Abstract
BackgroundAs China re-establishes its health insurance system through various cooperative schemes, little is known about schoolchildren's health insurance. This paper reports findings from a study that examined schoolchildren's insurance coverage, disparities between farmer and non-farmer households, and effects of low-premium cooperative schemes on healthcare access and utilization. It also discusses barriers to sustainable enrollment and program growth.MethodA survey of elementary school students was conducted in Pinggu, a rural/suburban district of Beijing. Statistical analyses of association and adjusted odds ratio via logistic regression were conducted to examine various aspects of health insurance.ResultsChildren's health insurance coverage rose to 54% by 2005, the rates are comparable for farmers' and non-farmer's children. However, 76% of insured farmers' children were covered under a low-premium scheme protecting only major medical events, compared to 42% among insured non-farmers' children. The low-premium schemes improved parental perceptions of children's access to and affordability of healthcare, their healthcare-seeking behaviors, and overall satisfaction with healthcare, but had little impact on utilization of outpatient care.ConclusionEnrolling and retaining schoolchildren in health insurance are threatened by the limited tangible value for routine care and low reimbursement rate for major medical events under the low-premium cooperative schemes. Coverage rates may be improved by offering complimentary and supplementary benefit options with flexible premiums via a multi-tier system consisting of national, regional, and commercial programs. Health insurance education by means of community outreach can reinforce positive parental perceptions, hence promoting and retaining insurance enrollment in short-term.
Highlights
As China re-establishes its health insurance system through various cooperative schemes, little is known about schoolchildren's health insurance
Enrolling and retaining schoolchildren in health insurance are threatened by the limited tangible value for routine care and low reimbursement rate for major medical events under the low-premium cooperative schemes
By 2003, insurance coverage fell to 54–55% in urban population with only 12% of the poorest fifth covered[3,4], while 79% (640 million) rural residents were without insurance due to the dissolution of agricultural communes that had served as the primary payer[2,3,5]
Summary
As China re-establishes its health insurance system through various cooperative schemes, little is known about schoolchildren's health insurance. This paper reports findings from a study that examined schoolchildren's insurance coverage, disparities between farmer and nonfarmer households, and effects of low-premium cooperative schemes on healthcare access and utilization. By the 1970s, most urban Chinese population and 85% rural residents were covered under a health insurance scheme[1]. As of 2006, households, local, and central governments each contributed no less than 20 yuan (RMB) per enrollee[13] Amid these fundamental reforms, health insurance access and coverage of schoolchildren is largely unknown[8]. Except for a few earlier studies on children's health insurance coverage using data from the China Health and Nutrition Survey prior to 1997[6,8], studies on healthcare access, outcomes, and disparities between urban and rural populations generally have not examined children [14,15,16]. The 2003 Third National Health Services Survey (NHSS) remained non-specific to the country's 270 million children[3]; another study by Xu et al [4] only considered agegroup insurance coverage for urban population based on the 2003 NHSS data
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