Abstract
BackgroundChina is reforming and restructuring its health insurance system to achieve the goal of universal coverage. This study aims to understand the determinants of public, private and multiple insurance coverage among people of retirement-age in China.MethodsWe used data from the China Health and Retirement Longitudinal Survey 2011 and 2013, a nationally representative survey of Chinese people aged 45 and over. Multinomial logit regression was performed to identify the determinants of public, private and multiple health insurance coverage. We also conducted logit regression to examine the association between public insurance coverage and demand for private insurance.ResultsIn 2013, 94.5% of this population had at least one type of public insurance, and 12.2% purchased private insurance. In general, we found that rural residents were less likely to be uninsured (Relative Risk Ratio (RRR) = 0.40, 95% Confidence Interval (CI): 0.34–0.47) and were less likely to buy private insurance (RRR = 0.22, 95% CI: 0.16–0.31). But rural-to-urban migrants were more likely to be uninsured (RRR = 1.39, 95% CI: 1.24–1.57). Public health insurance coverage may crowd out private insurance market (Odds Ratio = 0.55, 95% CI: 0.48–0.63), particularly among enrollees of Urban Resident Basic Medical Insurance. There exists a huge socioeconomic disparity in both public and private insurance coverage.ConclusionThe migrants, the poor and the vulnerable remained in the edge of the system. The growing private insurance market did not provide sufficient financial protection and did not cover the people with the greatest need. To achieve universal coverage and reduce socioeconomic disparity, China should integrate the urban and rural public insurance schemes across regions and remove the barriers for the middle-income and low-income to access private insurance.
Highlights
China’s public health insurance system covers the largest number of population in the world [1], to be precise, the system itself is fragmented rather than integrated
We found that rural residents were less likely to be uninsured (Relative Risk Ratio (RRR) = 0.40, 95% Confidence Interval (CI): 0.34–0.47) and were less likely to buy private insurance (RRR = 0.22, 95% confidence intervals (CIs): 0.16–0.31)
Public health insurance coverage may crowd out private insurance market (Odds Ratio = 0.55, 95% CI: 0.48–0.63), among enrollees of Urban Resident Basic Medical Insurance
Summary
China’s public health insurance system covers the largest number of population in the world [1], to be precise, the system itself is fragmented rather than integrated. There are three major types of public insurance—the New Rural Cooperative Medical Scheme (NCMS), the Urban Employee Basic Medical Insurance (UEBMI), and the Urban Resident Basic Medical Insurance (URBMI), covering 95% of the entire population in China [2]. The Hukou System classifies people as rural or urban residents based on their places of birth, which is not transferable from rural to urban residence [3]. Due to the Hukou System, rural people migrating and living in urban areas may still remain in their rural residence status. This study aims to understand the determinants of public, private and multiple insurance coverage among people of retirement-age in China
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