Does high-speed rail relieve income-related health inequalities? A quasi-natural experiment from China

Abstract

IntroductionThe rapid increases in income and high-speed rail (HSR) construction in China raise the prospect of reshaping the space economy, the exploration of which, from the perspective of optimised transportation networks, can provide insights into alleviating the increasing health inequalities. MethodsBased on matched data of prefecture-level cities and Chinese Labor Dynamic Survey packages from 2014 to 2018, we used the ordered probit model and ordinary least squares (OLS) with time- and city-fixed effects to estimate the effects of HSR on personal health status. We calculated the degree of income-related health inequalities and decomposed the contributive degree of HSR to health inequalities by decomposing the concentration index (CI) and Blinder-Oaxaca, respectively. ResultsPersonal health status showed significant differences under different income levels and in areas with and without HSR. The estimated coefficients regarding HSR on personal health status were 0.112 in the ordered probit model and 0.167 in the OLS model. The CI of health inequalities showed a positive coefficient of 0.059, with a pro-rich phenomenon. Contribution decomposition of CI showed that HSR accounted for an important contribution of 1.919% to health inequalities. Blinder-Oaxaca decomposition revealed that the contribution of HSR to overall CI was 0.075% from 2014 to 2018. CI decomposition also demonstrated a decreasing trend over time in the HSR's contribution to increasing health inequalities. Further, mechanism analysis showed that HSR improved health more significantly among high-income groups in ways that included improved high quality of healthcare services, socioeconomic status, and social capital. ConclusionsThere is a pro-rich distribution of health in China, and HSR exacerbates health inequalities more significantly among high-income groups in several ways, including high-quality healthcare services, socioeconomic status, and social capital. Furthermore, HSR has the potential to decrease health inequalities in the future.