. They were also 7.3% to 13.4% less likely to be employed, even though both groups had no significant difference in labor market participation. In terms of subjective well-being, they were 4.6% to 5.4% less likely to be satisfied with life. We suggest that these results are largely driven by husbands’ preference for sons and their intention to apply the son-biased fertility stopping rule, given the randomness of the firstborn’s gender. Specifically, 20.3% of urban fathers of firstborn girls expect a second child within two years, compared to 14.0% of those with firstborn boys. In contrast, fewer than 14.0% of mothers expect more children, regardless of the firstborn’s gender. Our findings suggest that a focus on how fertility-boosting efforts disproportionately impact women can guide the design of more effective policy responses, especially in developing countries where son preference is prevalent.

Many hospital payment schemes are designed to control health expenditure, but they could also influence the allocation of medical resources, which is crucial for efficient healthcare delivery. This paper studies the effects of hospital responses to a blended payment scheme—a diagnosis-based payment scheme with a global budget—and the distributional consequences of hospital heterogeneous responses. Exploiting a quasi-experimental reform in China in 2016, we find hospitals responded along multiple dimensions: upcoding, raising the shares of admissions in categories with higher upcoding potential, and increasing the total number of admissions. Hospitals’ heterogeneous responses led to a widened disparity in hospital payments, which is mainly driven by heterogeneous upcoding across hospitals. Hospitals with more knowledge about coding practices, greater exposure to the reform, higher tier, and larger size respond more strongly to the reform, therefore securing a larger portion of the global budget from the social health insurance fund.

This study reviews the achievements of major health insurance reforms in three developing countries—Brazil, Rwanda, and China— with a focus on their efforts to advance Universal Health Coverage (UHC). The research highlights the impact of these reforms on the overarching goals of strengthening health systems, including improving health status, protecting from financial risks, and achieving high levels of public satisfaction. In Brazil, the Sistema Único de Saúde (SUS) has been instrumental in improving health outcomes but faces challenges in equity due to the parallel growth of private healthcare. Rwanda’s Community-Based Health Insurance (CBHI) has significantly increased healthcare access and reduced financial burdens, though sustainability concerns arise with declining donor aid. China’s New Cooperative Medical Scheme (NCMS) has expanded coverage extensively, yet disparities in financial protection and healthcare quality remain. The study underscores the diverse strategies and challenges moving towards UHC and reveals that no single path can universally apply to all developing countries.

With China's rapidly aging population, the need for innovative eldercare models that support both longevity and quality of life has become increasingly urgent. This study examines the interplay between "aging in place" and "aging well" within the context of senior apartments in China, focusing on two pioneering examples: Taikang Home · Chu Garden and Xianghe · Da’ai City. This research adopts a qualitative approach, employing semi-structured interviews with residents, service team members, and management team members to explore how these senior apartments facilitate aging in place and contribute to the well-being of their elderly residents. The findings reveal that these apartments are well-equipped to address both the physical and emotional needs of the elderly, offering comprehensive medical care, age-friendly facilities, and a supportive social environment. Key to this success is the integration of healthcare services within living facilities, the use of smart technologies for safety and convenience, and a strong emphasis on community and social engagement. However, the study also identifies challenges, such as ensuring sufficient personal companionship and managing diverse resident lifestyles, suggesting areas for further policy and practice improvement. This research contributes to the literature on aging by integrating the concepts of aging in place and aging well, offering insights into how physical and social environments can support the elderly, and suggesting novel concepts that could be multiplied elsewhere.

This paper estimates the impact of the 8-7 National Plan for Poverty Reduction, a large-scale poverty alleviation program in China during 1994–2000, on the mortality rate from cerebrovascular diseases. The rollout of the program after 1994 was mainly based on whether the average income per capita of a county fell below a certain cutoff, which allows for the design of a combination regression discontinuity and difference-in-differences approach. Using data collected from the National Disease Surveillance Points system, the analysis suggests that the poverty alleviation program decreased the cerebrovascular disease mortality rate by at least 28.0%l, which is mainly attributed to the construction of local health centers under the poverty alleviation program. The analysis finds that the reduction in mortality was mostly due to fewer deaths at home. Other aspects of the program, such as road construction, also likely played a part in the reduction in mortality from cerebrovascular diseases.

This study aims to investigate the gap between expected and actual caregivers of parents in need of care and its impact on care receivers. Using panel data from the four waves of the nationally-representative China Health and Retirement Longitudinal Study (CHARLS), we employ a family fixed-effects linear probability model to examine the characteristics of expected and actual caregivers of individuals aged 45 and above who experienced functional impairment between 2011 and 2018. Our results suggest that 38.44% of men and 41.79% of women have at least one actual caregiver who met their earlier expectations. Regarding caregivers, the division of labor among siblings for supporting parents through economic transfer and in-person care depends on their opportunity cost of caring. Children who are not actual caregivers of their parents are more likely to provide economic support. Our findings imply that parents’ behaviors toward economic support align more with the altruism motivation, whereas their behavior toward providing care aligns more with the exchange motivation. Furthermore, women who reside in self-owned properties may have greater leverage in selecting their preferred caregivers. As a result, being taken care of by expected caregivers significantly enhances parents’ positive emotions toward life, especially for women.