Abstract
This study focuses on the variability in unmet healthcare needs among vulnerable Chinese elders and the degree to which these unmet needs are associated with socioeconomic disadvantages. We use the 2013 wave of China Health and Retirement Longitudinal Study (CHARLS) and a multinomial logistic model to investigate how poverty, residence status and particular health insurance schemes influence unmet healthcare needs independently and in combination. Our results show that poverty and rural residence are strong predictors of unmet healthcare needs due to financial and non-financial constraints, respectively. Although health insurance can reduce financial barriers, its influence varies with different insurance schemes, thus generating unequal healthcare access among heterogeneous vulnerable subgroups of elders and putting poor rural migrants at the highest risk for unmet healthcare needs. Our findings direct attention to the differences in resources available to various subgroups of elders and the importance of social stratification in predicting unmet health care needs.
Highlights
China is facing a growing aging population
This model showed that the implementation of the multiple basic insurance programs significantly moderated the influences of poverty on unmet needs, with relative risk ratio (RRR) reduced from 2.32 to 1.94
In Model 3, interaction terms between poverty, residence status and health insurance were included in order to examine the extent to which particular health insurance schemes boosted the main effects of poverty and residence status on unmet needs
Summary
China is facing a growing aging population. In 2000, when China stepped into the aging society, the percentage of people over the age of 65 was 7%. This insurance system covers 95% of the entire population in China, and tends to create more equitable access to healthcare by reducing income related barriers and out-of-pocket payments for healthcare service It mainly consists of three different schemes: the Urban Employee Basic Medical Insurance (UEBMI), the Urban Resident Basic Medical Insurance (URBMI), and the New Rural Cooperative Medical Scheme (NRCMS). These insurance schemes are designed to cover different people: UEBMI is intended to cover urban employees and retirees in formal sectors; URBMI provides insurance to informal-sector employees, the self-employed and unemployed; and NRCMS aims to cover the registered rural population These three schemes are classified mainly by hukou status, which has long been regarded as one of the most significant institutions in China in defining persons’ access to social welfare. Insurance should offer protection for vulnerable groups such as the poor and older adults, inequalities in schemes arising from hukou policy may give rise to disparities in healthcare access and utilization
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
