Health insurance coverage and inpatient services choice among rural-to-urban migrants from a nationwide cross-sectional survey in China: does location matter?

Abstract

BackgroundIn China, rural-to-urban migrants can participate in the new rural cooperative medical scheme (NCMS) from their hometown, or in urban residents or employee-based health-care insurance from the place they live. This study aimed to investigate the association between the location they enrolled in for the insurance and whether migrants used local inpatient services. MethodsData were taken from 2014 cross-sectional survey of National Migrant Dynamics Monitoring Survey in China, representing migrants aged 15–60 years who did not have the local “Hukou” (ie, government household registration) and had been living in local cities for more than 1 month. We used multivariate logistic regression to estimate the association between different insurance coverage and choice in locations for inpatient care among migrants, controlling for individual gender, age, marital status, education, income, occupation, commercial health-care insurance, migration types, years of migration, and community urbanicity. FindingsOf 170 904 rural-to-urban migrants aged 15–60 years, 68·6% enrolled in the NCMS from their hometown, 5·0% and 12·7% enrolled respectively in urban residents and employee-based insurance from the local city, and 13·7% had no insurance. In total, 3·1% used inpatient services during the previous year. Among them, 70·5% used inpatient services from the city they lived in. Regression analyses showed that enrolment in the urban employee-based insurance was associated with 1·79 times the odds of using local inpatient services (95% CI 1·44–2·21), and urban residents insurance coverage was associated with 1·50 times the odds of using local inpatient services (1·09–2·05) compared with NCMS coverage from hometown. Additionally, compared with those covered by NCMS, migrants without insurance were also more likely to use inpatient services in the local city (odds ratio 1·77, 1·44–2·17). InterpretationParticipation in the local urban insurance programmes seemed to be significantly linked with increased preference for local inpatient health-care services, while the majority of migrants were covered only by rural insurance from their hometown, which might affect their access to and preference for local health-care services. FundingNational Nature Science Foundation of China (71403007).