Abstract

BackgroundUnder the current healthcare system in China, there is no government-sponsored health insurance program for children. Children from families who move from rural and interior regions to large urban centres without a valid residency permit might be at higher risk of being uninsured due to their low socioeconomic status. We conducted a survey in Shanghai to describe children's health insurance coverage according to their migration status.MethodBetween 2005 and 2006, we conducted an in-person health survey of the adult care-givers of children aged 7 and under, residing in five districts of Shanghai. We compared uninsurance rates between temporary and permanent child residents, and investigated factors associated with child health uninsurance.ResultsEven though cooperative insurance eligibility has been extended to temporary residents of Shanghai, the uninsurance rate was significantly higher among temporary (65.6%) than permanent child residents (21.1%, adjusted odds ratio (OR): 5.85, 95% confidence interval (95% CI): 4.62–7.41). For both groups, family income was associated with having child health insurance; children in lower income families were more likely to be uninsured (OR: 1.96, 95% CI: 1.40–2.96).ConclusionChildren must rely on their parents to make the insurance purchase decision, which is constrained by their income and the perceived benefits of the insurance program. Children from migrant families are at even higher risk for uninsurance due to their lower socioeconomic status. Government initiatives specifically targeting temporary residents and providing health insurance benefits for their children are urgently needed.

Highlights

  • Under the current healthcare system in China, there is no government-sponsored health insurance program for children

  • Even though cooperative insurance eligibility has been extended to temporary residents of Shanghai, the uninsurance rate was significantly higher among temporary (65.6%) than permanent child residents (21.1%, adjusted odds ratio (OR): 5.85, 95% confidence interval: 4.62– 7.41)

  • Children must rely on their parents to make the insurance purchase decision, which is constrained by their income and the perceived benefits of the insurance program

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Summary

Introduction

Under the current healthcare system in China, there is no government-sponsored health insurance program for children. The 'hukou' system effectively minimized a person's mobility by tying various opportunities and social benefits (including employment, housing, healthcare, and children's education) with her/his official place of residence [1]. Starting in the 1980s, China went through major market reforms and fast economic growth Such growth was largely unbalanced, between urban and rural areas, and (page number not for citation purposes). Reforms in urban areas, including development of a contract labour system, created a large demand for rural migrants. The emerging private markets for housing and employment opened new opportunities for social mobility [2] As a result, it created a huge new "floating population", i.e., people who migrated from rural to urban areas, from underdeveloped to developed regions, and from central and western to eastern coastal areas. In 2003, China's floating population reached 140 million, accounting for 10 per cent of the total population and about 30 per cent of the rural labour force [3]

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