Can Health Poverty Alleviation Policies Simultaneously Mitigate Current and Future Medical- Related Poverty? A Quasi-Experimental Study of China’s National Programme

Background Health shocks were a major cause of poverty in low and middle income countries, including China. China has implemented a series of Health Poverty Alleviation Policy (HPAP) policies aimed at reducing poverty driven by health related factors. This study aims to systematically evaluate the short term and long term effects of China’s HPAP on preventing health induced poverty. Methods Four waves of data from the China Health and Retirement Longitudinal Study (CHARLS), involving 11380 respondents, were used in this study. We employed two indicators to estimate both current and future health-related poverty risks at the household level: the Catastrophic Health Expenditure (CHE) index and the Health Poverty Vulnerability index, calculated using a three-stage feasible generalized least squares (FGLS) method. A difference-in-differences (DID) model was applied to assess the impact of the Health Poverty Alleviation Policy (HPAP) on the incidence of CHE. Given that households with different levels of risk may respond differently to the policy, we further employed a quantile difference-in-differences (QDID) model to evaluate the heterogeneous effects of HPAP on health poverty vulnerability. Results The average household health poverty vulnerability index was 0.48 ± 0.02. Longitudinal analyses indicated a declining trend over time in both the treatment and control groups. However, the treatment group consistently exhibited higher vulnerability levels than the control group across all survey waves. Furthermore, the incidence of CHE in the treatment group showed a sustained downward trajectory. difference-in-differences (DID) analysis demonstrated that the HPAP significantly reduced the incidence of CHE. However, its impact on overall health poverty vulnerability was limited, with only modest improvements observed among high-risk subpopulations. Conclusions The HPAP policy achieved notable effects in alleviating the direct economic burden caused by illness, but its impact on the long-term health poverty vulnerability of uncompensated low-to-medium-risk households remains limited. This disparity in effects primarily stems from the policy’s focus on medical cost control, which, while helpful in reducing CHE, lacks systematic investment in health capacity building. Future policy design should strengthen risk identification and dynamic monitoring mechanisms, expand the scope of coverage for preventive care to achieve sustainable mitigation of health poverty vulnerability.