Gender differences in health insurance coverage in China

Mei Zhou,Zhi Zhao,Shaoyang Zhao

doi:10.1186/s12939-021-01383-9

Abstract

BackgroundChina initiated a reform of the health insurance system in the late 1990s. The new insurance, Urban Employee Basic Medical Insurance (UEBMI), is employment-based, which makes it more difficult than it used to be for those unemployed or informal employed (most of whom are women) to be covered by health insurance.MethodsBased on three large sample of micro datasets, we first use statistical methods to identify gender differences in health insurance. Next, we construct a logistic regression model to capture the differences in insurance coverage across age groups using the parameter of interaction terms for gender and age groups.ResultsBased on data from a demographic survey that covers a large sample, we find that in the below 50 (in 2005) or 60 (in 2015) years age group, the coverage gap of UEBMI between men and women was relatively smaller, while a larger disparity existed in the above 50 (in 2005) or 60 (in 2015) group. Moreover, gender differences in health insurance were more significant in the low-education group, while no gender differences were found in the high-education group.ConclusionsThis paper explains the gender gap in health insurance and the reason for the wider gap among older people. Our study indicates that because the UEBMI in China mainly covers people with formal jobs, a lower labor participation rate (even much lower in formal jobs) of women has led to their greater difficulty in obtaining health insurance. Since the older women’s greater difficulty in obtaining jobs or susceptibility to lay-offs during the period of the UEBMI’s implementation, the possibility of being covered was even much lower. In fact, it was because of the combined effects of the UEBMI system and the labor market condition at that time that older women had a lower proportion of being covered under the UEBMI.

Highlights

China initiated a reform of the health insurance system in the late 1990s
The ambitious social health insurance (SHI) initiative consists of three key programs: the Urban Employee Basic Medical Insurance (UEBMI) for the urban employed, initiated in 1998; the New Cooperative Medical Scheme (NCMS) for rural residents, established in 2003; and the
From the perspective of the UEBMI system reform in China, we investigate whether the basic health insurance coverage rate for women is lower than that for men and how this gender gap varies across the age groups

Summary

Introduction

The new insurance, Urban Employee Basic Medical Insurance (UEBMI), is employment-based, which makes it more difficult than it used to be for those unemployed or informal employed (most of whom are women) to be covered by health insurance. The ambitious SHI initiative consists of three key programs: the Urban Employee Basic Medical Insurance (UEBMI) for the urban employed, initiated in 1998; the New Cooperative Medical Scheme (NCMS) for rural residents, established in 2003; and the. Urban Resident Basic Medical Insurance (URBMI), covering urban residents without formal employment (including children, the elderly, and other unemployed), launched in 2007. While enrollment under the UEBMI is compulsory for urban employees, the NCMS and the URBMI are voluntary insurance programs.

Results

Discussion

Conclusion