Public and Commercial Medical Insurance Enrollment Rates of Rural-to-Urban Migrants in China

Objectives: Large-scale rural-to-urban migration of China has provoked heated discussion about the health of migrants and whether they have equal access to the health resources. This article aimed to compare the public and commercial medical insurance enrollment rates between temporary, permanent migrants and urban natives.Methods: Average marginal effects (AME) of the weighted logistic regression models using 2017 China General Social Survey from 2,068 urban natives, 1,285 temporary migrants, and 1,295 permanent migrants.Results: After controlling for the demographic and socio-economic characteristics, our results show that while the temporary and permanent migrants have a similar public insurance enrollment rate compared with the urban natives, both temporary and permanent migrants have significantly lower commercial insurance enrollment rates (7.5 and 5.3%, respectively) compared with the urban natives.Conclusions: The results highlight significant institutional barriers preventing the temporary migrants from gaining access to public medical insurance and the adverse impact of disadvantaged socio-economic backgrounds on the access of temporary migrants to both public and commercial insurance.

Insurance Coverage of Facial Gender Affirmation Surgery: A Review of Medicaid and Commercial Insurance

Objective To provide a portrait of gender affirmation surgery (GAS) insurance coverage across the United States, with attention to procedures of the head and neck. Study Design Systematic review. Setting Policy review of US medical insurance companies. Methods State policies on transgender care for Medicaid insurance providers were collected for all 50 states. Each state’s policy on GAS and facial gender affirmation surgery (FGAS) was examined. The largest medical insurance companies in the United States were identified using the National Association of Insurance Commissioners Market Share report. Policies of the top 49 primary commercial medical insurance companies were examined. Results Medicaid policy reviews found that 18 states offer some level of gender-affirming coverage for their patients, but only 3 include FGAS (17%). Thirteen states prohibit Medicaid coverage of all transgender surgery, and 19 states have no published gender-affirming medical care coverage policy. Ninety-two percent of commercial medical insurance providers had a published policy on GAS coverage. Genital reconstruction was described as a medically necessary aspect of transgender care in 100% of the commercial policies reviewed. Ninety-three percent discussed coverage of FGAS, but 51% considered these procedures cosmetic. Thyroid chondroplasty (20%) was the most commonly covered FGAS procedure. Mandibular and frontal bone contouring, rhinoplasty, blepharoplasty, and facial rhytidectomy were each covered by 13% of the medical policies reviewed. Conclusion While certain surgical aspects of gender-affirming medical care are nearly ubiquitously covered by commercial insurance providers, FGAS is considered cosmetic by most Medicaid and commercial insurance providers, potentially limiting patient access. Level of Evidence Level V.

The Role of Health Management in Commercial Medical Insurance Cost Control

The sharp increase in medical insurance cost has become a common concern of the world. In the process of commercial health insurance, academics, government and related departments usually lamented that medical service institutions don’t cooperate on the implementation of risk control measures. They often complained that the insured's moral hazard problem at the medical process. The control measures of the medical insurance cost mostly focused on internal underwriting and claims assessment, rarely focused on mobilization the initiative of the medical service provider and the recipient controlling the expenses. Combination of the cost control management of commercial medical insurance and health management is an effective method. We can shift funds usage patterns to a certain extent and strengthen preventive health input to the insured, in order to achieve the multi-effective cooperation and win-win.