The Impact of Rural Energy Poverty on Primary Health Services Efficiency: The Case of China

Primary healthcare is vital to achieving universal health coverage, as emphasized by Sustainable Development Goal 3 (SDG 3). However, energy poverty remains a critical yet overlooked barrier to the efficiency of primary healthcare services in rural China—precisely the focus of this study. It employs panel regression models and threshold analysis methods using data from 31 Chinese provinces for the period 2014–2021, sourced from the EPSDATA data platform. Robustness checks are performed using bootstrap procedures, accompanied by detailed mechanism analyses. The empirical results demonstrate that rural energy poverty significantly reduces primary healthcare efficiency, particularly in provinces initially characterized by lower healthcare performance. The mechanism analysis identifies four critical transmission channels—off-farm employment, internet intensity, food safety, and health education—through which rural energy poverty undermines healthcare outcomes. Furthermore, threshold regressions uncover nonlinear relationships, indicating that the negative impacts of rural energy poverty intensify when household medical expenditures exceed 10.9%, the old-age dependency ratio surpasses 22.61%, and the rural energy poverty index is higher than 0.641. In theoretical terms, this study identifies rural energy poverty as a critical determinant of primary healthcare efficiency, thereby addressing an important gap in the existing literature. At the policy level, the findings emphasize the necessity for integrated measures targeting both rural energy poverty and primary healthcare inefficiencies to achieve SDG 3 and sustainably promote equitable, high-quality healthcare access in rural China.