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Life satisfaction of older Chinese: The role of health and health insurance

Katja Hanewald

Image: Dr Katja Hanewald, CEPAR Associate Investigator

CEPAR researchers Dr Sisi Yang and Dr Katja Hanewald analyse in their recent paper whether the universal health insurance system in China increases the life satisfaction of middle-aged and older Chinese people and to what extent the type of health insurance affects the life satisfaction of this group. 

“Our study provides new evidence on the impact of health insurance on wellbeing and will inform the ongoing health insurance reforms in China,” says co-author Dr Sisi Yang.

“Two main factors are linked to the trajectory of life satisfaction in China: increasing inequality and the dissolution of the social security net during the economic transition.

“Older adults tend to be particularly concerned with the dissolution of traditional social security and the high costs of health services in the market-oriented health system. The unaffordability of health care can contribute to low life satisfaction among older adults,” she says.

Responding to this situation, the Chinese government has launched a series of reforms to establish a universal health security net and to provide access to affordable basic health care for all citizens, including older adults.

“However, the current public health insurance system is highly fragmented, consisting of different programs with different levels of premiums and benefits,” says Dr Yang.

“Therefore, we investigate whether universal health insurance coverage reduces risks and insecurity, and increases the life satisfaction of older adults.”

The researchers set out to examine the link between life satisfaction and different types of health insurance with different premium and reimbursement rates in China.

It is the first study in this area that is based on longitudinal data from the China Health and Retirement Longitudinal Study (CHARLS), a nationally representative longitudinal survey of Chinese aged 45 and above, in 2011, 2013, and 2015.

The researchers find that the life satisfaction of middle-aged and older adults does not depend on having any health insurance coverage but varies with the type of health insurance coverage, controlling for potential confounding variables such as health status, occupation, hukou (household registration) status, and other demographic variables. 

“Although nearly all older adults were covered by the public health insurance scheme in 2012, universal health insurance coverage does not necessarily increase life satisfaction in the current fragmented health insurance system,” says Dr Yang.

“Our results indicate important policy implications. The findings from this study suggest that establishing a more equitable health insurance system should be the next step in health reforms in China.”

Yang, S., Hanewald, K. (2020): Life Satisfaction of Middle-Aged and Older Chinese: The Role of Health and Health Insurance. Soc Indic Res.