Rural Cooperative Research Articles

A Generalized Accelerated Failure Time Model to Predict Restoration Time from Power Outages

Major disasters such as wildfire, tornado, hurricane, tropical storm, and flooding cause disruptions in infrastructure systems such as power and water supply, wastewater management, telecommunication, and transportation facilities. Disruptions in electricity infrastructure have negative impacts on sectors throughout a region, including education, medical services, financial services, and recreation. In this study, we introduced a novel approach to investigate the factors that can be associated with longer restoration time of power service after a hurricane. Considering restoration time as the dependent variable and using a comprehensive set of county-level data, we estimated a generalized accelerated failure time (GAFT) model that accounts for spatial dependence among observations for time to event data. The model fit improved by 12% after considering the effects of spatial correlation in time to event data. Using the GAFT model and Hurricane Irma’s impact on Florida as a case study, we examined: (1) differences in electric power outages and restoration rates among different types of power companies—investor-owned power companies, rural and municipal cooperatives; (2) the relationship between the duration of power outage and power system variables; and (3) the relationship between the duration of power outage and socioeconomic attributes. The findings of this study indicate that counties with a higher percentage of customers served by investor-owned electric companies and lower median household income faced power outage for a longer time. This study identified the key factors to predict restoration time of hurricane-induced power outages, allowing disaster management agencies to adopt strategies required for restoration process.

Growing up without health insurance: Evidence from rural China.

This paper examines the long-term effects of health insurance on children's educational attainment in a developing country. Utilizing the county-by-county rollout of the New Rural Cooperative Medical Scheme in rural China, we find that exposure to the health insurance program in early life leads to improved educational attainment in adulthood. Empirical tests suggest that a short-term increase in health care utilization is unlikely to be a potential channel. We provide some evidence for the channel that health insurance reduces household financial burdens and increases household expenditure on children's nutrition.

Вклад Фан Сяньтина в изучение проблем индустриализации Китая (1920-е – 1930-е гг.)

The article examines the history of the searches for China’s industrialization strategy in the writings of Fang Xianting. The experience of studying the history of the industrial development of England and the influence of the German historical school became important components of his understanding of China’s economic prospects in the first half of the 20th century. The starting point for the study of Chinese economy was Bücher’s classification of types of industrial organization in their historical evolution. Analysis of data collected by Fang Xianting on the socio-economic characteristics of a number of industries (carpet industry, cotton industry) made it possible to identify the obstacles to industrialization. The scholar recommended focusing on the development of rural industry while avoiding following the Western model of concentration of large enterprises in the cities. Rural industry needed no large investments, resources and sophisticated equipment, it could use the labor of peasants and was not under the control of foreign powers. Although China’s rural industry suffered from reduction in sales to foreign markets during the global crisis, Fang Xianting hoped for its revival and transformation into a driving force for industrialization. In the development of small-scale decentralized production, he saw the possibility of counteracting foreign dumping, preserving the family as a production unit and maintaining social stability. The scholar recommended developing a system of rural cooperatives that can protect the economic interests of producers and increase the competitiveness of Chinese goods. It is concluded that Fang Xianting’s research has become an important part of the advancement of Chinese economists towards a deeper understanding of the prospects of China’s industrialization that take into account national specifics. His research method combined the collection of objective economic information with the study of political, social and legal institutions for the sake of identifying the impact of industrialization on Chinese society. Emphasis on the priority of rural industry reveals the historical origins of the economic strategy in the initial stage of Chinese reforms in the 1980s that was aimed at improving the living standards of peasants through the development of rural industries.

Andhra Pradesh State Cooperative Bank: credit beyond convention

Learning outcomes After reading and analysing the case study, the students would be able to understand the various challenges in terms of credit expansion for a rural co-operative bank, discuss the role of an apex co-operative bank within the three-tier credit structure, understand the co-operative banks’ product offerings in the agribusiness space and understand the various styles of leadership and change management models within a rural bank. Case overview/synopsis This case study exemplified the enabling role played by a co-operative credit institution, Andhra Pradesh State Co-Operative Bank (APCOB). It discussed the issues and challenges APCOB faced in mainstreaming an unconventional lending process through its lower tiers. Although the three-tier credit structure played a significant role in the disbursal of short-term loan to farmers, the managing director strongly felt the need to reach out to farmer institutions like farmer producers organization through suitable product offering and right processes. Complexity academic level This case study could serve as an introduction to rural credit co-operatives in MBA courses such as bank management, agricultural finance and rural credit and organizational behaviour. The case study could also be administered as a part of training programmes for state co-operative banks, district central co-operative banks and urban co-operative bank that are involved in planning and execution of development strategies in the area of co-operative banking and agribusiness development. Supplementary materials Teaching notes are available for educators only Subject code CSS: 1: Accounting and Finance.

How are policy pilots managed? Findings from the New Rural Cooperative Medical Scheme in China

AbstractPolicy piloting has become a popular form of organization in implementing public policies. However, the current literature surprisingly discusses little about its management. This study investigates how two policy-pilot attributes – ambiguity and compatibility – shape policy-pilot management. To accomplish this, we developed an analytic framework consisting of four management strategies: experimentation, refinement, upscaling, and institutionalization. We chose a representative policy pilot in Chinese health governance, the New Rural Cooperative Medical Scheme, to examine the adoption of these four strategies. Our finding that, at various junctures, the Chinese state adopted these four strategies to manage policy piloting demonstrates the applicability of the analytic framework constructed in this study. This study contributes to the existing public policy literature by providing new insights into policy implementation in temporary organizing settings.

A new era for rural electric cooperatives: New clean energy investments, supported by federal incentives, will reduce rates, emissions, and reliance on outside power

This paper shows a least cost electricity generation portfolio for some of the largest rural electric cooperative utilities in the US. Due to the recent dramatic declines in renewable energy and battery storage costs, along with incentives under the federal Inflation Reduction Act (IRA) and excellent quality of renewable resource potential, we find that new investments in clean energy are significantly more cost-effective for most cooperative utilities than operating their existing coal and gas fired power plants. The study shows that rapid renewable energy (RE) deployment offers the rural cooperatives an opportunity to reduce their wholesale electricity costs by 10–20% compared with 2021 levels, while retiring their entire coal capacity by 2032. Most utilities could reduce their CO2 emissions by 80–90% relative to the 2021 levels, while also meeting load requirements at all hours, ensuring power supply reliability. While significant financing would be needed for such a transition to clean energy, we find that nearly half of the investments can be offset by the IRA tax credits. With bold and timely execution, cooperatives can reinvent their generation mix to provide affordable, reliable, and clean electricity that benefits rural communities.

Does the financial support to rural areas help to reduce carbon emissions? Evidence from China

Governance of County Carbon Emissions (CCEs) plays a pivotal role as China endeavors to align the strategies of rural revitalization with the goals of carbon peak and neutrality. This study delves into the influence of Financial Support to Rural Areas (FSRA) on CCEs, employing data from 955 counties across China. The primary findings encompass: (i) FSRA markedly influences CCEs. Specifically, both the depth and breadth of FSRA exhibit an inverted U-shaped relationship with CCEs. However, the strength of FSRA has a decidedly negative correlation. (ii) Heterogeneity analysis indicates a more pronounced effect of FSRA on CCEs reduction in China's central and western counties compared to the eastern ones. Moreover, following the receipt of loans, farmers display a greater inclination towards emission reduction behaviors than do farm-related economic entities. (iii) Mechanistic analysis elucidates that while FSRA augments CCEs through a scale effect, it curtails CCEs via the composition and technique effects. (iv) Further analysis reveals that the reform policies of Rural Credit Cooperatives (RCCs) bolster the reduction in CCEs. This effect becomes increasingly evident as the age of Rural Commercial Banks (RCBs) increases. This research serves as an empirical foundation for the progression of green inclusive finance and the green transformation of rural areas.

Utilization of basic medical insurance data in cancer-related researches in China

Objective: To explore the utilization of cancer-related data from basic medical insurance databases in China, and promote the application of medical insurance data in cancer prevention and treatment. Methods: Database PubMed, Web of Science, Wanfang, and CNKI were used to select related research papers using data from basic medical insurance system in China published by December 2021. Descriptive analysis was conducted in terms of the number of publications, types of cancer, primary research contents and author affiliations. Results: A total of 65 papers were included in the study. The number of publications increased rapidly after 2016. The most studied cancer type was lung cancer, and healthcare costs were the most common research contents. Fujian, Beijing, and Anhui have made a better use of cancer-related medical insurance databases compared to other provincial regions. The accessibility of the New Rural Cooperative Medical Scheme data was limited due to the high regional barriers, while the accessibility of the urban basic medical insurance data was relatively high. The researchers from Peking University and Fudan University had higher utilization of basic medical insurance data compared with those from other institutions. Conclusions: The utilization of cancer-related data from basic medical insurance databases in China is limited because of poor accessibility, insufficient data sharing, and regional restrictions. Thus, it is urgent to improve data accessibility and promote the integration and utilization of regional medical insurance data.

Enhancing stability and achieving high-quality development in rural credit cooperatives through inclusive finance: evidence from Shaanxi Province, China

ABSTRACT The stability of rural credit cooperatives is closely linked to regional economic development in China’s vast rural areas. This study aims to investigate how rural credit cooperatives in China can enhance their stability and achieve high-quality development using panel data from 87 county rural credit cooperatives in Shaanxi Province from 2008 to 2016. The Cov-AHP is employed to build an evaluation system and the effect of inclusive finance on the risk-taking capacity of rural credit cooperatives is analysed using a fixed effects model. Results demonstrate that inclusive finance can improve the risk-taking capacity of rural credit cooperatives and enhance their stability. This effect is more significant for rural credit cooperatives with a larger share of corporate shares, although property rights reform and the launch of community banks may weaken this effect. This study recommends vigorously promoting the development of inclusive finance, improving the operational mode of rural commercial banks, strengthening the corporate governance system of rural credit cooperatives, and enhancing the level of financial services for agriculture, rural areas, and farmers. These implications are important for promoting the further reform of rural credit cooperatives, especially in developing countries.

Cooperatives: The Only Hope for Rural India

The banking sector of any nation plays a crucial role in its economic development such as mobilization of savings and provision of credit. The present rural banking structure in India consists of multiple layers and serve needs of rural borrowers. The co- operative movement has been crucial in India in helping the rural poor's developmental demands be met. In order to safeguard the financial interests of the underprivileged and underrepresented in society, cooperatives are the organisations that assist individuals in utilising the power of collective bargaining. The purpose of this article is to point out the pivotal role of cooperative banks in India and the problems which are encountered by Rural Cooperative banks. This article highlights the structural impediments in this sector caused by regulatory overlap, an increase in Non Performing Assets, and frauds which have caused a decrease in depositor trust. It gives a stock of the present situation by analysing the coverage and regional variation of the cooperative banks in India. This paper highlights some areas of grave concern such as inadequate coverage, regional imbalances, high non-performing assets, high over-dues and makes recommendation to address these. Keywords: Cooperative movement, Cooperative banks, Non-performing assets, Over-dues, Rural Banking

A Rural Land Share Cooperative System for Alleviating the Small, Scattered, and Weak Dilemma in Agricultural Development: The Cases of Tangyue, Zhouchong, and Chongzhou

“Small, scattered and weak”, i.e., small-scale arable land holdings, decentralized operation, and weak effectiveness are common agricultural development problems that most developing countries face. Promoting the moderate-scale operation and modernization development of agriculture under the premise of protecting social stability is a complex and systemic process. In the evolution of China’s agricultural business model and land system reform, the Land Shareholding Cooperative System (LSCS) emerged. However, few studies have focused on the relationship between rural land institution innovation and agricultural economic development. We found great potential in this approach in solving the dilemma of “small, scattered, weak” in agricultural development, while protecting farmers’ land property rights. We described the cases of Tangyue, Zhouchong, and Chongzhou in rural China through the research method to illustrate how this occurred. This approach takes full advantage of the combination of “cooperative” and “shareholding” while alleviating the incompatibility of the historical allocation of arable land with urbanization and agricultural development. Balancing the development of factor markets and protecting the welfare of members contributes to its effective implementation. This study provides valuable examples of agricultural development in similar areas and countries.

The role of rural cooperatives in the development of rural household photovoltaics: An evolutionary game study

Promoting photovoltaics (PV) in rural households is a crucial step towards green development and rural revitalization. The current practice negatively affects the profit margins of rural households, creating a challenge in balancing efficiency and equity. This paper utilizes evolutionary game theory to construct a bipartite evolutionary game model involving enterprise and rural households, and a tripartite model involving enterprise, rural households, and rural PV cooperatives. We then investigate the strategic behavior and choices of stakeholders and examine the evolutionary trajectory of the system under different parameters based on numerical simulations. Results show that the rural PV cooperatives can increase the strategic choices of enterprises by reducing their market entry costs. The rural PV cooperatives also increase the expected profits of enterprises, rural households, and total social welfare. Our findings suggest that rural PV cooperatives may encourage the adoption of rural household PV and provide insights to balance efficiency and equity.

Effects of basic medical insurance integration on subjective wellbeing of residents in China: empirical evidence from a quasi-experiment.

Enhancing the wellbeing of residents through universal health coverage (UHC) is a long-term policy goal for China. In 2016, China integrated the New Rural Cooperative Medical Scheme (NRCMS) and the Urban Resident Basic Medical Insurance (URBMI) into the Urban and Rural Resident Basic Medical Insurance (URRBMI) to address the problem of fragmentation. The objective of this study was to investigate whether the integration of basic medical insurance had an impact on the subjective wellbeing of Chinese residents. Using the China Household Finance Survey data of 2015 and 2019, we empirically estimated the influence of the integration of basic medical insurance on Chinese residents through the difference-in-difference method based on propensity score matching (PSM-DID). Our findings indicate that the integration of basic medical insurance improved the subjective wellbeing of the insured population. Additionally, through heterogeneity testing, we validated that the integration increased the subjective wellbeing of residents from less developed regions in West China and rural areas, as well as those with older adult dependents. However, the subjective wellbeing of low-income groups, who were expected to benefit more from the URRBMI, did not improve significantly, at least in the short term. According to our research, the integration of basic medical insurance in China supports the country's objective of achieving equality and providing universal benefits for its residents. The introduction of the URRBMI has had a positive impact on the subjective wellbeing of insured individuals. This is particularly beneficial for disadvantaged groups in less developed regions, as well as for residents with older adult dependents. However, the subjective wellbeing of the middle-income group has improved significantly, whereas that of the low-income group, despite being the intended beneficiaries of the integration, did not show significant improvement. From a funding perspective, we recommend establishing a dynamic adjustment funding system that links residents' medical insurance funding standards with their disposable income. Regarding the utilization of the URRBMI, the benefit packages should be expanded, particularly by covering more outpatient services through risk pooling. We call for further research with additional data and continued efforts on improving wellbeing of residents, particularly for disadvantaged populations.

Can rural cooperatives reduce poverty vulnerability of smallholder households? Evidence from rural Western China

IntroductionPoverty eradication is one of the global challenges, and rural cooperatives provide an effective path to address smallholder households’ poverty. However, the effect of poverty reduction can show heterogeneity depending on the economic capital, human capital, and social capital of households.MethodsBased on comprehensive research data on the poverty status of 1,622 smallholder households in four provinces in the less developed regions of western China, using OLS and PSM models, this paper empirically analyzes the impact and heterogeneous characteristics of rural cooperatives on the poverty vulnerability of smallholder households.Results/DiscussionThe results show that rural cooperatives have a significant dampening effect on the poverty vulnerability of smallholder farmers, and the findings hold true after robustness tests using multiple methods. The impact of rural cooperatives on the poverty vulnerability of farming households differed significantly across smallholder households with different characteristics. Specifically, participation in cooperatives had a more pronounced effect on reducing poverty vulnerability among non-poor, higher human capital and higher income farm households compared to poor, lower human capital and lower income farm households. The results of the study can provide a useful reference for policy-making on rural mutual assistance and poverty reduction among farmers.

To investigate the individual and household-level factors influencing the willingness to pay for cataract surgery among patients aged 50 years and older in rural China: a cross-sectional study

ObjectivesTo investigate the factors influencing the willingness to pay (WTP) for cataract surgery among patients aged 50 years and older in rural China at both individual and household levels.DesignA cross-sectional...

Evidence From the China Family Panel Studies Survey on the Effect of Integrating the Basic Medical Insurance System for Urban and Rural Residents on the Health Equity of Residents: Difference-in-Differences Analysis.

The fragmentation of the medical insurance system is a major challenge to achieving health equity. In response to this problem, the Chinese government is pushing to establish the unified Urban and Rural Resident Basic Medical Insurance (URRBMI) system by integrating the New Rural Cooperative Medical Scheme and the Urban Resident Basic Medical Insurance. By the end of 2020, URRBMI had been implemented almost entirely across China. Has URRBMI integration promoted health equity for urban and rural residents? This study aims to examine the effect of URRBMI integration on the health level of residents and whether the integration can contribute to reducing health disparities and promoting health equity. We used the staggered difference-in-differences method based on the China Family Panel Studies survey from 2014 to 2018. Our study had a nationally representative sample of 27,408 individuals from 98 cities. We chose self-rated health as the measurement of health status. In order to more accurately discern whether the sample was covered by URRBMI, we obtained the exact integration time of URRBMI according to the official documents issued by local governments. Finally, we grouped the sample by urban and rural areas, regions, and household income to examine the impact of the integration on health equity. We found that overall, the URRBMI integration has improved the health level of Chinese residents (B=0.066, 95% CI 0.014-0.123; P=.01). In terms of health equity, the results showed that first, the integration has improved the health level of rural residents (B=0.070, 95% CI 0.012-0.128; P=.02), residents in western China (B=0.159, 95% CI 0.064-0.255; P<.001), and lower-middle-income groups (B=0.113, 95% CI 0.004-0.222, P=.04), so the integration has played a certain role in narrowing the health gap between urban and rural areas, different regions, and different income levels. Through further mechanism analysis, we found that the URRBMI integration reduced health inequity in China by facilitating access to higher-rated hospitals and increasing reimbursement rates for medical expenses. However, the integration did not improve the health of the central region and low-income groups, and the lack of access to health care for low-income groups was not effectively reduced. The role of URRBMI integration in promoting health equity among urban and rural residents was significant (P=.02), but in different regions and income groups, it was limited. Focusing on the rational allocation of medical resources between regions and increasing the policy tilt toward low-income groups could help improve the equity of health insurance integration.

A spatiotemporal analysis of the association between carbon productivity, socioeconomics, medical resources and cardiovascular diseases in southeast rural China.

With China's rapid industrialization and urbanization, China has been increasing its carbon productivity annually. Understanding the association between carbon productivity, socioeconomics, and medical resources with cardiovascular diseases (CVDs) may help reduce CVDs burden. However, relevant studies are limited. The study aimed to describe the temporal and spatial distribution pattern of CVDs hospitalization in southeast rural China and to explore its influencing factors. In this study, 1,925,129 hospitalization records of rural residents in southeast China with CVDs were analyzed from the New Rural Cooperative Medical Scheme (NRCMS). The spatial distribution patterns were explored using Global Moran's I and Local Indicators of Spatial Association (LISA). The relationships with influencing factors were detected using both a geographically and temporally weighted regression model (GTWR) and multiscale geographically weighted regression (MGWR). In southeast China, rural inpatients with CVDs increased by 95.29% from 2010 to 2016. The main groups affected were elderly and women, with essential hypertension (26.06%), cerebral infarction (17.97%), and chronic ischemic heart disease (13.81%) being the leading CVD subtypes. The results of LISA shows that central and midwestern counties, including Meilie, Sanyuan, Mingxi, Jiangle, and Shaxian, showed a high-high cluster pattern of CVDs hospitalization rates. Negative associations were observed between CVDs hospitalization rates and carbon productivity, and positive associations with per capita GDP and hospital beds in most counties (p < 0.05). The association between CVDs hospitalization rates and carbon productivity and per capita GDP was stronger in central and midwestern counties, while the relationship with hospital bed resources was stronger in northern counties. Rural hospitalizations for CVDs have increased dramatically, with spatial heterogeneity observed in hospitalization rates. Negative associations were found with carbon productivity, and positive associations with socioeconomic status and medical resources. Based on our findings, we recommend low-carbon development, use of carbon productivity as an environmental health metric, and rational allocation of medical resources in rural China.

Clinical analysis of secondary glaucoma in Central China

To describe the epidemiology, clinical and social characteristics, management, and outcomes of patients with secondary glaucoma in Central China, a total of 1,129 cases (1,158 eyes) among 710 males (62.89%) and 419 females (37.11%) were analyzed. The mean age was 53.75 ± 17.11 years. The New Rural Cooperative Medical System (NCMS) played the most important role in reimbursement (60.32%) for secondary glaucoma-related medical expenses. The predominant occupation was “farmer” (53.41%). Neovascularization and trauma were the leading causes of secondary glaucoma. Cases of trauma-induced glaucoma decreased substantially during the coronavirus disease 2019 (COVID-19) pandemic. An education level of senior high school or above was uncommon. Ahmed glaucoma valve implantation was the most commonly performed surgery. At the final follow-up, the overall intraocular pressure (IOP) in patients with vascular disease- and trauma-related secondary glaucoma was 19.53 ± 10.20 mmHg, 20.26 ± 11.75 mmHg, and 16.90 ± 6.72 mmHg, while the mean visual acuity (VA) was 0.33 ± 0.32, 0.34 ± 0.36, and 0.43 ± 0.36. In 814 (70.29%) eyes, the VA was < 0.01. Effective preventive measures for at-risk populations, increased NCMS coverage and the promotion of higher education are necessary. These findings will help ophthalmologists detect secondary glaucoma early and manage it in a timely manner.

The Impact of the Digital Economy on High-Quality Development of Specialized Farmers’ Cooperatives: Evidence from China

The development of the digital economy is profoundly changing and influencing the development mode of specialized farmers’ cooperatives. It can promote the development of specialized farmers’ cooperatives by optimizing resource allocation, improving production efficiency, and enhancing their external service and internal governance capacity. This paper used the panel data of 30 Chinese provinces and cities from 2017 to 2020 and applied various statistical analysis methods to investigate the role of the digital economy in promoting agricultural cooperatives and their internal mechanisms. The results show the following: (1) The development of specialized farmers’ cooperatives was slightly improved in China over the studied years. Cooperatives in the eastern areas had the highest development levels, and there was a marked increase in the development of cooperatives in western regions in these years. (2) The digital economy can effectively enhance the technological innovation level and then boost the high-quality development of agricultural cooperatives. (3) The results of the threshold regression analysis show that there is only one threshold for the impact of digitalization on the development of farmers’ cooperatives. (4) By analyzing the data from these regions, we found that digitalization can foster the development of rural cooperatives not only in specific regions, but also in surrounding areas. (5) The heterogeneity analysis showed that the promoting effect of digitalization on specialized farmers’ cooperatives was more evident in the west of China than in the eastern and central regions. Therefore, this paper provides a reference for accelerating the development of specialized farmers’ cooperatives under the background of the digital economy.

Income-related equity in inpatient care utilization and unmet needs between 2013 and 2018 in Tibet, China

BackgroundProviding equitable access to health care for all populations is an important sustainable development goal. China has made significant progress in achieving equity in healthcare utilization. However, research on equity in healthcare utilization in Tibet is sparse. This study aims to evaluate changes in income-related inequity in inpatient care utilization and unmet needs between 2013 and 2018 among the Tibetan population and identify the inequity source.MethodsData for this cross-sectional study were obtained from the fifth and sixth waves of the National Health Services Survey in 2013 and 2018. After excluding observations with missing values for key variables, 11,092 and 10,397 respondents were included in this study, respectively. The outcome variables of interest were inpatient service utilization and unmet hospitalization needs. The concentration index and horizontal inequity index (HI) were used to assess income-related inequity. Non-linear decompositions were performed to identify the main contributors to inequity. In the decomposition method, need variables included sex, age, chronic diseases, and the EuroQol-Visual Analog Scale; non-need variables consisted of income, education, employment status, marital status, and health insurance schemes.ResultsThe probability of inpatient care utilization increased from 6.40% in 2013 to 8.50% in 2018. The HI for inpatient care utilization was 0.19 (P < 0.001) in 2013, whereas it decreased to 0.07 (P < 0.001) in 2018. The contribution of income to inequity in inpatient care utilization decreased from 87.09% in 2013 to 59.79% in 2018. As for unmet inpatient care needs, although its probability increased from 0.76 to 1.48%, the percentage of reasons for financial hardship decreased from 47.62 to 28.57%. The HI for unmet hospitalization need was − 0.07 in 2013 and − 0.05 in 2018, and neither was statistically significant. The New Rural Cooperative Medical Scheme made majority contributions to promote equity in unmet hospitalization need. Moreover, the female respondents reporting low EuroQol-Visual Analog Scale scores and patients with chronic disease were not only more likely to seek for inpatient care, but also have more unmet need than the reference groups.ConclusionsThe inequity in inpatient care utilization in Tibet narrowed from 2013 to 2018, and there was no inequity in unmet hospitalization needs in 2013 and 2018. Income and the New Rural Cooperative Medical Scheme are the main drivers of equity promotion. To promote access to inpatient care utilization and decrease the probability of unmet hospitalization need in future, policymakers should target high-need residents in Tibet to improve accessibility, availability, and acceptability.