Medical care or clean energy? The impact of medical insurance on rural households' use of clean cooking energy.

Background: Promoting the use of clean cooking energy is crucial for safeguarding the health of rural households. However, despite its role as a health-enhancing good, few studies have examined the relationship between clean energy use and other forms of health investment. While medical insurance improves rural households' access to medical care, its impact on clean cooking energy use remains unclear. Methods: Using micro-level household panel data from 2012 to 2022, this study employs a two-way fixed effects model to examine the impact of medical insurance on rural households' use of clean cooking energy. In addition, we conduct a series of robustness checks to verify the reliability of the main findings. We further perform heterogeneity analyses to examine whether the effect of medical insurance on clean cooking energy use differs by household age structure, household assets, and medical access barrier. Results: The results show that: (1) medical insurance participation significantly reduces the probability that rural households use clean cooking energy; (2) medical insurance increases the probability of hospitalization, out-of-pocket medical expenditures, inpatient expenditures, total household medical expenditures, and the share of medical spending in the household budget; and (3) the negative effect is more pronounced among households with higher old-age dependency ratios, lower asset holdings, and greater barriers to medical access. Conclusion: This study reveals an unintended consequence of medical insurance and provides important insights for governments seeking to promote both insurance coverage and clean cooking energy use. This issue is particularly relevant for many developing countries, where health protection and clean energy promotion are often pursued simultaneously under tight household budget constraints.