{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T06:27:00Z","timestamp":1786688820507,"version":"build-2736575974"},"reference-count":29,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T00:00:00Z","timestamp":1786665600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Framework health legislation is increasingly used to codify government responsibility, health-promotion duties, and accountability for basic services, yet it is difficult to identify whether such laws produce measurable economic and health effects. China\u2019s Basic Medical and Health Care and Health Promotion Law, effective June 2020, consolidated these duties in a single national statute.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Using a province-year panel for 31 mainland provinces over 2015\u20132022 compiled from public statistical yearbooks, we evaluate the law with a differential-bindingness difference-in-differences (DID) design: because the statute applies nationwide, treatment is defined\n                      <jats:italic>ex ante<\/jats:italic>\n                      as provinces below the median of a frozen 2015\u20132019 public-health-capacity index, for which the law is expected to be more binding. The compiled data do not contain annual provincial maternal or infant mortality, so the executed analysis uses the health outcomes that are actually observed\u2014crude population mortality, emergency case-fatality and observation-room case-fatality in medical institutions, outpatient health checkups per resident, and average hospital length of stay. These are availability-driven proxies, not the ideal outcomes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The most consistent association is a relative post-law decline in emergency case-fatality in high-bindingness provinces (about \u22120.03 percentage points,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.05 in the full model); its magnitude is stable across pandemic-sensitivity checks, but statistical significance weakens when 2022, the most coronavirus disease 2019 (COVID-19)-disrupted year, is excluded. The crude-mortality estimate is suggestive but fragile: it is significant only with full controls (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f\u2248\u202f0.06), is attenuated under matching, and reverses sign under a fiscal-capacity-based treatment definition. Mechanism tests reveal no robust mediator through fiscal, staffing, or institutional channels; only outpatient checkups respond marginally. Event-study diagnostics do not reject parallel pre-trends, but the short post-law window and 31 clusters limit precision.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>We find suggestive, definition-sensitive evidence that framework health law may be associated with modest differential gains in some service-quality outcomes where pre-law capacity was weaker. Still, the data cannot support strong causal claims, and post-law shifts cannot be fully separated from province-specific COVID-19 dynamics. The contribution is a transparent, reproducible evaluation scaffold and a cautionary finding: detecting the economic effects of health legislation requires better subnational outcome reporting, especially maternal and infant mortality.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1908891","type":"journal-article","created":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T05:32:24Z","timestamp":1786685544000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Evaluating economic and health-system associations of a national public health legal framework: evidence from China\u2019s basic medical and health care and health promotion law"],"prefix":"10.3389","volume":"14","author":[{"given":"Peiran","family":"Lu","sequence":"first","affiliation":[{"name":"Beijing Foreign Studies University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,14]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1111\/j.1468-0009.2010.00595.x","article-title":"Making the case for laws that improve health: a framework for public health law research","volume":"88","author":"Burris","year":"2010","journal-title":"Milbank Q"},{"key":"ref2","volume-title":"Public health law: power, duty, restraint. 3rd ed","author":"Gostin","year":"2016"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1857","DOI":"10.1016\/S0140-6736(19)30233-8","article-title":"The legal determinants of health: harnessing the power of law for global health and sustainable development","volume":"393","author":"Gostin","year":"2019","journal-title":"Lancet"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1165","DOI":"10.1056\/NEJMhpr051133","article-title":"Privatization and its discontents \u2014 the evolving Chinese health care system","volume":"353","author":"Blumenthal","year":"2005","journal-title":"N Engl J Med"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"l2349","DOI":"10.1136\/bmj.l2349","article-title":"What can we learn from China\u2019s health system reform?","volume":"365","author":"Meng","year":"2019","journal-title":"BMJ"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"833","DOI":"10.1016\/S0140-6736(11)61880-1","article-title":"Early appraisal of China\u2019s huge and complex health-care reforms","volume":"379","author":"Yip","year":"2012","journal-title":"Lancet"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1192","DOI":"10.1016\/S0140-6736(19)32136-1","article-title":"10 years of health-care reform in China: progress and gaps in universal health coverage","volume":"394","author":"Yip","year":"2019","journal-title":"Lancet"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1146\/annurev-publhealth-032315-021841","article-title":"A transdisciplinary approach to public health law: the emerging practice of legal epidemiology","volume":"37","author":"Burris","year":"2016","journal-title":"Annu Rev Public Health"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"2837","DOI":"10.1001\/jama.283.21.2837","article-title":"Public health law in a new century: part I","volume":"283","author":"Gostin","year":"2000","journal-title":"JAMA"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"2979","DOI":"10.1001\/jama.283.22.2979","article-title":"Public health law in a new century: part II","volume":"283","author":"Gostin","year":"2000","journal-title":"JAMA"},{"key":"ref11","first-page":"649","article-title":"Empirical health law scholarship: the state of the field","volume":"96","author":"Mello","year":"2008","journal-title":"Georgetown Law J"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1846","DOI":"10.1016\/S0140-6736(08)61368-9","article-title":"Reform of how health care is paid for in China","volume":"372","author":"Hu","year":"2008","journal-title":"Lancet"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"990","DOI":"10.1016\/j.jhealeco.2008.02.002","article-title":"Can insurance increase financial risk? 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