Health insurance and healthcare utilisation for Shenzhen residents: a tale of registrants and migrants?

BMC Public Health

Janice M Johnston¹  Kelvin KF Lam¹ 

[1] Department of Community Medicine, School of Public Health, The University of Hong Kong, 5/F, William MW Mong Block, Faculty of Medicine Building, 21 Sassoon Road, Hong Kong, China

关键词: Healthcare utilisation and migrant;    Health insurance coverage;   

Others  :  1162984
DOI  :  10.1186/1471-2458-12-868

 received in 2012-04-10, accepted in 2012-09-25,  发布年份 2012

【 摘 要 】

Background

Shenzhen’s rapid growth and urbanisation has attracted a large, mobile, migrant working population. This article explores health protection through the means of social health insurance between migrants and registrants and their point of access to healthcare.

Methods

A cross-sectional questionnaire survey was conducted in Shenzhen, with a random sample of 793 registered and 750 non-registered residents. Chi-square test and multivariate logistic regression were applied to analyse the association between health insurance coverage with Hukou registration status and healthcare utilisation.

Results

Amongst 1543 respondents, 43.1% of non-registered residents were uninsured. Being non-registered strongly predicted for no insurance (OR = 5.00; CI 3.53,7.07) and have purchased additional/ private insurance(OR = 2.99; CI 1.66,5.37). Migrants who self-reported chronic health conditions were also more likely to utilisehealth services in general (OR = 2.77; CI 1.18,6.52).

Conclusions

Inadequate health insurance coverage for migrants as observed in Shenzhen remains a challenge for the Chinese health reform. Our results suggest that the current insurance system must seek to include migrants in order to achieve universal coverage and improved health protection for its population.

【 授权许可】

   
2012 Lam and Johnston; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]National Population and Family Planning Commission of China: National population statistics. Annual statistical report of National Population and Family Planning Commission of China. 2011.
• [2]China Renji Medical Group Limited: Business Review and Projections. Annual business report of the China Renji Medical Group. 2008.
• [3]Mou J, Fellmeth G, Griffiths S, Dawes M, Cheng J: Tobacco Smoking Among Migrant Factory Workers in Shenzhen. China, Nicotine Tob Res; 2012.
• [4]Yuen P: Reforming health care financing in urban China. International Journal of Public Administration 1996, 19(2):211-232.
• [5]Yip WC, Hsiao WC: Medical savings accounts: Lessons from China. Health Affair 1997, 16(6):244-251.
• [6]Liu GG, Zhao ZY, Cai RH, Yamada T, Yamada T: Equity in health care access to: assessing the urban health insurance reform in China. Social Science & Medicine 2002, 55(10):1779-1794.
• [7]National Development and Reform Commission of China: Opinions of the CPC Central Committee and the State Council on Deepening the Health Care System Reform. National Development and Reform Commission of China; 2009.
• [8]Blomqvist Å: Health system reform in China: What role for private insurance? China Econ Rev 2009, 20(4):605-612.
• [9]McLeod CB, Lavis JN, Mustard CA, Stoddart GL: Income inequality, household income, and health status in Canada: A prospective cohort study. Am J Public Health 2003, 93(8):1287-1293.
• [10]Mou J, Cheng JQ, Zhang D, Jiang HP, Lin LQ, Griffiths SM: Health care utilisation amongst Shenzhen migrant workers: does being insured make a difference? Bmc Health Serv Res 2009, 9:214. BioMed Central Full Text
• [11]Van Doorslaer E, O’Donnell O, Rannan-Eliya RP, Somanathan A, Adhikari SR, Garg CC, Harbianto D, Herrin AN, Huq MN, Ibragimova S, et al.: Catastrophic payments for health care in Asia. Health Econ 2007, 16(11):1159-1184.
• [12]Merler E, Bizzotto R, Calisti R, Cavone D, De Marzo N, Gioffre F, Mabilia T, Marcolina D, Musti M, Munafo MG, et al.: Mesotheliomas among Italians, returned to the home country, who worked when migrant at a cement-asbestos factory in Switzerland. Soz Praventiv Med 2003, 48(1):65-69.
• [13]Hesketh T, Jun YX, Lu L, Mei WH: Health status and access to health care of migrant workers in China. Public Health Rep 2008, 123(2):189-197.
• [14]Hu S, Tang S, Liu Y, Zhao Y, Escobar ML, de Ferranti D, Wagstaff A, Lindelow M: Reform of how health care is paid for in China: challenges and opportunities. Lancet 2008, 372(9652):1846-1853.
• [15]Liu M: Change in access to healthcare in Guangzhou 1999–2009. MPH dissertation thesis. University of Hong Kong; 2010.
• [16]World Bank: Financing health care: issues and options for China. World Bank Report. 1998.
• [17]Centre for Health Statistics and Information China: Report on the results of the 1998 National Health Services Survey. Centre for Health Statistics and Information, Ministry of Health, China; 1999.
• [18]Leung GM, Wong IOL, Chan WS, Choi S, Lo SV, Grp HCFS: The ecology of health care in Hong Kong. Social Science & Medicine 2005, 61(3):577-590.
• [19]Census and Statistics Department of Hong Kong: Thematic Household Survey Report - Report No. 48. Census and Statistics Department of Hong Kong; 2011.
• [20]Chinese National Health Services Survey: Guangdong Province– general health statistics by cities. Chinese National Health Services Survey Report; 2008.
• [21]Cleary PD, Edgmanlevitan S, Roberts M, Moloney TW, Mcmullen W, Walker JD, Delbanco TL: Patients Evaluate Their Hospital-Care - a National Survey. Health Affair 1991, 10(4):254-267.
• [22]Honaker J, King G: What to Do about Missing Values in Time-Series Cross-Section Data. Am J Polit Sci 2010, 54(2):561-581.
• [23]Royston P: Multiple imputation of missing values: further update of ice, with an emphasis on interval censoring. Stata J 2007, 7(4):445-464.
• [24]Royston P: Multiple imputation of missing values: Further update of ice, with an emphasis an categorical variables. Stata J 2009, 9(3):466-477.
• [25]Zhao DH, Rao KQ, Zhang ZR: Coverage and utilization of the health insurance among migrant workers in Shanghai, China. Chinese Med J-Peking 2011, 124(15):2328-2334.
• [26]Chinese National Health Services Survey: Guangdong Province– Insurance coverage by cities. Chinese National Health Services Survey Report; 2008.
• [27]Xiamen Municipal Bureau of Human Resources and Social Security: Xiamen Health insurance statistics. Annual report of Xiamen Municipal Bureau of Human Resources and Social Security; 2008.
• [28]Peng YC, Chang WH, Zhou HQ, Hu HP, Liang WN: Factors associated with health-seeking behavior among migrant workers in Beijing. China. Bmc Health Serv Res 2010, 10:69. BioMed Central Full Text
• [29]Tuohy CH: Parting at the crossroads: The emergence of health insurance in the United States and Canada. J Health Polit Polic 2000, 25(5):1005-1008.
• [30]Joshi S, Simkhada P, Prescott GJ: Health problems of Nepalese migrants working in three Gulf countries. Bmc Int Health Hum R 2011, 11:3. BioMed Central Full Text
• [31]Gravel S, Vissandjee B, Lippel K, Brodeur JM, Patry L, Champagne F: Ethics and the compensation of immigrant workers for work-related injuries and illnesses. J Immigr Minor Health 2010, 12(5):707-714.
• [32]Xu L, Wang Y, Collins CD, Tang SL: Urban health insurance reform and coverage in China using data from National Health Services Surveys in 1998 and 2003. Bmc Health Serv Res 2007, 7:37. BioMed Central Full Text
• [33]Dumoulin-Smith A: Social Health Insurance in China: An Example of Nascent Social Security in China. Center for the Study of Inequality, Cornell University; 2005.
• [34]Yu B, Meng Q, Collins C, Tolhurst R, Tang S, Yan F, Bogg L, Liu X: How does the New Cooperative Medical Scheme influence health service utilization? A study in two provinces in rural China. Bmc Health Serv Res 2010, 10(1):116. BioMed Central Full Text