Multi-Level Social Health Insurance System in the Age of Frequent Employment Change: The Urban Unemployment-Induced Insurance Transition and Healthcare Utilization in China.

Bocong Yuan,Lily Wu,Jiannan Li,Zhaoguo Wang

doi:10.3390/healthcare7020077

Abstract

Job tenure has been significantly shortened with the prevalence of the gig economy around the world. Workers are faced with a new age of frequent employment change. This emerging situation is out of expectation of social health insurance policymakers. As the multi-level social health insurance system in China is closely associated with employment status; urban workers cannot enjoy the urban employee basic medical insurance (UEBMI) during the unemployment period. At this time, unemployed rural-to-urban migrant workers can only rely on the new cooperative medical scheme (NCMS) and unemployed urban residents can only rely on the urban resident basic medical insurance (URBMI). This study provides a preliminary analysis on healthcare utilization change triggered by the unemployment-induced social health insurance transition that has never been investigated. Using the data of a nationwide survey, empirical results show that the unemployment-induced social health insurance transition can significantly deteriorate the healthcare utilization of insurance beneficiaries experiencing the transitions from the UEBMI to the NCMS (or from the UEBMI to the URBMI). Specifically, the outpatient service quality and the conventional physical examination become worse, and the out-of-pocket expenditure increases. Therefore, the multi-level social health insurance system currently in effect can expose workers to a high risk of insufficient health security in the age of frequent employment change.

Highlights

A growing number of enterprises and institutions in China are adapting to the trend of gig economy and tending to hire an increasing number of temporary staff instead of permanent staff.Reports published by LinkedIn, a famous business-oriented social networking service, show that the average job tenure has reduced to 22 months in China [1], and the average tenure for the first job has even reduced to seven months for the post-1995s generation [2]
This study provides a preliminary investigation on the healthcare utilization change triggered by the unemployment-induced insurance transition that has never been explored
The unemployment-induced transition of urban employee basic medical insurance (UEBMI) from active to inactive status would lead to the deterioration of healthcare utilization, which is manifested as the decline of outpatient service quality, the decrease in the number of items of the purchased conventional physical examination, and the increase in out-of-pocket expenditure

Summary

Introduction

A growing number of enterprises and institutions in China are adapting to the trend of gig economy and tending to hire an increasing number of temporary staff instead of permanent staff.Reports published by LinkedIn, a famous business-oriented social networking service, show that the average job tenure has reduced to 22 months in China [1], and the average tenure for the first job has even reduced to seven months for the post-1995s generation [2]. For policy makers of social health insurance, this emerging situation is out of expectation. Healthcare 2019, 7, 77 challenge to the existing multi-level social health insurance system in China that is closely associated with employment status. China’s social health insurance largely determines the level of healthcare services that residents can enjoy. China’s public healthcare services are covered by the multi-level social health insurance system, which includes the urban employee basic medical insurance (UEBMI) for urban employed population or retirees, the urban resident basic medical insurance (URBMI) for urban unemployed population, and the new cooperative medical scheme (NCMS) for the rural population [4]

Results

Discussion

Conclusion