Impact of Urban-Rural Health Insurance Integration on Mental Health Among Rural Adults in China: Evidence From a Quasiexperimental Study

Objective: Few studies have examined the psychological effects of expanding and integrating health insurance programmes. This study aimed to examine the effects of health insurance on mental health based on a large natural experiment in China: the integration of the rural and urban resident health insurance programmes.Methods: Using four waves of data from the China Health and Retirement Longitudinal Study (CHARLS) collected in 2011, 2013, 2015 and 2018, this study adopted a time-varying DID approach to capture the effect of urban-rural health insurance integration on depressive symptoms among rural residents in China. The group heterogeneity of the policy effect and possible mechanisms through which the reform produced psychological effects were further analysed.Results: The average CES-D score of rural adults decreased by 0.424 and the likelihood of depressive symptoms decreased by 3.5% after the implementation of the urban-rural health insurance integration policy. The positive effects may be due to the reduced cost sharing rates as well as improvements in health satisfaction, social interactions and physical activity. However, the integration reform had a limited impact on improving the mental health of those with the lowest economic status, the worst health status and those aged 40-49 or over 70.Conclusion: Urban-rural health insurance integration had a positive psychological effect among rural residents in China. Additional improvements in mental health could flow from further expanding the beneficiary population and improving benefit equity under urban-rural integrated basic medical insurance.