scholarly journals The relationship between urban and rural health insurance and the self-rated health of migrant workers in Southwest China

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Dingying Fu ◽  
Li Liu ◽  
Xuewen Zhang ◽  
Chuan Yu ◽  
Huiqiang Luo ◽  
...  
Keyword(s):  
Health Insurance ◽  
Rural Health ◽  
Urban Health ◽  
Migrant Workers ◽  
Southwest China ◽  
The Self ◽  
Self Rated Health ◽  
Basic Medical Insurance ◽  
The Relationship ◽  
Basic Medical

Abstract Background Following health insurance reforms, China’s health care system has made great progress. However, there are still huge differences between the urban and rural health insurance systems. For rural-to-urban migrant workers, there may be differences in the use of urban and rural health insurance to improve their health status. This study aimed to determine whether any disparities exist in the relationship between urban and rural health insurance and the self-rated health (SRH) of migrant workers in Southwest China from the perspective of urban and rural segmentation. Methods Using cross-sectional survey data on Southwest China in 2016, a representative data sample drawn from 8507 migrant workers was analysed. An ordinary least squares (OLS) model and instrumental variable (IV) estimation were used to analyse the relationship between urban and rural health insurance and the SRH of migrant workers. Results Using the IV method to control the endogeneity problems associated with health insurance, this study found that there are differences in the relationship between urban and rural health insurance and the SRH of migrant workers. Urban health insurance is associated with significant improvements in the SRH of migrant workers. Compared with the NRCMS, participating in urban health insurance, including urban employee basic medical insurance (UEBMI) and urban resident basic medical insurance (URBMI), increases the likelihood of migrant workers having better SRH. Conclusions There are disparities in the relationship between urban and rural health insurance and the SRH of migrant workers in China. Compared to rural health insurance, urban health insurance has a more positive correlation with the health of migrant workers. Our study shows that it is necessary to integrate urban and rural health insurance to promote social equity.

scholarly journals The Impact of Health Insurance Policy on the Health of the Senior Floating Population—Evidence from China

2018 ◽  
Vol 15 (10) ◽  
pp. 2159 ◽  
Author(s):  
Yingying Meng ◽  
Junqiang Han ◽  
Siqi Qin
Keyword(s):  
Health Insurance ◽  
Instrumental Variable ◽  
Academic Research ◽  
Medical Insurance ◽  
Floating Population ◽  
Insurance System ◽  
Self Rated Health ◽  
Basic Medical Insurance ◽  
The Impact ◽  
Basic Medical

The impact of health insurance on residents’ health is one of the focal points of academic research. Due to the fact that China’s medical insurance system is composed of a variety of programs and that the pooling districts are at the lower administrative level, enrollment in different medical insurance programs or at different places may have certain influences on the health of residents. This has mostly been neglected by previous studies. This paper uses data from the 2015 China Migrants Dynamic Survey (CMDS), focusing on the senior floating population and taking the difference in government subsidy proportions as an instrumental variable in order to identify the effects of health insurance programs and regional differences on the health of the senior floating population. Three effects were observed: First, participation in the health insurance system significantly improves floating seniors’ self-rated health. Second, the health status of floating seniors affects their choice of health insurance program: Less healthy persons tend to choose high-paying, wide-coverage basic medical insurance available for urban employees. Using an instrumental variable to control for the problem of endogeneity, it is discovered that compared with the basic medical insurance system for urban residents, the system for urban employees significantly enhances the health of the senior floating population. Third, “adverse selection” could be observed in the choice between enrolling in health insurance at the place of settlement or another place. Senior migrants with worse self-rated health tend to choose place of settlement in order to enjoy higher compensation and less complex reimbursement procedures. With an instrumental variable to control for the problem of endogeneity, it was found that compared with joining the medical insurance system at other places, joining at a place of settlement could improve the health of the floating senior population.

scholarly journals Costs of hospitalization for chronic kidney disease in Guangzhou, China

2019 ◽  
Vol 22 (2) ◽  
pp. 138-151
Author(s):  
Hui Zhang ◽  
Chao Zhang ◽  
Sufen Zhu ◽  
Feng Zhu ◽  
Yan Wen
Keyword(s):  
Chronic Kidney Disease ◽  
Health Insurance ◽  
Kidney Disease ◽  
Urban Health ◽  
Medical Insurance ◽  
Content Type ◽  
Basic Medical Insurance ◽  
Hospitalization Costs ◽  
The Mean ◽  
Basic Medical

Purpose Chronic kidney disease (CKD) is a worldwide public health problem which imposes a significant financial burden not only on patients but also on the healthcare systems, especially under the pressure of the rapid growth of the elderly population in China. The purpose of this paper is to examine the hospitalization costs of patients with CKD between two urban health insurance schemes and investigate the factors that were associated with their inpatient costs in Guangzhou, China. Design/methodology/approach This was a prevalence-based, observational study using data derived from two insurance claims databases during the period from January 2010 to December 2012 in the largest city, Guangzhou in Southern China. The authors identified 5,803 hospitalizations under two urban health insurance schemes. An extension of generalized linear model – the extended estimating equations approach – was performed to identify the main drivers of total inpatient costs. Findings Among 5,803 inpatients with CKD, the mean age was 60.6. The average length of stay (LOS) was 14.4 days. The average hospitalization costs per inpatient were CNY15,517.7. The mean inpatient costs for patients with Urban Employee-based Basic Medical Insurance (UEBMI) scheme (CNY15,582.0) were higher than those under Urban Resident-based Basic Medical Insurance (URBMI) scheme (CNY14,917.0). However, the percentage of out-of-pocket expenses for the UEBMI patients (19.8 percent) was only half of that for the URBMI patients (44.5 percent). Insurance type, age, comorbidities, dialysis therapies, severity of disease, LOS and hospital levels were significantly associated with hospitalization costs. Originality/value The costs of hospitalization for CKD were high and differed by types of insurance schemes. This was the first study to compare the differences in hospitalization costs of patients with CKD under two different urban insurance schemes in China. The findings of this study could provide economic evidence for understanding the burden of CKD and evaluating different treatment of CKD (dialysis therapy) in China. Such useful information could also be used by policy makers in health insurance program evaluation and health resources allocation.

scholarly journals Migration and Health—Freedom of Movement and Social Benefits for Chinese Migrant Workers

2021 ◽  
Vol 13 (22) ◽  
pp. 12371
Author(s):  
Fengxian Qiu ◽  
Jing Liu ◽  
Heying Jenny Zhan
Keyword(s):  
Health Insurance ◽  
Low Income ◽  
Migrant Workers ◽  
Work Experience ◽  
Cumulative Effect ◽  
Social Contexts ◽  
Structural Barriers ◽  
Health Seeking ◽  
Self Rated Health ◽  
Chinese Migrant Workers

This study utilized the concept of social right to understand factors affecting migrant workers’ health and healthcare in China. Using mixed methods, this study integrated findings from a survey of 817 migrant workers and a follow-up study of 30 intensive interviews to present an in-depth understanding of cumulative disadvantage of health and healthcare of rural-to-urban migrant workers. Our quantitative results indicated that migrant workers with no more than 5 years of working experience and having a good relationship with employers were 65% and 72.8% more likely to report good self-rated health as compared to their counterparts; those with work-related injury experience and low income were 41.6% and 53.6% less likely to report good self-rated health. Qualitative findings revealed the social contexts of the cumulative effect of the length of work experience and fear of medical cost on migrant workers’ declining health. Even though the participation rate for health insurance in China is reported to be over 99%, the lack of portability in health insurance and different reimbursement rates in health care access are structural barriers in health-seeking behaviors among Chinese migrant workers and in establishing sustainability in China’s healthcare system. This study adds to the literature by delineating the process of the unequal access to social rights in general, healthcare in particular as the major explanation for migrant workers’ poor health beyond the surface of China’s universal healthcare.

scholarly journals Patients’ preferences for health insurance coverage of new technologies for treating chronic diseases in China: a discrete choice experiment

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e038051
Author(s):  
Jinsong Geng ◽  
Xiaowei Chen ◽  
Haini Bao ◽  
Danmin Qian ◽  
Yuting Shao ◽  
...  
Keyword(s):  
Health Insurance ◽  
Chronic Diseases ◽  
Discrete Choice Experiment ◽  
Discrete Choice ◽  
Choice Experiment ◽  
New Technologies ◽  
Insurance Coverage ◽  
Medical Insurance ◽  
Basic Medical Insurance ◽  
Basic Medical

ObjectivesOur study aimed to inform insurance decision-making in China by investigating patients’ preferences for insurance coverage of new technologies for treating chronic diseases.DesignWe identified six attributes of new medical technologies for treating chronic diseases and used Bayesian-efficient design to generate choice sets for a discrete choice experiment (DCE). After conducting the DCE, we analysed the data by mixed logit regression to examine patient-reported preferences for each attribute.SettingThe DCE was conducted with patients in six tertiary hospitals from four cities in Jiangsu province.ParticipantsPatients aged 18 years or older with a history of diabetes or hypertension and taking medications regularly for more than 1 year were recruited (n=408).ResultsThe technology attributes regarding expected gains in health outcomes from the treatment, high likelihood of effective treatment and low incidence of serious adverse events were significant, positive predictors of choice by the study patients (p<0.01). The out-of-pocket cost was a significant, negative attribute for the entire study sample (β = −0.258, p<0.01) and for the patients with Urban-Rural Residents Basic Medical Insurance (URRBMI) (β = −0.511, p<0.01), but not for all the patients with Urban Employees Basic Medical Insurance (UEBMI) (β = −0.071, p>0.05). The severity of target disease was valued by patients with lower EQ-5D-5L index value as well as URRBMI enrollees.ConclusionsPatients highly valued the health benefits and risks of new technologies, which were closely linked to their feelings of disease and perceptions of health-related quality of life. However, there existed heterogeneity in preferences between URRBMI and UEBMI patients. Further efforts should be made to reduce the gap between insurance schemes and make safe and cost-effective new technologies as a priority for health insurance reimbursement.

scholarly journals Outpatient Visits among Older Adults Living Alone in China: Does Health Insurance and City of Residence Matter?

2020 ◽  
Vol 17 (12) ◽  
pp. 4256
Author(s):  
Jianyun Wang ◽  
Yaolin Pei ◽  
Renyao Zhong ◽  
Bei Wu
Keyword(s):  
Older Adults ◽  
Health Insurance ◽  
Insurance Coverage ◽  
Health Resources ◽  
Medical Insurance ◽  
Urban China ◽  
Living Alone ◽  
Basic Medical Insurance ◽  
Outpatient Visits ◽  
Basic Medical

This study aimed to examine the association between health insurance, city of residence, and outpatient visits among older adults living alone in China. A sample of 3173 individuals was derived from “Survey on Older Adults Aged 70 and Above Living Alone in Urban China” in five different cities. Logistic regression models indicated that older adults living alone who had urban employee basic medical insurance, urban resident basic medical insurance, and public medical insurance were more likely to have outpatient visits than those without any health insurance. After controlling the number of chronic diseases, only those with public medical insurance were more likely to have outpatient visits than uninsured older adults. Additionally, older adults who resided in Shanghai and Guangzhou were more likely to have outpatient visits than those in Chengdu, whereas older adults who were in Dalian and Hohhot were less likely to have outpatient visits. To improve the equity of outpatient visits among older adults living alone in China, policy efforts should be made to reduce fragmentation of different health insurance plans, expand the health insurance coverage for older adults, provide programs that consider the needs of this special group of older adults, and reduce the inequality in health resources and health insurance policies across cities.

scholarly journals Effects of health insurance integration on health care utilization and its equity among the mid-aged and elderly: evidence from China

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Chaofan Li ◽  
Chengxiang Tang ◽  
Haipeng Wang
Keyword(s):  
Health Care ◽  
Health Insurance ◽  
Health Care Utilization ◽  
Concentration Index ◽  
Care Utilization ◽  
Control Group ◽  
Positive Effects ◽  
Basic Medical Insurance ◽  
Outpatient Visits ◽  
Basic Medical

Abstract Background The fragmentation of health insurance schemes in China has undermined equity in access to health care. To achieve universal health coverage by 2020, the Chinese government has decided to consolidate three basic medical insurance schemes. This study aims to evaluate the effects of integrating Urban and Rural Residents Basic Medical Insurance schemes on health care utilization and its equity in China. Methods The data for the years before (2013) and after (2015) the integration were obtained from the China Health and Retirement Longitudinal Study. Respondents in pilot provinces were considered as the treatment group, and those in other provinces were the control group. Difference-in-difference method was used to examine integration effects on probability and frequency of health care visits. Subgroup analysis across regions of residence (urban/rural) and income groups and concentration index were used to examine effects on equity in utilization. Results The integration had no significant effects on probability of outpatient visits (β = 0.01, P > 0.05), inpatient visits (β = 0.01, P > 0.05), and unmet hospitalization needs (β =0.01, P > 0.05), while it had significant and positive effects on number of outpatient visits (β = 0.62, P < 0.05) and inpatient visits (β = 0.39, P < 0.01). Moreover, the integration had significant and positive effects on number of outpatient visits (β = 0.77, P < 0.05) and inpatient visits (β = 0.49, P < 0.01) for rural residents but no significant effects for urban residents. Furthermore, the integration led to an increase in the frequency of inpatient care utilization for the poor (β = 0.78, P < 0.05) among the piloted provinces but had no significant effects for the rich (β = 0.25, P > 0.05). The concentration index for frequency of inpatient visits turned into negative direction in integration group, while that in control group increased by 0.011. Conclusions The findings suggest that the integration of fragmented health insurance schemes could promote access to and improve equity in health care utilization. Successful experiences of consolidating health insurance schemes in pilot provinces can provide valuable lessons for other provinces in China and other countries with similar fragmented schemes.

Undiagnosed and Uncontrolled Chronic Conditions in China: Could Social Health Insurance Consolidation Make a Change?

2017 ◽  
Vol 75 (4) ◽  
pp. 479-515 ◽  
Author(s):  
Xing Lin Feng
Keyword(s):  
Health Insurance ◽  
Social Health Insurance ◽  
Medical Insurance ◽  
Integrated System ◽  
Noncommunicable Diseases ◽  
Chinese Adults ◽  
Policy Makers ◽  
Basic Medical Insurance ◽  
Cooperative Medical Scheme ◽  
Basic Medical

Policy makers in China are considering consolidating the country’s fragmented health insurance programs. This system consists of three components. The Urban Employee Basic Medical Insurance (UEBMI) covers formal employees, the New Cooperative Medical Scheme (NCMS) covers rural residents, and the Urban Resident Basic Medical Insurance (URBMI) covers urban residents. Consolidation could, in theory, create a more efficient health system that is better able to address noncommunicable diseases. Using national survey data during 2011 to 2013, I found that 44% to 76% cases of hypertension, diabetes, and dyslipidemia went undiagnosed among Chinese adults aged 45 and older. I found that the UEBMI enrollees had a greater number of health checks and 10% higher rates of diagnosis. Assuming that this level of efficiency would be possible under an integrated system, I conducted microsimulation analyses to project future benefits. Such consolidation could result in 46.2 million new diagnoses, and 30.0 million of these cases would be controlled.

Chinese residents’ educational disparity and social insurance coverage

2018 ◽  
Vol 31 (7) ◽  
pp. 746-756 ◽  
Author(s):  
Yen-Han Lee ◽  
Timothy Chiang ◽  
Mack Shelley ◽  
Ching-Ti Liu
Keyword(s):  
Health Insurance ◽  
Health Reform ◽  
Central Government ◽  
Insurance Coverage ◽  
Social Health Insurance ◽  
Medical Insurance ◽  
Social Health ◽  
Content Type ◽  
Basic Medical Insurance ◽  
Basic Medical

Purpose The Chinese society has embraced rapid social reforms since the late twentieth century, including educational and healthcare systems. The Chinese Central Government launched an ambitious health reform program in 2009 to improve service quality and provide affordable health services, regardless of individual socio-economic status. Currently, the Chinese social health insurance includes Urban Employee Basic Medical Insurance, Urban Resident Basic Medical Insurance, and New Cooperative Medical Insurance for rural residents. The purpose of this paper is to measure the association between individual education level and China’s social health insurance scheme following the reform. Design/methodology/approach Using the latest (2011) China Health and Nutrition Survey (CHNS) data and multivariable logistic regression models with cross-sectional design (n=11,960), the odds ratios (OR) and 95% confidence intervals (95% CI) are reported. Findings The authors found that education is associated with all social health insurance schemes in China after the reform (p<0.001). Residents with higher educational attainments, such as technical school (OR: 6.64, 95% CI: 5.44–8.13) or university and above (OR: 9.86, 95% CI: 8.14–11.96), are associated with UEBMI, compared with lower-educated individuals. Practical implications The Chinese Central Government announced a plan to combine all social health insurance schemes by 2020, except UEBMI, a plan with the most comprehensive financial package. Further research is needed to investigate potential disparities after unification. Policy makers should continue to evaluate China’s universal health coverage and social disparity. Originality/value This study is the first to investigate the association between residents’ educational attainment and three social health insurance schemes following the 2009 health reform. The authors suggest that educational attainment is still associated with each social health insurance coverage after the ambitious health reform.

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