| Summary: | In recent years, the health conditions of the elderly (the middle-aged and the old, which for this study means people over 50 years of age) have deteriorated along with the aggravation of air pollution, which led to the change of medical insurance costs. This phenomenon is particularly prominent in developing countries, such as China. A total of 15,892 research subjects from 56 prefecture-level cities in 23 provinces were collected from the database of China Health and Retirement Longitudinal Survey (CHARLS). We investigated the effects of air pollution, physical health, and medical insurance costs among three mechanisms using logistics and Ordinary Least Squares (OLS) hybrid cross-sectional regression, and we conducted a robust test. Overall, two pollutants, namely, PM10 and NO2, respectively showed an “inverted U-shaped” and “positive U-shaped” influencing path to health. In addition, when we studied the mechanism of air pollution affecting medical insurance costs, we found that air pollution can affect medical insurance costs through affecting self-rated health, and that the impact path is related to different diseases to some extent. At the same time, there was a certain negative correlation between air pollution and medical insurance: The higher the degree of air pollution, the worse the self-rated health, and the fewer opportunities there are to purchase medical insurance. It can be seen that air pollution affects the physical health of middle-aged and elderly people, thus indirectly and negatively affecting the medical insurance cost. Further research also found that the types of air pollutants in southern and northern China showed some differences. Specifically, NO2 and SO2 were the pollutants that harm the health of the elderly in the south and north, respectively.
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