Description
China has undergone a multitude of healthcare-related reforms in favor of providing health coverage to its internal migrant workers. Also known as the “floating population” who are typically rural-born with socioeconomic disadvantages, China’s internal migrant workers are often excluded from healthcare access. Currently, China has two main types of health coverage: the Urban Employee Basic Medical Insurance (UEBMI), a mandatory health insurance that aims to provide coverage for all persons legally employed in urban areas, and the Urban and Rural Resident Basic Medical Insurance (URRBMI), for rural residents and urban unemployed residents. Aside from the targeted population, the main differences between these two coverage types are found within their funding mechanisms: whereas the UEBMI risk pooling structure is salary-based from employer-employee joint contributions, the URRBMI is funded via affordable personal premiums and heavily dependent upon government subsidies. Consequently, not only is the UEBMI the legally-stipulated mandatory coverage for Chinese migrant workers, it is also the coverage that provides true access to healthcare for urban employees. Yet, healthcare access inequities still exists between China’s migrant workers and their urban-born counterparts.
Therefore, the aims of this study were to assess whether China’s migrant workers truly had the right type of health coverage, and to investigate the socioeconomic determinants associated with their healthcare access. To assess migrant workers’ healthcare access, we used out-of-pocket (OOP) health expenditures as indicator.
In this study, we used the China Migrants Dynamics Survey, a nationally representative annual survey from 2009 to 2018 with probability-proportion-to-size sampling methods. We included five years (2009, 2011, 2013, 2015, 2018) and participants aged 15 years and above (N=681,659). We estimated the prevalence of migrant workers’ who reported having the UEBMI coverage, using logistic regression models. We also investigated the relationship between socioeconomic determinants and out-of-pocket expenditures, using linear regression models.
We observed an increasing trend in prevalence of the UEBMI coverage over time, from 4.7% (CI: 4.5-4.9) in 2009 to 21.4% (CI: 21.2-21.6) in 2018. However, stratified trends showed that UEBMI coverage is higher in wealthier provinces in Eastern region, and among those with at least university education. UEBMI coverage remains low, less than 10% in 2018, among migrant worker who have up to primary education. We also observed higher OOP health expenditure (22%, CI: 20% - 25%) for those who had a non-UEBMI health coverage; those who have attained university education had 7% lower OOP when seeking healthcare (CI: 4% - 10%), compared with migrant workers who had up to primary education.
The findings of our study shows that despite China’s multiple policy reforms on healthcare access for migrant workers, those who are socioeconomically disadvantaged remain those who are still left behind, most notably those with low education. Given that certain common challenges, such as language barrier for international migrants, can be ruled out in our study, our findings suggests that lack of awareness and paucity in adequate support to safeguard vulnerable populations’ rights still needs further improvement, to fully realize a true Universal Health Coverage.
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