The impact of the East-West Pairing Assistance Policy on the health of older adults: evidence from China

Amid accelerated global population aging, China faces the challenge of “growing old before becoming affluent” alongside regional developmental disparities. The paired assistance policy between Eastern and Central-Western China is a central strategy for balanced regional development and is widely recognized for its socioeconomic benefits as implementation deepens. However, its health impacts remain largely unexamined, particularly given the issue of “impoverished aging” in central-western China. Therefore, this study examines the relationship between the East-West Pairing Assistance Policy (EWPAP) and older adults’ health outcomes, and explores the mechanisms through which the policy exerts its effects. Utilizing five-wave panel data (2011–2020) from the China Health and Retirement Longitudinal Study (CHARLS), this study employs a difference-in-differences (DID) model to systematically evaluate the impact of the EWPAP on the health of older adults and its underlying mechanisms, treating the 2016 policy enhancement as a natural experiment. The findings suggest that policy implementation is associated with improved health status among older adults, a conclusion supported by robustness checks. Mechanism analysis indicates that the policy may enhance the health of older adults is consistent with three plausible pathways: (1) improved healthcare accessibility, reflected by increased medical insurance participation and a reduced relative burden of outpatient out-of-pocket expenditure rather than an expansion in the number of healthcare institutions; (2) increased economic capacity of older adult households; and (3) systematic upgrades in digital and transportation infrastructure. Furthermore, the heterogeneity analysis shows a statistically significant effect in urban samples and a substantially stronger effect among older adults in economically disadvantaged regions, whereas the rural coefficient is positive but not statistically significant. This study underscores the critical role of the EWPAP in improving the health of older adults. Beyond providing empirical evidence to help developing countries tackle healthy aging challenges through regional cooperation policies, it proposes targeted policy recommendations aimed at strengthening healthcare financial protection and service accessibility, promoting household economic development, and upgrading digital and transportation infrastructure. These findings offer significant practical value for advancing the United Nations Sustainable Development Goals and the “Healthy China” initiative.