Please wait a minute...
Journal of Integrative Agriculture  2021, Vol. 20 Issue (4): 1068-1079    DOI: 10.1016/S2095-3119(20)63372-X
Section 4: Poverty alleviation through social safety net programs Advanced Online Publication | Current Issue | Archive | Adv Search |
The impact of the New Rural Cooperative Medical Scheme on the “health poverty alleviation” of rural households in China
QIN Li-jian1, Chien-ping CHEN2, LI Yu-heng3, SUN Yan-ming4, CHEN Hong
1 Research Center for Health Economics, Anhui University of Finance and Economics, Bengbu 233000, P.R.China
2 School of Business Administration, University of Houston-Victoria, Sugar Land 77449, USA
3 Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing 100101, P.R.China
4 Institute for Global Innovation and Development/Institute of Eco-Chongming/School of Urban and Regional Science, East China Normal University, Shanghai 200062, P.R.China
5 School of Languages and Media, Anhui University of Finance and Economics, Bengbu 233000, P.R.China
Download:  PDF in ScienceDirect  
Export:  BibTeX | EndNote (RIS)      


This study investigates the impact of the New Rural Cooperative Medical Scheme (NRCMS) on rural households to escape poverty.  We employ the instrumental variable method, the IVProbit model, to analyze the national data from the rural-resident field survey by the China Family Panel Studies (CFPS) in 2016.  Based on the large-scale data, we found that, first, the hospitalization of family members is the key factor in increasing the risk of the family falling into poverty.  The NRCMS has significantly reduced the likely risk of falling into poverty.  Second, the impact of the NRCMS on poverty alleviation varies among groups with different levels of income.  There is no impact on the upper-middle and high-income groups; in contrast, the NRCMS has substantially improved the capacity of low-income rural families to prevent poverty due to illness, especially for the lower-middle-income group.  Third, there exist significant regional differences in the impact of NRCMS on the health poverty alleviation of rural households in China.  The NRCMS has successfully reduced the risk of rural households in the western region falling into poverty, simultaneously, no significant impact on those in the eastern and central regions.  In order to diminish and eliminate poverty eventually and boost rural residents’ capacity for income acquisition, we propose the following: raise the actual compensation ratio of the NRCMS, control the rising expense of NRCMS by promoting the payment method reform, construct the comprehensive healthcare system in the western region, strengthen the medical security for the poor in remote area, and enhance the living environment for rural residents. 
Keywords:  New Rural Cooperative Medical Scheme        rural households        health poverty alleviation  
Received: 20 February 2020   Accepted:
Fund: We gratefully acknowledge the supports by the National Social Science Fund of China (18FGL014), the Key Project of Humanities and Social Science Base of Anhui Province of China (SK2019A0491), the Humanities and Social Science Foundation of the Ministry of Education of China (18YJA790065), the Social Science Foundation of Anhui Province of China (AHSKY2017D01), the Outstanding Scholar Project of Anhui Province of China (gxbjZD12), the Key Project of the Social Science Foundation of Anhui Province of China (AHSKY2020D44), and the 2019 Major Project of the Social Science Foundation of Anhui Province of China (AHSKZD2019D04).
Corresponding Authors:  Correspondence CHEN Hong, Tel: +86-552-3113120, E-mail:; LI Yu-heng, E-mail:   
About author:  QIN Li-jian, E-mail:;

Cite this article: 

QIN Li-jian, Chien-ping CHEN, LI Yu-heng, SUN Yan-ming, CHEN Hong . 2021. The impact of the New Rural Cooperative Medical Scheme on the “health poverty alleviation” of rural households in China. Journal of Integrative Agriculture, 20(4): 1068-1079.

Ahmed S, Szabo S, Nilsen K. 2018. Catastrophic healthcare expenditure and impoverishment in Tropical Deltas: Evidence from the Mekong Delta Region. International Journal for Equity in Health, 17, 1–28.
Alatinga K A, Williams J J. 2019. Mixed methods research for health policy development in Africa: The case of identifying very poor households for health insurance premium exemptions in Ghana. Journal of Mixed Methods Research, 13, 69–84.
Antunes A F, Jacobs B, de Groot R. 2018. Equality in financial access to healthcare in Cambodia from 2004 to 2014. Health Policy and Planning, 33, 906–919.
Aryeetey G C, Westenen J, Spaan E. 2016. Can health insurance protect against out-of-pocket and catastrophic expenditure and also support poverty reduction? Evidence from Ghana’s national health insurance scheme. International Journal for Equity in Health, 15, 1–11.
Bai Z E, Dong L X, Zhao W Z. 2013. Redistribution effect of new rural cooperative medical scheme: Analysis based on micro-survey data of rural China. Quantitative Economics in the 21st Century, 1, 371–387. (in Chinese)
Benitez J A, Adams E K, Seiber E E. 2018. Did health care reform help Kentucky address disparities in coverage and access to care among the poor? Health Services Research, 53, 1387–1406.
Chaudhuri A, Roy K. 2008. Changes in out-of-pocket payments for healthcare in Vietnam and its impact on equity in payments, 1992–2002. Health Policy, 88, 38–48.
Chen K, Wu G, He X, Bi J, Wang Z. 2018. From rural to rural urban integration in China: Identifying new vision and key areas for post-2020 poverty reduction strategy. International Food Policy Research Institute. [2020-5-16].
Chen Z G, Bi J Y, Wu G B, He X J, Wang Z M. 2019. Current situation and evolution of poverty alleviation in China and its post-2020 poverty alleviation vision and strategic priorities. Chinese Rural Economy, 34, 2–16. (in Chinese)
Cheng M W, Jin Y H, Gai Q E, Shi Q H. 2014. Rural poverty reduction: Whether more importance should be attached to education or health. Economic Research, 59, 130–144.(in Chinese)
Ekman B. 2007. Catastrophic health payments and health insurance: Some counterintuitive evidence from one low-income country. Health Policy, 83, 304–313.
Fang L M. 2013. The impact of new rural cooperative medical care system and rural medical assistance system on the economic burden of poor rural residents for medical care. China Rural Survey, 33, 80–92. (in Chinese)
Fry C, Sommers B D. 2018. Effect of medicaid expansion on health insurance coverage and access to care among adults with depression. Psychiatric Services, 69, 1146–1152.
Hadley C, Maxfield A, Hruschka D. 2019. Different forms of household wealth are associated with opposing risks for HIV infection in East Africa. World Development, 113, 344–351.
Hamid S A, Roberts J, Mosley P. 2011. Can micro health insurance reduce poverty? Evidence from Bangladesh. The Journal of Risk and Insurance, 78, 57–82.
Huang W. 2017. Research on targeted poverty alleviation effect of medical insurance policies - Based on household survey data of URBMI pilot assessment. Economic Research, 62, 117–132. (in Chinese)
Huang W. 2019. Insurance policy and poverty reduction in China: Experience, dilemma, and path optimization. Management World, 34, 135–150. (in Chinese)
Kwon E, Park S, McBride T D. 2018. Health insurance and poverty in trajectories of out-of-pocket expenditure among low-income middle-aged adults. Health Services Research, 53, 4332–4352.
Lattof S R. 2018. Health insurance and care-seeking behaviours of female migrants in Accra, Ghana. Health Policy and Planning, 33, 505–515.
Li Y H, Wu W H, Song C G, Liu Y S. 2019. Research on the spatial and temporal evolution pattern and key issues of world poverty. Bulletin of the Chinese Academy of Sciences, 33, 42–50. (in Chinese)
Luo R F, Liu C F, Gao J J, Wang T Y, Zhi H Y, Shi P F, Huang J K. 2020. Impacts of the COVID-19 pandemic on rural poverty and policy responses in China. Journal of Integrative Agriculture, 19, 2946–2964.
Mozumdar A, Aruldas K, Jain A. 2018. Understanding the use of India’s national health insurance scheme for family planning and reproductive health services in Uttar Pradesh. International Journal of Health Planning and Management, 33, 823–835.
NBSC (National Bureau of Statistics of China). 2016. Statistical bulletin of the People’s Republic of China on national economic and social development in 2016. [2017-2-28]. (in Chinese)
NBSC (National Bureau of Statistics of China). 2017. Statistical bulletin of the People’s Republic of China on national economic and social development in 2017. [2018-2-28]. (in Chinese)
Nguyen B T, Albrecht J W, Vroman S B, Westbrook M D. 2003. A quantile regression decomposition of urban–rural inequality in Vietnam. Journal of Development Economics, 83, 466–490.
Qi L S. 2011. Research on the effects of new rural cooperative medical scheme on poverty reduction, income increase and redistribution. Quantitative & Technical Economics, 27, 35–52. (in Chinese)
Qin L J, Wang W, Lu Y. 2018. The working and living conditions of college-educated rural migrants in China. Asian Population Studies, 14, 172–193.
Qin L J, Yang Q, Chen B. 2015. Impact of educational human capital and ownership of enterprise on attainment of social of migrant workers. Wuhan University Journal, 68, 13–21.(in Chinese)
Qin X Z, Zhou J B, Xin Y, Zhuang C. 2014. The influence of urban–rural dual medical insurance structure on migrant workers’ willingness to return home: A case study of migrant workers in Beijing. Chinese Rural Economy, 29, 56–68. (in Chinese)
Saksena P, Antunes A F, Xu K. 2011. Mutual health insurance in Rwanda: Evidence on access to care and financial risk protection. Health Policy, 99, 203–209.
SCOPRC (State Council Office for Poverty Reduction of China). 2017. China Poverty Alleviation and Development Yearbook 2017. Unity Press, Beijing. (in Chinese)
Shmueli A, Achdut L, Sabag E M. 2008. Financing the package of services during the first decade of the national health insurance law in Israel: Trends and issues. Health Policy, 87, 273–284.
Singh I, Squire L, Strauss J. 1986. The basic model: Theory, empirical results, and policy conclusions. In: Singh I, Squire L, Strauss J, eds., Agricultural Household Models, Extensions, Applications and Policy. Johns Hopkins University Press, Baltimore.
Song Y, Zhao J. 2015. The status and characteristics of poverty in China: A reanalysis based on equivalent scale adjustments. Management World, 30, 65–77. (in Chinese)
Sun X, Jackson S, Carmichael G, Sleigh A C. 2009. Catastrophic medical payment and financial protection in rural China: Evidence from the new rural cooperative medical scheme in Shandong Province. Health Economics, 18, 103–119.
Umeh C A. 2018. Challenges toward achieving universal health coverage in Ghana, Kenya, Nigeria, and Tanzania. International Journal of Health Planning and Management, 33, 794–805.
United Nations. 2017. Report of the secretary-general on the work of the United Nations (supplement No.1 to official records of the general assembly at its 72nd session) [2017-7-28].
Wagstaff A, Lindelow M. 2008. Can insurance increase financial risk? The curious case of health insurance in China. Journal of Health Economics, 27, 990–1005.
Wagstaff A, Lindelow M, Gao J, Xu L, Qian J. 2009. Extending health insurance to the rural population: An impact evaluation of China’s new cooperative medical scheme. Journal of Health Economics, 28, 1–19.
Wang C G, Rada N, Qin L J, Pan S W. 2014. Impacts of rural out-migration on household production choices: Evidence from China. Journal of Development Studies, 50, 413–425.
Wang S G, Liu M Y. 2019. Mechanism, implementation dilemma and policy choice of health poverty alleviation. Journal of Xinjiang Normal University, 40, 55–64. (in Chinese)
Wang Y Z, Ning Y F. 2018. The progress, problems and countermeasures of ethnic minority areas in the New Era to secure a decisive victory in building a moderately prosperous society in all respects. Management World, 33, 39–52. (in Chinese)
Wang Z X, Fan C Q, He Y, Zhang K, Wang H X. 2009. Research on rural poverty and polarization: A case study of Hubei Province. Social Sciences in China, 29, 78–88. (in Chinese)
WHO (World Health Organization). 2016. Working for Health and Growth: Investing in the Health Workforce. Report of the High-Level Commission on Health Employment and Economic Growth. Switzerland, Geneva.
Wooldridge J M. 2018. Introductory Econometrics: A Modern Approach. 7th ed. Cengage Learning Press, Boston.
World Bank. 2018. Poverty and Shared Prosperity 2018: Piecing Together the Poverty Puzzle. World Bank Publications, Washington, D.C.
Xie E. 2008. Health insurance and urban and rural anti-poverty: 1989–2006. Journal of Finance and Economics, 52, 68–83.(in Chinese)
Yan Y Y, Zhang L X, Luo S G, Wang H. 2006. Implementation effect analysis of new rural cooperative medical scheme: An empirical study from 101 villages in 5 provinces of China. Chinese Rural Economy, 21, 64–71. (in Chinese)
Yao Y, Liu B, Liu G E, Zang W B. 2014. Medical insurance, household registration system and utilization of medical services. Insurance Studies, 20, 105–116. (in Chinese)
Yu H Y, Ding H, Yang Q, Meng N N, Xie T T, Wang X Y. 2018. Analysis on the utilization and cost of inpatient services for poor population in the context of poverty alleviation on health. Journal of Health Economics, 24, 52–55.
Zhu L. 2013. Removing development obstacles of farmers and herdsmen - Research on the implementation of development policies in Kangzang farming and pastoral areas. Social Sciences in China, 33, 126–146. (in Chinese)
Zhu M B, Li S. 2017. The key of targeted poverty alleviation is to accurately identifying the poor. Social Sciences in China, 37, 90–112. (in Chinese)
[1] LUO Ren-fu, LIU Cheng-fang, GAO Jing-jing, WANG Tian-yi, ZHI Hua-yong, SHI Peng-fei, HUANG Ji-kun. Impacts of the COVID-19 pandemic on rural poverty and policy responses in China[J]. >Journal of Integrative Agriculture, 2020, 19(12): 2946-2964.
No Suggested Reading articles found!