Health insurance portability and coverage: Evidence from China’s cross-regional instant reimbursement reform
中文摘要
在许多发展中国家背景下，流动的非正规就业人口仍难以获得公平的医疗服务。我们考察了中国跨区域即时结算（CRIR）改革第一阶段——一项省级层面的改革——对医疗保险参保和医疗服务利用的影响。在一个理论模型的指导下，我们利用CRIR的交错（分批）推行实施三重差分设计，以识别因果效应。结果显示，CRIR大幅提高了本地城镇职工基本医疗保险（UEBMI）参保率（提高8%）和就医次数（提高14%），同时降低了自付支出（降低22%）。这些成效源于行政摩擦的降低和财务保护力度的增强。低收入、受教育程度较低以及非正规就业程度较高的流动人口获益最大，凸显了该改革在促进包容性发展方面的作用。我们的发现强调了可携带社会保险在改善流动人口医疗服务可及性方面的重要性，并为其他发展中背景下的类似改革提供了启示。
Abstract
Equitable healthcare access for mobile, informally employed populations remains elusive in many developing contexts. We examine the impact of the first phase of China’s cross-regional instant reimbursement (CRIR) reform—a province-level reform—on enrollment in health insurance and healthcare utilization. Informed by a theoretical model, we implement a triple-differences design leveraging CRIR’s staggered rollout to identify causal effects. Results show that CRIR substantially increased local UEBMI enrollment (by 8%) and healthcare visits (by 14%), while reducing out-of-pocket spending (by 22%). These gains stem from lower administrative frictions and strengthened financial protection. Low-income, less-educated, and more informally employed migrants benefit the most, underscoring the reform’s role in promoting inclusive development. Our findings highlight the importance of portable social insurance in improving healthcare access for mobile populations and offer insights for similar reforms in other developing settings.