Over the past two decades, China has pursued an ambitious plan to establish an accessible and affordable health system that meets the needs of its population. As part of this journey, China’s leadership implemented comprehensive health system reforms and achieved near-universal health insurance coverage at a relatively low per capita income level. Key to this process was the integration of rural and urban resident health insurance programs, which has proven to yield positive outcomes in health care utilization, physical health, and related equity issues. Thus far, however, the integration’s potential psychological effects have been understudied.

New research, published in the journal Health & Social Care in the Community, addresses this gap in the literature. The researchers – Stanford health economist Karen Eggleston, the director of APARC’s Asia Health Policy Program (AHPP); Peking University’s Gordon Liu; and Renmin University of China’s Yue-Hui Yu and Qin Zhou, the latter a former visiting scholar with AHPP – find that the urban-rural health insurance integration has been beneficial for improving mental health among China’s rural adults.

Their study underscores the potential of policy-driven health system reforms to address longstanding disparities, promote mental well-being in vulnerable communities, and enhance quality of life among aging populations. This is the researchers’ final installment in a series of studies on China’s urban-rural health insurance integration.

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Tracking Mental Health Over Eight Years

For decades, China had a fragmented health insurance system, which led to disparities between different populations and hindered the implementation of the Healthy China 2030 blueprint, a bold national strategy to make public health a precondition for all future economic and social development. Responding to this challenge, in 2016, China announced plans to unify its rural and urban health insurance programs. The unified health insurance system, called Urban and Rural Residents’ Basic Medical Insurance (URRBMI), offered equal health service packages and insurance benefits to rural and urban residents. Studies have shown that the integrated system improved healthcare access for nearly 800 million rural residents and helped reduce coverage gaps and inequality. Yet evidence about the integration’s potential psychological impacts has been limited.

Eggleston and her co-authors hypothesized that this reform might also benefit rural adults’ psychological well-being. To test this hypothesis, the researchers conducted a comprehensive analysis using data from the China Health and Retirement Longitudinal Study (CHARLS), a nationally representative survey that tracks health, economic, and social variables among Chinese adults aged 45 and older. The study focused specifically on rural residents, examining changes in mental health, particularly depressive symptoms, before and after the insurance integration. Data from four waves of CHARLS, spanning from 2011 to 2018, allowed the team to analyze trends over a substantial period.

The researchers used an event study combined with a time-varying difference-in-differences (DID) approach, capturing the effect of the health insurance integration on depressive symptoms and comparing changes over time between those affected by the reform and a control group not yet impacted (since local governments introduced the integration reforms in different years, samples in the control group had constantly entered the treatment group during the survey period). This method helps isolate the effect of the policy from other confounding factors, providing a clearer picture of causality. The researchers further examined the heterogeneity of the integration effect across subgroups by gender, age, health status, and family economic status. They also analyzed possible mechanisms through which the reform produced psychological effects

Key Findings: A Significant Drop in Depression

The researchers find that the health insurance integration was associated with a measurable reduction in depressive symptoms among rural seniors. Specifically:

• CES-D scores – a standard measure of depression severity (using a version of the Centre for Epidemiological Studies Depression Scale) – decreased by an average of 0.441 points among those covered by the reform.
• The likelihood of experiencing depression dropped by approximately 3.5% in the post-reform period.
• The decline in depression scores following the integration was continuous, suggesting cumulative effects of the reform. Notably, some psychological benefits appeared up to two years before the reform took effect, likely due to public awareness and positive expectations generated by advance announcements from local authorities.

The results were statistically significant, indicating that the health insurance integration reform has significantly improved the mental health of rural adults and reduced their risk of becoming depressed.

The findings also indicate that a key driver that produced continuous positive psychological effects was the integration’s reduction of health care costs for rural residents, particularly for hospital care. By lowering financial barriers to treatment, the integration improved access to healthcare and made its use more equitable. This, in turn, boosted rural adults’ satisfaction with their health and overall sense of well-being. The improvement may have set off a positive cycle, encouraging more social engagement and physical activity, which helped further ease symptoms of depression.

While the reform reduced depressive symptoms for both male and female older adults, the findings revealed differences across subgroups. It appears the reform did not significantly reduce depressive symptoms for those aged 40-49 and over 70, individuals in poor health, or those in the lowest economic bracket. The researchers attribute this to ongoing financial barriers and limited insurance financing, which may blunt the perceived benefits for high-need groups.

Policy Implications: A Path Toward Health Equity

The study’s co-authors highlight several policy implications for China:

• Expand and standardize coverage: Build on the success of the URRBMI by moving from local-level integration to broader provincial or national coverage, and encourage enrollment among vulnerable populations through subsidies.
• Improve equity for high-need groups: Design more targeted insurance policies for older adults, those with chronic illnesses or disabilities, and low-income groups, especially by covering outpatient treatments for high-cost conditions.
• Increase funding for the URRBMI: Despite progress, reimbursement rates remain low, highlighting the need for greater investment in the program.
• Strengthen rural health infrastructure: Insurance reforms must be paired with improvements in rural healthcare facilities and services to ensure quality care is both accessible and effective.

China’s experience offers valuable lessons for countries aiming to achieve universal health coverage and those grappling with health disparities and aging populations. The positive association between insurance integration and mental health among rural adults in China underscores the importance of comprehensive, inclusive policies addressing financial and social determinants of health.

The study’s findings highlight the need to ensure that the most vulnerable populations benefit equally from health reforms. They also serve as a compelling reminder that thoughtfully designed and implemented reforms can improve physical health and increase mental resilience and social cohesion.

Alicia R. Chen, PhD Candidate in Political Science, Stanford University
Research Topic: Roads to (No) Influence: Domestic Incentives and the Distribution of Chinese Aid

Alicia Chen is a PhD candidate in the political science department at Stanford University. Chen’s research focuses on conflict, development, and international economics, with an empirical focus on Chinese development aid. Chen holds an MA in international policy from Stanford University and a BA in political science from the University of Southern California. Prior to doctoral studies, Chen was a Research Specialist at the Empirical Studies of Conflict (ESOC) project at Princeton University. 

Q: What advice would you give to someone just starting out in your field of research?
A: I encourage everyone to do fieldwork in the countries they are interested in studying as early as possible. Media coverage (and even data) often doesn’t capture the full picture, and it was immensely helpful to see for myself what the situation is on the ground.

Q: If you could snap your fingers and have one part of your research magically completed, what would it be?
A: Data collection… Many fieldwork trips end up taking much longer than expected because of bureaucratic delays, and there is not much that can be done to speed up the process.

Matthew DeButts, PhD Candidate in Communication, Stanford University
Research Topic: PRC Influence and Chinese Diasporic Media in the Digital Age

Matt DeButts is a PhD candidate in communication, studying Chinese media, censorship, and propaganda. Before coming to Stanford, Matt wrote about Chinese economics and politics for The Economist Intelligence Unit in Beijing, covered culture as a special correspondent for the Los Angeles Times, and edited the foreign affairs newsletter Legation Quarter. At Stanford, he was a 2023-24 Human-Centered Artificial Intelligence (HAI) fellow, and a graduate research assistant at the Stanford Internet Observatory. His academic work has been published in the Journal of Communication, Social Media+ Society, and EMNLP Findings.

Q: What advice would you give to someone just starting out in your field of research?

Q: How would you describe your research to a fifth grader?
A: My research looks into how powerful people, like governments, try to get people to believe things. Sometimes, governments treat you like a grown-up, explaining things and allowing you to decide for yourself. But other times, they treat you like a kid, always thinking they know what’s best for you. My research looks into how and why they do that.

SCCEI offers grants to support exceptional researchers conducting data-driven research related to China's economy. We accept proposals two times per year, Fall and Winter. Visit the SCCEI Research Grants and Fellowships webpage for more details and current opportunities.

Slowing Growth, Thriving Tech
Despite slowing economic growth, China’s industrial and tech strength remains formidable. Its economy is ~75% the size of the U.S. in dollar terms, but China accounts for 33% of global manufacturing value-added, projected to rise to 49% by 2050. “China is very strong in all sorts of advanced manufacturing... in many cases it is almost entirely a Chinese concern.”

The gap is vast, according to another panelist: in 2023, China had 1,500 commercial ships under construction; the U.S. had three. Non-state firms drive export growth, crowding out for shrinking shares of foreign-led exports (60% to 30%). “There is plenty of profitable activity going on, especially in the non-state sector.”

Meanwhile, Made in China 2025 has paid dividends. “At a first approximation, it looks like a pretty good success,” said one panelist, citing EVs, clean tech, and automation, but admitted that weaknesses persist in sectors like semiconductors and aerospace. Nevertheless, China’s highly competent manufacturers, tech companies, and deep reservoir of human capital ensure that despite costly and inefficient industrial policies, China still has “a good amount of fuel left in the tank.”

Rather than stagnating like Japan in the 1990s, panelists agreed China would more closely resemble a “Leninist Germany”—an authoritarian state with a globally competitive, export-driven, tech-intensive economy.

An Enduring Value Proposition for the World, but Pushback is Growing 
Around the world China is embedding itself in local production ecosystems. Several panelists described how Chinese firms have established smartphone assembly plants in Ethiopia, Uganda, Kenya, and Indonesia. EV assembly and battery processing plants have followed, particularly in Zimbabwe and the DRC. In practice, countries receiving China’s investment often express more concern about being left behind by the West than overwhelmed by China.

China’s outbound investment is not just commercial; it is also strategic. As one panelist put it, this “industrial diplomacy” steers capital toward geopolitically friendly or economically useful countries—especially those with preferential trade access to the U.S. or E.U., like Mexico and Morocco—and away from places perceived as hostile, such as India.

This strategy has helped China rebuild global supply chains with itself at the center, creating new production ecosystems around batteries, robotics, AI, and advanced manufacturing. As one expert noted, firms like BYD, Xiaomi, and Huawei are at the core of “interlocking industrial ecosystems” that tie together multiple cutting-edge sectors across borders.

Yet pushback is growing. In 2023, 117 of 198 World Trade Organization complaints against China came from low- and middle-income countries. These nations aren’t rejecting Chinese investment, panelists pointed out—they’re renegotiating harder, hedging more, and believing less.

The conference underscored a world in flux—one where China’s industrial and technological dynamism continues to reshape global supply chains even as its assertive statecraft provokes growing resistance. While some panelists warned of the breakdown of integrationist hopes, others saw opportunity in a more defined and stable strategic rivalry, even if it takes the form of a new cold war. A key takeaway was the paradox of China’s global role: it remains an important source of growth and innovation, yet inspires distrust that is prompting nations to pursue more reciprocal, conditional partnerships. In navigating this uncertain era, both China and the West appear to be groping toward a new equilibrium—messy, complex, and decidedly post-unipolar.

Discover more from the 2025 SCCEI China Conference. 
 

Beijing, May 30, 2024 — Earlier this month, the Stanford Center at Peking University (SCPKU) hosted former Italian Prime Minister Romano Prodi and his former Chief of Staff who delivered his remarks on "The Role of European Variables in U.S.-China-Europe Relations," and engaged in a roundtable discussion with faculty and students from Stanford and Peking University. The event underscored SCPKU's capacity as a catalyst for cross-cultural collaboration and intellectual exchange in advancing global dialogue, bringing together global thought leaders, policymakers, and academic luminaries.

A Confluence of Expertise and Vision

The roundtable centered on ​Romano Prodi, who served as a distinguished professor both before and after his time as Prime Minister, and who to this day prefers the title “professor.”  Prof. Prodi has been hailed as an architect of EU integration and a global advocate for multilateralism. Joining him were ​Dr. Daniele De Giovanni, the Italian Chief of Staff during Prodi's term, and ​Dr. Qinghong Wang, Executive Director of Peking University’s China-Europe Philanthropy Innovation Research Center (CEPIRC). The discussion included contributions from Stanford scholars Professors Andrew Walder, Matthew Kohrman, Xueguang Zhou, and Jean Oi. Professor Oi chaired the session.

SCPKU as a Platform for Global Discourse

18 Stanford undergraduates from the Bing Overseas Study Program China Studies in Beijing program and 20 Peking University students joined the roundtable dialogue, which explored Europe’s strategic influence in bridging transatlantic frameworks. Topics spanned economic interdependence, climate collaboration, and the EU’s evolving role in mitigating great-power competition.

In his opening remarks, ​Prof. Prodi emphasized the urgency of multipolar dialogue. His perspective resonated with SCPKU’s mission to cultivate transnational academic partnerships. The center’s role in hosting such high-level exchanges—spanning academia, governance, and civil society—was lauded as a model for fostering meaningful dialogue in an era of complex geopolitics.

Bridging Scholarship and Policy

The discussion highlighted SCPKU’s commitment to bridging academic scholarship with real-world policy implications. ​Dr. Wang underscored CEPIRC’s work in advancing Sino-European philanthropic innovation, stating, “Our collaboration with Prodi and Stanford underscores the power of interdisciplinary networks to reimagine global solidarity.” Meanwhile, Stanford scholars shared comparative analyses of EU-China-U.S. trade ecosystems and technological interoperability.

About the Stanford Center at Peking University
Located on the Peking University campus in Beijing's vibrant Haidian District, the Stanford Center at Peking University (SCPKU) is a focal point for building academic and educational networks throughout East Asia. The tri-level center offers collaborative spaces, offices, event support services, and funding for innovative research and education. SCPKU brings together established researchers and a new generation of young scholars to create a dynamic hub of intellectual exchange and collaboration.  

Urgent Rethink Needed on U.S-China Trade and Technological Competition
Stein also pushed back against long-held assumptions that the U.S. market alone can dictate global business trends. The notion that “the only market that matters is the U.S. market” no longer holds, noting that Chinese consumers and innovation ecosystems now play a decisive role in shaping product development and global supply chains. He noted that European businesses have expressed a radical shift in strategy, they said, “we've been in China for Asia, in North America, for the Americas…We're now going from that model to what could very well become an, ‘in China for China and the world minus one.’ And the minus one is, of course, the U.S. market.”

On the technology front, he offered a candid evaluation of the U.S.-China competition. Stein reflected on the current state of artificial intelligence in China and the U.S., he said, “ at the end of the day it's not who has the best model; a good enough model is a good enough model, where it really makes a difference is in the application…and I see China racing ahead in the application of AI.” 

Know Your Competitor
Stein concluded with a call for more measured and constructive engagement. He urged both Washington and Beijing to establish clearer rules of the road, maintain open lines of communication, and invest in policy solutions that reduce uncertainty rather than amplify it.

Stein’s keynote offered a business-grounded counterpoint to prevailing narratives of decoupling and confrontation. His insights reinforced the importance of understanding the full complexity of economic interdependence, as well as China’s capacity for global market disruption, and the costs of miscalculation. As part of the broader SCCEI China Conference, his remarks served as a reminder that if America does not properly understand its competitor, efforts to stay ahead may well backfire and erode U.S. strength and global standing. 

A full recording of Sean Stein’s keynote is available on YouTube and below.

China’s Global Ambitions
In response to a question posed by Professor Li, Economy said, “I think, under Xi Jinping, there are big ambitions.” She followed by listing out several of China’s objectives including:

1. Become the dominant power in the Indo-Pacific, which begins with China's sovereignty claims around Taiwan, Hong Kong and the South China Sea;
2. Continue to have the international business community be dependent on China for parts of its supply chain;
3. Create an insulated domestic economy that is protected from pressures of the global economy but at the same time exerts enormous influence on it;
4. Shape the geostrategic and political landscape in new ways through programs like the Belt and Road Initiative and through its behavior in international institutions;
5. De-dollarize the global economy and increase the role of the Chinese currency.

Economy concluded by sharing that China has “a number of big ambitions, none of which actually coincides with us,” and although there are certainly areas for collaboration between China and the U.S., she’s not sure the current U.S. administration is interested in exploring them.

Economy’s address was a highlight of the SCCEI China Conference, which featured panels and presentations from leading scholars and practitioners on China’s economy, governance, and international strategy. The event reflects SCCEI’s mission to promote policy-relevant research and open dialogue on China’s role in the global economy.

A full recording of Dr. Economy’s talk is available on YouTube and below.

Jessie Kong: Every year, SJEC puts on a week-long, entirely student-run, exchange program for 20-25 visiting Japanese students from Keio, Doshisha, and Kyoto Universities. Through this programming, we strive to provide authentic insights into Stanford academics, extracurriculars, and lifestyle by having the Japanese students join our lives and develop bonding experiences. 

As one of the co-presidents of SJEC this year, my work has centered around coordinating the entire team of Stanford officers, delegating tasks between teams, communicating with and preparing the Japanese students, and facilitating activities during the conference.

Through leading SJEC this year, I have realized the importance of dedication and commitment when planning these activities. My previous years in SJEC leading the social team has also shown me how to plan events from start to finish in an efficient way that leverages the capabilities of everyone on the team while focusing on the experience for the Japanese students. I think being able to put the group's interest above my own was also a good skill I learned while in the co-president position.

Socially, I have been able to build connections both for myself and other Stanford students with the Japanese student community. Starting with SJEC, I was able to meet and take care of visiting Japanese students at Stanford, and this effort was reciprocated when I went to study abroad through the BOSP Kyoto program. Being able to feel the reciprocity of my efforts in SJEC only makes me more motivated to continue working in SJEC to create a good experience for more Japanese students who visit in the future.
 

Yifei Cheng: The main event from our organization this year is the FACES annual summit that took place in January 2025. We invited 40 college students from Chinese and American universities to engage in dialogue about US-China relations on Stanford campus. As the president of FACES, I was involved in candidate selection and planning the summit schedule. I also took the initiative to organize the summit field trip at the Angel Island Immigration Facility. 

Through the lecture of Professor Gordon H. Chang on the persecution of Chinese scientists during the McCarthy Era, I learned about the repeated interlocks between politics and academia in the US, which has significant contemporary repercussions with the current administration's restrictions of student visas and immigration process. 

The FACES summit also enhanced my understanding of diplomacy on a personal level. This experience taught me that cultural exchange isn’t about reaching agreement—it’s about creating a shared space where different truths can coexist. I learned to listen across differences, become comfortable with discomfort, and see the value in ambiguity. These lessons have reshaped how I engage in conversations not only about geopolitics, but also about identity, equity, and belonging more broadly.

I gained concrete organizational skills with managing timelines, delegating tasks, and staying calm when things went wrong—like when the hotel rooming list gets wrong and messy. I also learned that leadership is less about control and more about creating the conditions for others to grow. I facilitated the daily reflection session during the summit. As the discussion facilitator, I found it rewarding to moderate discussions where sometimes disagreements arise. I think this is a valuable skill for my academic and professional development. 
 

Aimen Ejaz and Luv Jawahrani: This year, in its inaugural term, the Stanford Indo-Pak Dosti Forum (SIPDF)achieved what many said was impossible: bringing together Indians and Pakistanis in the same room – voluntarily – twice a week.

In the fall, we launched INTNL REL 47SI: Bridging the Divide, a student-initiated course focused on the political and economic dimensions of India-Pakistan relations. The class brought together prominent individuals concerned about peace-building, ranging from former Indian and Pakistani ambassadors who’d been involved in negotiating peace to professors from the Stanford Graduate School of Business (GSB), to research fellows at the Hoover Institute and the Center for International Security and Cooperation (CISAC), and veteran journalists who have covered the subcontinent for decades.

In spring, we co-taught GLOBAL 47SI: Building Bridges—a course that spotlights cross-border entrepreneurship as a tool for soft diplomacy. We invited legendary South Asian entrepreneurs and venture capitalists from both sides of the border: Mamoon Hamid (Managing Director at Kleiner Perkins), Samir Kaul (Managing Director at Khosla Ventures), Amit Patel (Managing Director at Owl Ventures), Bilal Zuberi (Partner at Lux Capital), and Anand Swaminathan (Senior Partner at McKinsey), among others. The goal? To explore how venture-building, innovation, and chai-fueled resilience can outpace political gridlock.

Academically, co-leading our student-led initiative taught us more than any textbook ever could, mostly because we had to build the syllabus ourselves. And we didn’t just co-lead — we co-dreamed and co-hustled, getting the syllabi approved by multiple departments and cold-emailing, even chasing down, speakers from across the U.S.

In designing INTNL REL 47SI: Bridging the Divide, we dove headfirst into the complexities of India-Pakistan political and economic relations. But we didn’t stop at reading IR theory. We debated it with the very diplomats and policymakers who once shaped those theories in real time. Every week became a crash course in postcolonial statecraft, regional security, and the surprisingly human side of high diplomacy.

Then came GLOBAL 47SI: Building Bridges, where we shifted from conflict to collaboration, exploring how entrepreneurship can serve as a tool of soft power. Through case studies, guest lectures, and our own classroom debates, we began asking whether a startup pitch can accomplish  what politicians can't. What happens when innovation moves faster than diplomacy? And what does it mean when the biggest South Asian venture capitalist in the world funds a startup founded by someone from the "other" side?

More than anything, we learned how to turn theory into action. Whether it was teaching concepts like diaspora diplomacy or moderating discussions between venture capitalists and undergrads, we were constantly translating complex ideas into real-world conversations. We didn’t just learn. We taught, we built, and we questioned everything along the way.

Culturally and socially, our student-led initiative felt less like organizing a class and more like hosting weekly peace talks, with chai and biryani. We came in thinking we were building a curriculum; we ended up navigating generations of silence, suspicion, and identity.

We learned that Partition isn’t just a historical event–it’s a living memory passed down through stories and subconscious hesitation. It’s in the way some students avoid eye contact when the topic turns political, or how others lower their voices when mentioning where their family is really from. But we also learned that these barriers can soften when people feel safe enough to speak, and laugh, together.

We watched students from India and Pakistan, often meeting for the first time, begin to open up. Conversations that started stiffly turned into long debates, jokes, shared Desi Spotify playlists, and sometimes even plans to visit each other’s cities, if our countries ever allow it. We learned that vulnerability—especially in a region taught to fear it—is a radical act. And that our generation is more ready than we think to rewrite the script we inherited.

There were moments when we questioned whether this initiative was worth it. When we received backlash online for platforming certain voices. When a class discussion got tense and uncomfortable. When friends warned us that this was “too political,” “too idealistic,” “too risky.” And we didn’t always have the perfect response.

But leadership, we realized, isn’t about always being right. It’s about being rooted in a vision that peace isn’t naïve — it’s necessary. That bridging divides isn’t weakness—it’s the only strength that can outlast hate. And when things fell apart — when a high-profile speaker pulled out at the last minute, or a student pushed back hard in class — we didn’t pivot away from our mission. We dug deeper. We turned cancellations into teachable moments. We turned criticism into conversation. Most importantly, we learned to trust ourselves and to trust that our generation doesn’t have to inherit the silence, the suspicion, and the separation.