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| Downward Allocation of Primary Healthcare Resources and Rural Household Poverty Vulnerability: Evidence from the Construction of County-based Close-knit Medical Communities in China |
| AI Shuang, MENG Enhui, NIU Geng
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| Survey and Research Center for China Household Finance/ Research Institute of Economics and Management, Southwestern University of Finance and Economics |
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Abstract Achieving common prosperity for all is a fundamental requirement of Chinese-style modernization. In 2020, China successfully lifted impoverished rural residents living under the current poverty line out of poverty, accomplishing a globally recognized milestone in eliminating absolute poverty. However, consolidating these poverty alleviation achievements remains a long-term and challenging task. Rural low-income households have limited capacity to withstand future uncertainties and remain vulnerable, facing the risk of falling back into poverty. Individual health is the foundation of personal well-being, and public health is the cornerstone of national development. Illness not only directly harms individual health but also reduces labor capacity and income, thereby increasing the likelihood of household poverty. Ensuring the health of rural residents is therefore a critical measure to reduce household poverty vulnerability. Despite the continuous increase in the total supply of medical resources, the problem of their uneven distribution across regions still exists, which restricts the balanced development of basic public health services. How to improve rural healthcare service quality to reduce household poverty vulnerability, prevent large-scale poverty relapse, and sustain income growth among the formerly poor is an urgent policy concern. Against this backdrop, this study systematically examines the impact of healthcare resource decentralization on household poverty vulnerability, offering important insights for consolidating poverty alleviation achievements, advancing comprehensive rural revitalization, and promoting the construction of a modern socialist country.
Building on the institutional background and existing literature, this paper develops a theoretical framework linking healthcare resource decentralization to rural household poverty vulnerability. We first verify that the reform of Close-knit Medical Communities (CMCs) improves the supply of primary public healthcare resources. We then exploit the 2019 CMC pilot program as a quasi-natural experiment and employ a difference-in-differences approach, using five waves (2015-2023) of microdata from the China Household Finance Survey (CHFS) to estimate the causal effect of healthcare resource decentralization on rural household poverty vulnerability. The results show that healthcare resource decentralization driven by CMC reform significantly reduces rural household poverty vulnerability, and this finding remains robust across a series of specification checks. In terms of resource provision, CMC reform significantly increases the number of medical personnel in community health stations and clinics, hospitals, and village health centers, thereby improving the supply of primary public healthcare resources. Mechanism analysis indicates that reductions in household health risks, increases in medical insurance participation, and higher reimbursement rates for medical expenditures are key channels through which healthcare resource decentralization lowers rural household poverty vulnerability. Heterogeneity analysis further reveals that the vulnerability-reducing effect of CMC reform is more pronounced among rural households with lower levels of human capital, physical capital, and social capital.
Based on these findings, three policy implications follow. First, optimizing the structure of healthcare resource allocation and promoting the sustained downward deployment of high-quality medical resources, which can be achieved through personnel rotation, technical assistance, and equipment sharing, can enhance the service capacity of primary healthcare institutions. Expanding CMC coverage while emphasizing equity and accessibility in resource distribution is essential. Second, deepening health insurance reform by expanding coverage, increasing reimbursement rates for primary care, improving provider payment mechanisms, and enhancing fund efficiency can strengthen households' financial protection. Designing flexible contribution schemes and targeted fiscal subsidies for elderly rural residents would further improve the inclusiveness and fairness of the medical insurance system. Third, improving the quality of primary healthcare services through enhanced training of grassroots medical personnel, upgraded medical facilities, and the promotion of family doctor contract services and preventive health management can reduce health risks at the source and lower the probability that illness translates into poverty vulnerability.
The marginal contributions of this study are threefold. First, it examines the impact and mechanisms of healthcare resource decentralization on rural household poverty vulnerability, providing direct evidence on how decentralization reduces vulnerability. Second, it expands health economics research by focusing on how the downward allocation of high-quality medical resources affects rural poverty vulnerability, offering new empirical insights for resource allocation and poverty alleviation. Third, the findings offer practical policy guidance for strengthening county-level medical communities and establishing routine mechanisms to prevent rural households from falling back into poverty, supporting rural revitalization and the pursuit of common prosperity.
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Received: 08 September 2025
Published: 24 April 2026
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| Cite this article: |
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AI Shuang,MENG Enhui,NIU Geng. Downward Allocation of Primary Healthcare Resources and Rural Household Poverty Vulnerability: Evidence from the Construction of County-based Close-knit Medical Communities in China[J]. Journal of Financial Research,
2026, 550(4): 168-186.
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| URL: |
| http://www.jryj.org.cn/EN/ OR http://www.jryj.org.cn/EN/Y2026/V550/I4/168 |
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