Social health insurance coverage and financial protection among rural-to-urban internal migrants in China: evidence from a nationally representative cross-sectional study

ObjectivesThere is a tendency to pursue higher-level hospitalisation services in China, especially for internal migrants. This study aims to investigate the choices of hospitalisation services among internal migrants, and evaluate the association between social health insurance and hospitalisation choices.MethodsData were from a 2014 nationally representative cross-sectional sample of internal migrants aged 15–59 years in China. Descriptive analyses were used to perform the distribution of healthcare facility levels for hospitalisation services, and multinomial logistic regression was applied to examine the association between social health insurance and hospitalisation choices.ResultsOf the 6121 inpatient care users, only 11.50% chose the primary healthcare facilities for hospitalisation services, 44.91% chose the secondary hospitals and 43.59% preferred the tertiary hospitals. The choices presented large regional variations across the country. Compared with the uninsured, social health insurance had no statistically significant effect on patient choices of healthcare facility levels among internal migrants in China, whereas socioeconomic status was positively associated with the choices.ConclusionsSocial health insurance had little influence on the hospital choice among the internal migrants. Thus, social health insurance should be consolidated and portable to enhance the proper incentive of health insurance on healthcare seeking behaviours.

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Inequality in Health Services for Internal Migrants in China: A National Cross-Sectional Study on the Role of Fund Location of Social Health Insurance

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17176327 ◽

2020 ◽

Vol 17 (17) ◽

pp. 6327

Author(s):

Qiang Yao ◽

Chaojie Liu ◽

Ju Sun

Keyword(s):

Health Insurance ◽

Health Services ◽

Insurance Coverage ◽

Social Health Insurance ◽

Health Insurance Coverage ◽

Social Health ◽

Local Health ◽

Public Health Services ◽

Internal Migrants ◽

Use Of Health Services

On-the-spot settlements of medical bills for internal migrants enrolled with a social health insurance program outside of their residential location have been encouraged by the Chinese government, with the intention to improve equality in healthcare services. This study compared the use of health services between the internal migrants who had local health insurance coverage and those who did not. Data (n = 144,956) were obtained from the 2017 China Migrants Dynamic Survey. Use of health services was assessed by two indicators: visits to physicians when needed and registration (shown as health records) for essential public health services. Multi-level logistic regression models were established to estimate the effect size of fund location on the use of health services after controlling for variations in other variables. The respondents who enrolled with a social health insurance scheme locally were more likely to visit physicians when needed (adjusted odds ratio (AOR) = 1.18, 95% CI = 1.06–1.30) and to have a health record (AOR = 1.47, 95% CI = 1.30–1.65) compared with those who enrolled outside of their residential location: a gap of 3.5 percentage points (95% CI: 1.3%–5.8%) and 6.1 percentage point (95% CI: 4.3%–7.8%), respectively. The gaps were larger in the rural-to-urban migrants than those in the urban-to-urban migrants (AOR = 1.17, 95% CI = 0.93–1.48 for visiting physicians when needed; AOR = 0.71, 95% CI = 0.54–0.93 for having a health record). The on-the-spot medical bill settlement system has yet to fully achieve its proposed potential as inequalities in both medical and public health services remain between the internal migrants with and without local health insurance coverage. Further studies are needed to investigate how on-the-spot settlements of medical bills are implemented through coordination across multiple insurance funds.

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Understanding Subnational Variation in Chinese Social Health Insurance

Social Protection under Authoritarianism ◽

10.1093/oso/9780190073640.003.0006 ◽

2020 ◽

pp. 134-159

Author(s):

Xian Huang

Keyword(s):

Health Insurance ◽

Insurance Coverage ◽

Social Health Insurance ◽

Health Insurance Coverage ◽

Social Health ◽

Cross Sectional ◽

Insurance Benefits ◽

Social Risks ◽

Political Economies ◽

Regional Comparisons

Chapter 6 investigates the coverage and generosity of Chinese social health insurance in the first decade of the 2000s, with a focus on the regional (i.e., cross-provincial) variation using a cross-sectional time-series research design. First, a cluster analysis provides supportive evidence for the existence of four models of social health insurance expansion in China. The clustering of Chinese provinces in social health insurance expansion also corresponds to the differences among local political economies. Second, the chapter makes detailed inter-regional comparisons and intra-regional studies to reconstruct the mechanism linking a local political economy to the local distributive patterns of health insurance benefits—that is, local socioeconomic conditions shape local leaders’ policy preferences and choices for allocating social health insurance benefits in their jurisdictions. Finally, a regression analysis demonstrates significant correlations between local social risks and social health insurance coverage, and between local fiscal resources and social health insurance generosity.

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