China's Health Insurance Reform and Disparities in Healthcare Utilization and Costs: A Longitudinal Analysis

China's economic success during the past 30 years was not mirrored in its health care system. As a result, the rural-urban disparities in health insurance coverage and the related health care areas became prominent. Since the late 1990s, China has been expanding insurance coverage, in order to provide accessible and affordable health care to all residents. My study analyzes whether the insurance expansion reduces rural-urban disparities in terms of health care utilization and financial protection. To my knowledge, this is the first study to address the disparity issue by examining China's health care reform policies over an extended 18-year period (1993-2011). It is also the first study to address the dynamic phenomenon of rural-urban migration during the study period by separating the study group into 4 subgroups in terms of respondents in residential areas versus household registration type.;Drawing on seven waves of data from the China Health and Nutrition Survey and applying multivariate analysis techniques, such as difference-in-difference analysis and generalized linear model, I find that rural-urban disparities in formal care and outpatient utilization were significantly reduced by the expanded health insurance coverage in rural area in 2003. The rural-urban disparity in total health costs is also significantly reduced. However, no evidence shows that the policy changes in health insurance coverage had impact on disparities in inpatient utilization or having high out-of-pocket payments. By conducting several sets of sensitivity analyses, my study also finds that the expanded health insurance coverage impacted richer province more than poorer provinces, and impact high-income families more than medium- and low-income families.;The study findings have important policy implications for China's ongoing health care reform. First, China's policy makers should provide better health care coverage and more health care resources to rural areas to further reduce the rural-urban disparity. Second, since prior policy changes affected rich province more than poor province, new policy should target specifically poor provinces. Third, given the finding that the positive impact on health care utilization of policy change in 2003 happening mainly in high-income groups, new policy change should focus more on medium- and low-income group.