Does the rural social pension alleviate urban-rural health inequality of opportunity? Evidence from China

Cheng Qin; Jing Zhao; Jianyi Liu

doi:10.15611/aoe.2025.2.03

Authors

Cheng Qin Guangxi University https://orcid.org/0009-0006-6770-0417
Jing Zhao Southwestern University of Finance and Economics https://orcid.org/0009-0008-1915-9253
Jianyi Liu ✉️ Southwestern University of Finance and Economics
ljy.idvice@qq.com https://orcid.org/0009-0003-5960-4116

DOI:

https://doi.org/10.15611/aoe.2025.2.03

Keywords:

health inequalities, social pension, inequality of opportunity (IOp), urban-rural disparities

Abstract

Aim: To examine the impact of the New Rural Pension Scheme (NRPS) on health disparities between the urban and rural elderly in China.

Methodology: The authors constructed health inequality of opportunity (IOp) based on the ex-ante principle and utilised panel data from the China Health and Retirement Longitudinal Study (2015-2018), employing both difference-in-differences (DID) and propensity score matching DID methodologies to assess the impact.

Results: It was found that enrolment in the NRPS significantly enhanced health levels of the rural elderly and reduced health inequality of opportunity between the urban and rural elderly by 6.67%. The impact was more pronounced among lower-income and older age groups. Implications and recommendations: The findings suggest that targeted social pension programmes can effectively reduce regional health disparities. Future research should explore the long-term sustainability of these effects and their applicability to other developing countries with similar urbanrural divides.

Originality/value: This study uniquely applied inequality of opportunity theory to distinguish between ‘justifiable’ and ‘unjustifiable’ health disparities, providing a more comprehensive understanding of urban-rural health inequalities and demonstrating the effectiveness of social pension programmes in addressing these disparities.

Downloads

Download data is not yet available.

References

Abdesslam, B. (2012). Evolution of rural–urban health gaps in Morocco: 1992–2011. BMC Res Notes, 5, 381. https://doi.org/10.1186/1756-0500-5-381

Bosworth, B. (2018). Increasing disparities in mortality by socioeconomic status. Annual Review of Public Health 39, 237-251. https://doi.org/10.1146/annurev-publhealth-040617-014615

Chetty, R., Stepner, M., Abraham, S., Lin, S., Scuderi, B., Turner, N., et al. (2016). The association between income and life expectancy in the United States, 2001-2014. JAMA 315, 1750–1766. https://doi.org/10.1001/jama.2016.4226

Cohen, S. A., Cook, S. K., Sando, T. A., & Sabik, N. J. (2018). What Aspects of Rural Life Contribute to Rural-Urban Health Disparities in Older Adults? Evidence From a National Survey. The Journal of Rural Health, 34, 293-303. https://doi.org/10.1111/jrh.12287

Davillas, A., & Jones, A. M. (2020). Ex ante inequality of opportunity in health, decomposition and distributional analysis of biomarkers. Journal of Health Economics, 69, 102251. https://doi.org/10.1016/j.jhealeco.2019.102251

Du, X., Wang, X., & Li, Z. (2022). Can the new rural insurance delay the dementia of the rural elderly? Scientific Decision Making, 57-70.

Fleurbaey, M., & Peragine, V. (2013). Ex ante versus ex post equality of opportunity. Economica, 80, 118-130. https://doi.org/10.1111/j.1468-0335.2012.00941.x

Fleurbaey, M., & Schokkaert, E. (2009). Unfair inequalities in health and health care. Journal of Health Economics, 28, 73-90. https://doi.org/10.1016/j.jhealeco.2008.07.016

Fleurbaey, M., & Schokkaert, E. (2011). Equity in health and health care. In Handbook of health economics (pp. 1003–1092). Elsevier.

Gwatkin, D. R. (2017). Trends in health inequalities in developing countries. The Lancet Global Health, 5, e371-e372. https://doi.org/10.1016/S2214-109X(17)30080-3

Huang, W., & Zhang, C. (2021). The power of social pensions: Evidence from China’s New Rural Pension Scheme. AEJapp, 13, 179-205. https://doi.org/10.1257/app.20170789

Hufe, P., Kanbur, R., & Peichl, A. (2022). Measuring unfair inequality: Reconciling equality of opportunity and freedom from poverty. RES.

Li, Y., Liu, J., & Li, L. (2022). The impact and its heterogeneity of New Rural Pension Program on health service utilization of the rural elderly. Journal of Agrotechnical Economics, 1-12.

Ma, C., Gu, H., & Sun, X. (2017). The effects of urban-rural integrated medical insurance system on substantial equity of health care and health − based on equality of opportunity. Journal of Public Management, 14, 97-109+157.

Qian, W., & Li, M. (2020). Impact of China’s new rural social endowment insurance program on the rural elderly’s health behavior and its mechanism. Journal of Zhejiang University(Humanities and Social Sciences), 50, 29-46.

Ramos, X., & Van de Gaer, D. (2016). Approaches to inequality of opportunity: Principles, measures and evidence. Journal of Economic Surveys, 30, 855-883. https://doi.org/10.1111/joes.12121

Rawls, J. (1971). A Theory of Justice. Cambridge University Press.

Roemer, J. E. (1998). Equality of opportunity. Harvard University Press.

Roemer, J. E. (2002). Equality of opportunity: A progress report. Social Choice and Welfare, 19(2), 455-471.

Rosa Dias, P. (2009). Inequality of opportunity in health: Evidence from a UK cohort study. Health Economics, 18, 1057-1074. https://doi.org/10.1002/hec.1535

Smith, K. B., Humphreys, J. S., & Wilson, M. G. A. (2008). Addressing the health disadvantage of rural populations: How does epidemiological evidence inform rural health policies and research? Australian Journal of Rural Health, 16, 56-66. https://doi.org/10.1111/j.1440-1584.2008.00953.x

Shi, X., Li, S., Chen, T., & Fang, S. (2022). Understanding common prosperity from the perspective of equality of opportunity: An empirical study based on the low-income groups. Economic Research Journal, 57, 99-115.

Tang, Y., Fu, R., & Noguchi, H. (2024). Impact of medical insurance integration on reducing urban-rural health disparity: Evidence from China. Social Science & Medicine, 357, 117163. https://doi.org/10.1016/j.socscimed.2024.117163

Trannoy, A., Tubeuf, S., Jusot, F., & Devaux, M. (2009). Inequality of opportunities in health in France: A first pass. Health Economics, 19, 921-938. https://doi.org/10.1002/hec.1528

Yang, Y., & Lee, L. C. (2010). Dynamics and heterogeneity in the process of human frailty and aging: Evidence from the U.S. older adult population. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 65B, 246-255. https://doi.org/10.1093/geronb/gbp102

Zhang, C., Giles, J., & Zhao, Y. (2015). Policy evaluation of China’s New Rural Pension Program: Income, poverty, expenditure, subjective wellbeing and labor supply. China Economic Quarterly, 14, 203-230.

Zhang, Y., & Chen, D. (2022). Does New Rural Social Pension alleviate the inequality of opportunity in health between urban and rural elderly? Evidence from the CHARLS data. Issues in Agricultural Economy, 1-18.

Zhang Y., Cheng, L., and Liu, Z. (2016). Does China’s New Rural Pension Scheme improve the life quality of the rural elderly? China Economic Quarterly, 15, 817-844.

Zheng, X., & Fang, X. (2018). The social pension scheme and the subjective well-being of the elderly in rural china. Journal of Finance and Economics, 44, 80-94.