Abstract
BackgroundMore than 90% of the Chinese population was covered by its three basic social health insurances. However, the Chinese rural-to-urban migrant workers (RUMWs), accounting for about one-fifth of China’s total population, seem to be put on a disadvantaged position under the current health insurance schemes. The purpose of this study is to identify the current barriers and to provide policy suggestions to the ineffective health insurance coverage of RUMWs in China.MethodsA systematic review guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The searched databases included PubMed, Embase, Medline, Web of Science, PsycINFO, Maternity and Infant Care Database MIDIRS, the Cochrane Library, WHO Library Database (WHOLIS), WHO Global Health Library, World Bank eLibrary, OpenGrey, CNKI, and Wanfang. In total, 70 articles were reviewed.Results(1) Chinese RUMWs have high work mobility and low job stability; (2) Barriers faced by RUMWs in obtaining effective health insurance coverage are primarily due to the reluctance of employers to provide insurance for all employees and the disadvantaged position held by RUMWs when negotiating with their employers; (3) Fissures among existing health insurance schemes leaves no room for RUMWs to meet their primary needs; and (4) Recent efforts in improving the portability and transferability of insurance across borders and schemes are not enough to solve the barriers.ConclusionIt is argued that the Chinese central government must deal with the fragmentation of healthcare system in China and promote effective coverage by: (1) playing a more active role in coordinating different healthcare and social welfare schemes across the country, (2) increasing the health insurance portability, (3) making the healthcare policies more compatible with RUMW’s characteristics to meet their primary health needs, (4) strengthening supervision of employers, and (5) providing more vocational training and other support to increase RUMW’s job stability.
Highlights
IntroductionMore than 90% of the Chinese population was covered by its three basic social health insurances
The number of rural-to-urban migrant workers (RUMWs) almost accounts for one-fifth of China’s total population, and around 90% of them are covered by health insurance
We summarized why and how RUMWs was selectively included into the local health insurance
Summary
More than 90% of the Chinese population was covered by its three basic social health insurances. As early as 2010, more than 90% of the Chinese population was covered by its three basic social health insurances (SHI) [5], namely New-rural Cooperative Medical Scheme (NCMS) for rural residents, Urban Residentbased Basic Medical Insurance (URBMI) for urban residents, and Urban Employee-based Basic Medical Insurance (UEBMI) for formal urban workers) [6] Their role in increasing health service accessibility, reducing economic burden, and improving health equity are evidential [5, 7]. The studies during 2014 and 2018 indicated that the Chinese rural-to-urban migrant workers (RUMWs)—villagers who migrate to urban areas for employment opportunities—seem to be put on a disadvantaged position in UHC Their effective health insurance coverage is low [8,9,10,11,12,13], largely because they are geographically removed from their place of insurance registration. The problem of geographical disjunction from the health insurance register and usage makes health services less accessible for RUMWs [14, 16, 19,20,21, 23, 26,27,28,29,30,31,32] or they have to face higher health economic burden compared with urban or even rural residents [9, 11, 14,15,16, 21, 23, 33,34,35]
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