There is a need to keep through whole article distinction between safety nets and cargo nets. Namely in the abstract term "safety nets/cargo nets paradigms" suggest that these are synonyms. As well it must be precisely documented that such distinction was originally proposed in “Barrett’s research”. Provided references [35, 36] are irrelevant.

Similarly, statement “As the largest poverty reduction attempt in human history [27], the policy package of the Chinese government ….” is supported by “Results from a survey of rural residents in Shanxi, China” that is more than inadequate.

Figure 1. Need to be improved: there is a safety net box devoted to medical insurance and safety net box with other measures. Such decomposition should be explained. What is the meaning of “+” and “-“on the figures 1 and 3?

Description of the model need to be revised - it referees at the beginning of the description to Table 1 (Description of the sample) but all the variables are listed in Table 2.

Overall article provides interesting information that can support policy formulation in developing countries.

Author Response

Dear reviewer:

Thanks a lot for having reviewed our manuscript (land- 2346164) and for your valuable comments. We also appreciate your positive evaluation of our work. The sections highlighted by yellow is the ones we have made crucial revisions in manuscript. We have revised the full text in the light of the review comments, which are described below.

Point 1: There is a need to keep through whole article distinction between safety nets and cargo nets. Namely in the abstract term “safety nets/cargo nets paradigms” suggest that these are synonyms. As well it must be precisely documented that such distinction was originally proposed in “Barrett’s research”. Provided references [35, 36] are irrelevant.

Response: Thank you for your valuable suggestions. The definition of safety nets and cargo nets is shown in section 2.2. To avoid ambiguity, the term “safety nets/cargo nets paradigms” is changed as “Based on existing paradigms in the poverty research area” in abstract. Additionally, reference [35, 36] has been revised as [51, 52].

Point 2: Similarly, statement “As the largest poverty reduction attempt in human history [27], the policy package of the Chinese government ….” is supported by “Results from a survey of rural residents in Shanxi, China” that is more than inadequate.

Response: Many thanks for your valuable suggestions. The statement has been revised as “To accelerate progress towards extreme poverty reduction, China launched the Targeted Poverty Alleviation programme in 2013, which contained a series of policies and made China the first developing country to eradicate extreme poverty [9, 31, 32]. ” In this revision, two paper and a government document is added in reference.

Point 3: Figure 1. Need to be improved: there is a safety net box devoted to medical insurance and safety net box with other measures. Such decomposition should be explained. What is the meaning of “+” and “-“on the figures 1 and 3?

Response: We are grateful for the suggestion. The safety net box devoted to medical insurance is a universal safety nets that all rural households on the edge of poverty are covered. However, the safety net box with other measures is the policies supporting certain poor rural households. The former safety net box has been revised as “universal safety nets” in Figure 1. Moreover, a note has been added to explain the meaning of “+” and “-“on the Figures 1 and 3. Specifically, for Figure 1, +” indicates the positive effects between different modules, while “-” implies the negative effects. Additionally, the thickness of the lines indicates the magnitude of the effects. For Figure 3, “+” indicates the positive effects between different modules, while “-” implies the negative effects.

Point 4: Description of the model need to be revised - it referees at the beginning of the description to Table 1 (Description of the sample) but all the variables are listed in Table 2.

Response: Many thanks for your valuable suggestions. The mistake has been revised in manuscript. In model section, the initial description of “Table 1” has been substituted as “Table 2”.

Point 5: Overall article provides interesting information that can support policy formulation in developing countries.

Response: Thank you very much for your recognition and encouragement. According to your comments, we have revised the problems you mentioned above.

Author Response File: Author Response.docx

Reviewer 2 Report

To the authors

This article has very good points, but there are serious problems with the analysis of the article.

1. The references are cited incorrectly. Please check references 35 and 36 in lines 156-158

2. The authors should redesign the empirical strategy. According to the authors' statistical description of the dependent variable, it is incorrect to use multiple regression analysis.

3. the mediating effects model cannot be used to analyze policy effects.

4. The lack of reasonable control variables in the empirical strategy can lead to coefficients that do not accurately reflect causality.

5. The authors should define some concepts more clearly. For example, human capital in the paper seems to be inconsistent with the definition in the mainstream literature. what is meant by Industry share.

6. Table 5 is not clear what the authors mean. Why are there so many null values. Even if the coefficients are not significant, they should be written and compared with the analysis, which can better reflect the contribution of the article.

7. Section 5.4 is not a robustness analysis. It is a heterogeneity analysis.

8. The discussion of the article lacks a logical relationship with the empirical results.

The author should engage the help of a copyeditor as some of the writing is a bit awkward. The writing is mostly clear, but the argument would be better understood if the writing were improved.

Author Response

Dear reviewer:

This article has very good points, but there are serious problems with the analysis of the article.

Thank you very much for your recognition and encouragement. According to your comments, the problems in the manuscript have been addressed.

Point 1: The references are cited incorrectly. Please check references 35 and 36 in lines 156-158

Response: Thank you for your valuable suggestions. We have checked reference, the initial reference [35, 36] has been revised as [51, 52].

Point 2: The authors should redesign the empirical strategy. According to the authors’ statistical description of the dependent variable, it is incorrect to use multiple regression analysis.

Response: The authors take the reviewer’s advice. In initial manuscript, the main depend variable “income increase” refers to “The perception of rural household with respect to their household income”, which was divided into four levels. The “income increase” is a categorical variable and is inappropriate to use multiple regression analysis. Thus, we substitute “income increase” as “per capita household income” in revised manuscript. “Per capita household income” can reflect the welfare of all people in a household, which can also represent the status of poor rural household income. Moreover, it is a continuous variable that can be analyzed through multiple regression analysis.

Point 3: the mediating effects model cannot be used to analyze policy effects.

Response: Many thanks for your valuable suggestions. The interactive variables were utilized in some studies to examine the effective of research object. For example, “Natural Disasters, Household Welfare, and Resilience: Evidence from Rural Vietnam. World Development 2015, 70, 59-77.” and “The impact of political status and social capital on herders' overgrazing behaviors in the pastoral areas of China. Journal of Environmental Management 2023, 327, 116861.” In these studies both binary variable and continuous variables were used in interactive variables, which is similar to our research. Thus, in order to avoid ambiguity, we describe this method as “The role of support policies in per capita household income is examined by the interactive items between human capital and support policies” in Section 4.3.

Point 4: The lack of reasonable control variables in the empirical strategy can lead to coefficients that do not accurately reflect causality.

Response: The authors take the reviewer’s advice. We add three control variables, namely, water, housing structure and members. Water refers to “Whether a poor rural household has access to safe tap water”. The variable can reflect natural environment and the level of rural infrastructure, which may affect the output efficiency of poor rural households in research area. Housing structure implies the quality of house, which is the symbol of wealth and can buffer health shocks to somewhat. Additionally, given members can not reflect labourers and depend members in a household, which is included in human capital in initial manuscript, it was also changed as control variable in revised manuscript. Additionally, restricted by survey data, there is still much room for improvement in the choice of control variables. We point out the limitation in the end of the paper and hope these issues to be explored in the future.

Point 5: The authors should define some concepts more clearly. For example, human capital in the paper seems to be inconsistent with the definition in the mainstream literature. What is meant by Industry share?

Response: The authors take the reviewer’s advice. The definition of human capital has been revised in paragraph 1 of Section 2.1. In this paper, the research object is poor rural households, among which the quality aspect of human capital is low, for example, the educational level of householder and specialized experience for agricultural or nonagricultural industry. Moreover, the quality aspect of human capital is difficult to improve in a short time. However, with the improvement of infrastructure in rural area and rapid economic growth in nationwide, the output efficiency of human capital has risen, and even the low level holder of human capital can also benefit. Therefore, it is reasonable to measure the quantity aspect of human capital of poor rural households. Additionally, given health shocks cause the increase both in depend members and agricultural labourers in poor rural household, we measure human capital of poor rural household from labourers and depend members.

Point 6: Table 5 is not clear what the authors mean. Why are there so many null values? Even if the coefficients are not significant, they should be written and compared with the analysis, which can better reflect the contribution of the article.

Response: Many thanks for your valuable suggestions. In Table 5, we want to explain that human capital can be improved by some policies. From the purpose of policy making, both safety nets and cargo nets are carried out to support poor rural household escaping from poverty traps. Therefore, the human capital of poor rural households can be improved when they obtain related policies, which means that policy acquisition is positively correlated with poor rural households’ human capital. On the contrary, policies cannot directly improve poor rural households’ human capital when policy is irrelevant or negatively correlated with their human capital. In this paper, what we care about is that whether the human capital of poor rural households is improved by some of these policies, rather than why these policies did not play their roles. Therefore, policies that are insignificantly positive connected with human capital are not shown in Table 5.

Point 7: Section 5.4 is not a robustness analysis. It is a heterogeneity analysis.

Response: The authors take the reviewer’s advice. The title of Section 5.4 has been revised as “The effects of health shocks on household income in different income groups”. The aim of this Section is to test whether health shocks have no adverse effects on per capita income of different income groups, so as to reflect whether China’s poverty alleviation policies can benefit all poor rural households, thus explain the effectiveness and reliability of the policies.

Point 8: The discussion of the article lacks a logical relationship with the empirical results.

Response: Many thanks for your valuable suggestions. The discussion mainly explains the empirical results and puts forward some policy implications in some parts by comparing with relevant international studies. Among them, Section 6.1 mainly discusses monitoring nets mentioned in Section 5.1. Likewise, Section 6.2 corresponds to Section 5.2, which mainly discusses the mitigating effect of human capital on health shocks and explains the mechanism of policies to increase human capital. Additionally, Section 6.3 corresponds to Section 5.3, which mainly explains how policies and human capital affect per capita household income. Meanwhile, by comparing the differences with related studies, some policy suggestions are put forward in this Section.

Comments on the Quality of English Language

The author should engage the help of a copyeditor as some of the writing is a bit awkward. The writing is mostly clear, but the argument would be better understood if the writing were improved.

Response: Many thanks for your valuable suggestions. The paper has been revised by professional institution in this revision.

Author Response File: Author Response.docx

Reviewer 3 Report

1. There is no purpose of the work in the abstract. Keywords do not reflect the essence of the paper and conducted research.

2. The theoretical part is definitely a weakness of the study, which is also confirmed by the list of publications used and the relatively small number of literature items. The introduction does not fulfill its role, it does not introduce the problem of rural poverty signaled in the title. Fragments of the text require significant rework, e.g. sentences such as (‘Poverty and health are intertwined.’ - line 35) must be eliminated or need to be clarified. The concept of poverty, which is very broad, is treated fragmentarily by the Authors.

3. There is a lack of specific statistical data describing the situation in terms of poverty in China synthetically, which is an important background for the conducted research. It will allow us to better understand some of the Authors' conclusions e.g. Line 94 –‘China was the first developing country to eradicate extreme poverty’.

4. In many places in the paper, the importance of the country's development level in the context of poverty is emphasized (the statement: in developing countries ... is indicated). However, in the case of considerations about the analyzed country, it is not illustrated by any statistical data showing the development/level of development of China to the international reader.

5. There are discrepancies in the time range of the research. The abstract states that the research comes from 2018 (line 17), while the methodological part also indicates 2019 (line 242).

6. The paper (also in the title) includes the phrase: ‘poor rural households’. However, it has not been explained what it means and on what basis it was distinguished. Line 251- ‘…households identified as poverty-stricken were selected…’ - the question arises how exactly they were selected?

7. There is no justification why a particular region was chosen. There is a statement: ‘As a research area, Chongqing has typicality and representativeness’. (line 236) - what proves it, why it is representative and allows full conclusions? This is all the more important and necessary to clarify, given the fact that the Authors will miss this pointing to the limitations of the study (line 646).

8. The concept of human capital has been greatly simplified, both in theory and in the empirical part. This requires supplementing and explaining why individual variables were selected and how to understand them in the context of the level of human capital and health shocks, e.g. ‘The number of rural households’ table 2 (it may indicate a high or low level of human capital?).

Author Response

Dear reviewer:

Point 1: There is no purpose of the work in the abstract. Keywords do not reflect the essence of the paper and conducted research.

Response: The authors take the reviewer’s advice. The purpose of this paper is to summarize and explore the roles of Chinese support policies in poor rural households coping with health shocks. Keywords have also been revised. Concretely, targeted poverty alleviation is removed, long-term income increase and targeted policy support are added to keywords.

Point 2: The theoretical part is definitely a weakness of the study, which is also confirmed by the list of publications used and the relatively small number of literature items. The introduction does not fulfill its role, it does not introduce the problem of rural poverty signaled in the title. Fragments of the text require significant rework, e.g. sentences such as (‘Poverty and health are intertwined.’ - line 35) must be eliminated or need to be clarified. The concept of poverty, which is very broad, is treated fragmentarily by the Authors.

Response: The authors take the reviewer’s advice. A large amount of literature has been referenced in this revision, related references has been added. The concept of poverty has been explained in paragraph 2 of Introduction. Different from the poverty criterion of the World Bank, according to which people are poor when they live on less than 1.9 USD per day, in China, the Two Assurances and Three Guarantees are utilized to identify poor rural households. If rural households fall below the level of acceptability on any of these indicators, they are identified as poor rural households, and their household members are considered as poor population. Moreover, to accurately assist poor rural households, the government set up the Chinese Poor Population Tracking Dataset, which records the poverty causes, support policies and other basic information of registered poor rural households. Hence, poor rural households are also called registered poor rural households because they are contained in the Chinese Poor Population Tracking Dataset.

The background of health shocks and poverty are introduced in paragraph 1 of Introduction. Poverty and health are intertwined. Before the COVID-19 pandemic, each year, close to 100 million people were pushed into extreme poverty because they had to pay for health expenses out of their own pockets. The fallout from the pandemic threatens to push over 70 million people into extreme poverty. Meanwhile, the social insurance system is in-adequate, especially in low- and middle-income countries. The World Health Organization noted that the government covers nearly 70% of health care spending in high-income countries, while the value is approximately 30% in low-income countries. At the current rates of progress, up to 5 billion people will lack health care in 2030.

The China’s background of health shocks and poverty are introduced in study area.

Point 3: There is a lack of specific statistical data describing the situation in terms of poverty in China synthetically, which is an important background for the conducted research. It will allow us to better understand some of the Authors' conclusions e.g. Line 94 –‘China was the first developing country to eradicate extreme poverty’.

Response: The authors take the reviewer’s advice. The situation of poverty in China had been described in paragraph 5 of Introduction Section. China had long been plagued by poverty at a scale and level of severity that have rarely been seen anywhere else in the world. According to data released by the World Bank, until 2012, there were 897 million people living on less than 1.9 USD per day in the world, among whom 87 million people were living in China. Meanwhile, poverty caused by health shocks has always been the greatest problem in China’s poverty alleviation. The Poverty Alleviation Office of the State Council of China claimed that illness induced 42.3% of poor rural households in the registered poor rural household database to slip into poverty or slip back into poverty in 2017. To accelerate progress towards extreme poverty reduction, China launched the Targeted Poverty Alleviation programme in 2013, which contained a series of policies and made China the first developing country to eradicate extreme poverty.

Point 4: In many places in the paper, the importance of the country’s development level in the context of poverty is emphasized (the statement: in developing countries ... is indicated). However, in the case of considerations about the analyzed country, it is not illustrated by any statistical data showing the development/level of development of China to the international reader.

Response: The authors take the reviewer’s advice. The situation of poverty in China has been described in paragraph 5 of Introduction Section. Moreover, the poverty caused by illness and corresponding poverty alleviation progress have also been described in study area.

Point 5: There are discrepancies in the time range of the research. The abstract states that the research comes from 2018 (line 17), while the methodological part also indicates 2019 (line 242).

Response: The authors take the reviewer’s advice. The description in abstract part has been revised as “Using a questionnaire survey of 4635 poor rural households in a municipality in Southwest China conducted from December 2018 to January 2019……”, which is in line with methodological part.

Point 6: The paper (also in the title) includes the phrase: ‘poor rural households’. However, it has not been explained what it means and on what basis it was distinguished. Line 251- ‘…households identified as poverty-stricken were selected…’ - the question arises how exactly they were selected?

Response: The authors take the reviewer’s advice. The definition of poor rural households has been explained in paragraph 2 of Introduction. Different from the poverty criterion of the World Bank, according to which people are poor when they live on less than 1.9 USD per day, in China, the Two Assurances and Three Guarantees are utilized to identify poor rural households. If rural households fall below the level of acceptability on any of these indicators, they are identified as poor rural households, and their household members are considered as poor population. Moreover, to accurately assist poor rural households, the government set up the Chinese Poor Population Tracking Dataset, which records the poverty causes, support policies and other basic information of registered poor rural households. Hence, poor rural households are also called registered poor rural households because they are contained in the Chinese Poor Population Tracking Dataset.

Point 7: There is no justification why a particular region was chosen. There is a statement: ‘As a research area, Chongqing has typicality and representativeness’. (line 236) - what proves it, why it is representative and allows full conclusions? This is all the more important and necessary to clarify, given the fact that the Authors will miss this pointing to the limitations of the study (line 646).

Response: The authors take the reviewer’s advice. We have added some description about Chongqing in the second paragraph of “3.1. Study area” in revised manuscript. In 2014, 0.47 million poor rural households, a poor rural population of 1.66 million and 1919 poor villages were identified in Chongqing, and the poverty headcount was 7.1%, which is nearly equal to the national poverty headcount ratio (7.2%). In these poor rural households, approximately 1/3 of them fell into poverty due to illness. Additionally, by the end of June 2020, only 4946 poor rural households remained in poverty due to illness. At the same time, the National Health Commission of China claimed that China had completed the task of health-related poverty alleviation and that poverty caused by illness had been effectively resolved. From this aspect, the pace of Chongqing in governing poverty induced by illness is consistent with nationwide, and the Targeted Poverty Alleviation practice in where is a reflection of that across China. Therefore, Chongqing can be selected as research area to explore the role of external intervention policies on poor rural household coping with health shocks.

Point 8: The concept of human capital has been greatly simplified, both in theory and in the empirical part. This requires supplementing and explaining why individual variables were selected and how to understand them in the context of the level of human capital and health shocks, e.g. ‘The number of rural households’ table 2 (it may indicate a high or low level of human capital?).

Response: The authors take the reviewer’s advice. The definition of human capital has been revised in paragraph 1 of Section 2.1. In this paper, the research object is poor rural households, among which the quality aspect of human capital is low, for example, the educational level of householder and specialized experience for agricultural or nonagricultural industry. Moreover, the quality aspect of human capital is difficult to improve in a short time. However, with the improvement of infrastructure in rural area and rapid economic growth in nationwide, the output efficiency of human capital has risen, and even the low level holder of human capital can also benefit. Therefore, it is reasonable to measure the quantity aspect of human capital of poor rural households. Additionally, given health shocks induce the increase in both depend members and agricultural labourers in poor rural household, we measure human capital of poor rural household from labourers and depend members.

Additionally, given members can not reflect labourers and depend members in a household, which is included in human capital in initial manuscript, it was also changed as control variable in revised manuscript.

Author Response File: Author Response.docx

Reviewer 4 Report

The manuscript entitled “Protecting poor rural households against health shocks: Poverty alleviation practices in Chonqing, China” used a questionnaire survey of 4635 rural households in Chonqing, China at the end of 2018 to examine the relationships among health shocks, human capital, supporting policies, and household income increase. The topic is important and interesting. The quality of the writing and overall quality of the content are high. The statistical methods are valid and correctly applied. It can be accepted after improving the abstract section and adding a discussion section.

Author Response

Dear reviewer:

Response: Thank you very much for your recognition and encouragement. The abstract and discussion sections have been improved in revised manuscript.

Author Response File: Author Response.docx

Round 2

Reviewer 2 Report

Accept in present form.

Language is reasonable.

Reviewer 3 Report

The article has been improved, the indicated issues have been clarified.

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Protecting Poor Rural Households from Health Shocks: Poverty Alleviation Practices in Chongqing, China

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