scholarly journals Assessing Income-Related Inequality on Health Service Utilization among Chinese Rural Migrant Workers with New Co-Operative Medical Scheme: A Multilevel Approach

2021 ◽  
Vol 18 (20) ◽  
pp. 10851
Author(s):  
Dan Li ◽  
Shaoguo Zhai ◽  
Jian Zhang ◽  
Jinjuan Yang ◽  
Xiao Wang
Keyword(s):  
Health Service ◽  
Service Utilization ◽  
Migrant Workers ◽  
Health Service Utilization ◽  
Medical Insurance ◽  
Total Cost ◽  
Rural Migrant ◽  
Related Inequality ◽  
Income Related Inequality ◽  
Rural Migrant Workers

Background: Eliminating inequality in health service utilization is an explicit goal of China’s health system. Rural migrant workers with New Rural Cooperative Medical Insurance (NCMS) still face the dilemma of limited health service; however, there is a lack of analysis or measurement on the income-related inequality of health service utilization. Method: The nationally representative data of the China Labor-Force Dynamic Survey in 2016 were used for analysis. Multilevel regressions were used to obtain robust estimates and to account for various covariates associated with health service utilization of rural migrant workers with NCMS. The concentration index and its decomposition method were applied to quantify the income-related inequality of health service utilization of rural migrant workers. Result: The multilevel model analysis indicated that influencing factors of health service utilization were diversified, including gender, city service quality index, type of industry, the per capita annual income, marital status, health self-assessment, the community health index and the number of friends. The concentration indices of the total cost of inpatient and OOP cost of inpatient were 0.102 (95%CI: 0.031, 0.149), and the CI of OOP cost of inpatient was 0.094 (95%CI: 0.007, 0.119), respectively. The horizontal inequality indices of the total cost of inpatient and OOP cost of inpatient were 0.051 and 0.009, respectively. Conclusion: Our study presented a unique opportunity to examine the potential influence factors of health service utilization of rural migrant workers with NCMS, and highlighted that unequal health service utilization is evident among rural migrant workers with NCMS. This study provides important corroborative evidence to take full account of the contribution of each determinant to the inequality and health service needs among rural migrant workers with NCMS, in order to improve the basic medical insurance and social security systems—particularly for some marginal groups in China.

scholarly journals Decomposing Differences of Health Service Utilization among Chinese Rural Migrant Workers with New Cooperative Medical Scheme: A Comparative Study

2021 ◽  
Vol 18 (17) ◽  
pp. 9291
Author(s):  
Dan Li ◽  
Liang Zhu ◽  
Jian Zhang ◽  
Jinjuan Yang
Keyword(s):  
Health Service ◽  
Service Utilization ◽  
Migrant Workers ◽  
Health Service Utilization ◽  
Individual Characteristics ◽  
Service Needs ◽  
Mutual Aid ◽  
Exact Matching ◽  
Rural Migrant ◽  
Rural Migrant Workers

The New Rural Cooperative Medical Insurance (NCMS) in China has provided benefits for rural migrant workers’ health service utilization, but the financial coordination and mutual aid of NCMS is mainly based on the county or district as a unit, leading NCMS with the characteristics of regional segmentation. Our study aims to explore their health service utilization, as well as to decompose differences of the health service utilization into contributors.Data from the China Labor-Force Dynamic Survey in 2016 and Urban Statistical Yearbook in 2016 were used. We used coarsened exact matching to control the confounding factors in order to enhance the comparison of two groups. The Fairlie decomposition method was used to analyze the differences and the sources of health service utilization.Influencing factors of health service utilization for rural migrant workers with NCMS were diversified, especially contextual characteristic and individual characteristics. The proportion of ethnic minorities, the number of medical institutions for 10,000 people in the community, the number of beds for 10,000 people in the city, and the urban service quality index were the major contributors of the differences. The proportion of difference in the health service utilization of rural migrant workers with NCMS caused by health service need were −54.73% and 6.92%, respectively. The inequities of the probability of two weeks outpatient, and the probability of inpatients, were −0.006 and −0.007, respectively. There were substantial differences in the health service utilization between rural migrant workers with NCMS in the county/district and rural migrant workers with NCMS across the county/district. Our results illustrated the inequity from the differences on basis of characteristic effect and the discrimination effect. Our studies clarified that health service needs of should be fully considered, contributing to a more reliable understanding of the health service utilization of rural migrant workers.

scholarly journals Decomposing Differences in Health Service Utilization between Older Rurul-to-Urban Migrant Workers and Older Rural Residents：What is Driving the Differences?

2021 ◽  
Author(s):  
Dan Li ◽  
Jian Zhang
Keyword(s):  
Health Service ◽  
Service Utilization ◽  
Migrant Workers ◽  
Health Service Utilization ◽  
Influence Factors ◽  
Andersen Model ◽  
Inpatient Utilization ◽  
Urban Migrant ◽  
Total Difference ◽  
Rural Dwellers

Abstract Background: In recent years, the widening gap of health service utilization between different groups in mainland China has become an important issue that cannot be avoided. Yet the related study on the health services utilization for older rural-to-urban migrant workers and comparative study on older rural-to-urban migrants in China is still in its infancy. Our study explored the health service utilization of the older rural-to-urban migrant workers based on a sinicization of the latest Andersen model, by comparison with the older rural dwellers. Further, our study revealed the facets and causes by decomposing the differences in the health service utilization into determinants.Methods: The data of China Labor-Force Dynamic Survey in 2016, the data of Urban Statistical Yearbook in 2016, and Statistical Bulletin were used. Our study applied the lasted Andersen Model according to China's currency situation. Before we studied the health service utilization, we used Coarsened Exact Matching to control the confounding factors to enhance the comparability of the two groups. The matched data were used to analyze the influencing factors. Fairlie decomposition method was used to analyze the differences and the sources of health service utilization between older rural-to-urban migrant workers and their rural counterparts.Results: After matching, the probability of two weeks outpatient of older rural-to-urban migrant workers (5.59%) was significantly lower than older rural dwellers (7.57%). The probability of inpatient of older rural migrant workers (5.59%) was significantly lower than older rural dwellers (9.07%). 17.98% of the total difference of two weeks outpatient utilization was due to the observed influence factors. 71.88% of the total difference of inpatient utilization was due to the observed influence factors. Income quantiles (49.57%), self-assessed health (80.91%), and sex ratio in the community (-102.29%) were significant in the differences of inpatient utilization.Conclusions: The findings have important implications for the difference in the health services utilization between older rural-to-urban migrant workers and older rural residents in China, urging the government to take full account of the heterogeneity. The results provide references for the healthcare policy reform in the process of active ageing in China.

scholarly journals What fragile factors hinder the pace of China’s alleviation efforts of poverty-stricken population?

2020 ◽  
Author(s):  
Ye Li ◽  
Xinye Qi ◽  
Linghan Shan ◽  
Xiao Tan ◽  
Jiahui Wang ◽  
...  
Keyword(s):  
Economic Development ◽  
Health Service ◽  
Service Utilization ◽  
Poverty Alleviation ◽  
Health Service Utilization ◽  
Medical Insurance ◽  
World Health ◽  
Western Region ◽  
Medical Expense ◽  
Medical Impoverishment

Abstract Objective: China has made remarkable achievements in poverty alleviation. However, with the change in economic development and age structure, the population stricken by poverty due to medical expenses and disability accounted for 42.3% and 14.4% of the total poverty-stricken population, respectively. The efforts to reduce the catastrophic health expenditure among Chinese residents are not optimistic. Poverty alleviation efforts might only focus on the people who are currently poor but ignores the increase in poverty that may occur. Accordingly, it is crucial to accurately pinpoint the characteristics of people who are about to become poor due to illness. Therefore, we prospectively analyzed the incidence of impoverishment by medical expense at the provincial, family, and different medical insurance scheme levels to identify the precise groups that are vulnerable to medical-related poverty.Method: This study obtained the data from the Chinese government’s Fifth National Health Service Survey for 2013. This survey is conducted every five years and has the most nationally representative sample obtained through a multi-stage, stratified, and random sampling method. To clean the data, we excluded incomplete records and those with logic errors, leaving 93,570 households (273,626 people) for the final sample. The method recommended by World Health Organization (WHO) was adopted to calculate impoverishment by medical expense, and logistic regression was adopted to evaluate its determinants.Results: The poverty rates in western region had much higher poverty rates than the other two regions, and the eastern region had the lowest. The rate of medical impoverishment (MI) was higher in the western region (7.2%) than that in the central (6.5%) and eastern (5.1%) regions. Compared with people enrolled in other medical insurance schemes, those enrolled in the Medical Insurance for Urban Employees Scheme (UE-BMI) and a mixture of schemes had better capacity to deal with the burden brought by diseases. The New Cooperative Medical Scheme (NCMS)was associated with the highest rate (9.1%) of MI cases. A comparison of the MI groups revealed that the top three diseases associated with MI were malignant tumor, congenital heart disease, and mental disease. Households with members suffering from NCDs, and with members who were inpatients were all more likely to suffer from MI. NCMS-enrolled households had greater exposure to the risk of MI, at 1.84 times that of UE-BM-enrolled households. Poorer households were 15.8 times more likely to suffer from MI than richer households.Conclusion: The joint roles of economic development, health service utilization, and welfare policies result in medical impoverishment for different regions. Poverty and health service utilization are indicative of households with high incidence of medical impoverishment. Chronic diseases lead to medical impoverishment. The inequity existing in different medical insurance schemes leads to different degrees of risk of MI. A combined strategy to precise target multiple vulnerabilities of poor population should be more effective.

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