The relationship between urban and rural health insurance and the self-rated health of migrant workers in Southwest China

Dingying Fu,Xuewen Zhang,Huiqiang Luo,Chuan Yu,Ningxiu Li,Li Liu

doi:10.1186/s12913-021-06646-3

Abstract

BackgroundFollowing health insurance reforms, China’s health care system has made great progress. However, there are still huge differences between the urban and rural health insurance systems. For rural-to-urban migrant workers, there may be differences in the use of urban and rural health insurance to improve their health status. This study aimed to determine whether any disparities exist in the relationship between urban and rural health insurance and the self-rated health (SRH) of migrant workers in Southwest China from the perspective of urban and rural segmentation.MethodsUsing cross-sectional survey data on Southwest China in 2016, a representative data sample drawn from 8507 migrant workers was analysed. An ordinary least squares (OLS) model and instrumental variable (IV) estimation were used to analyse the relationship between urban and rural health insurance and the SRH of migrant workers.ResultsUsing the IV method to control the endogeneity problems associated with health insurance, this study found that there are differences in the relationship between urban and rural health insurance and the SRH of migrant workers. Urban health insurance is associated with significant improvements in the SRH of migrant workers. Compared with the NRCMS, participating in urban health insurance, including urban employee basic medical insurance (UEBMI) and urban resident basic medical insurance (URBMI), increases the likelihood of migrant workers having better SRH.ConclusionsThere are disparities in the relationship between urban and rural health insurance and the SRH of migrant workers in China. Compared to rural health insurance, urban health insurance has a more positive correlation with the health of migrant workers. Our study shows that it is necessary to integrate urban and rural health insurance to promote social equity.

Highlights

Following health insurance reforms, China’s health care system has made great progress
This system consists of three predominant health insurance schemes, the major distinguishing features of which are that the availability of a specific health insurance plan depends on one’s employment status, household registration, and place of residence [8]: urban employee basic medical insurance (UEBMI) is for urban formal sector employees, the new rural cooperative medical system (NRCMS) is for rural people, and urban resident basic medical insurance (URBMI) is mainly for urban informal sector workers and unemployed urban residents
25% of the respondents are covered by urban health insurance, 60% are covered by the NRCMS, and 15% are uninsured

Summary

Introduction

China’s health care system has made great progress. The reimbursement rate of the NRCMS is 10% lower than that of UEBMI and URBMI [10], which is mainly due to the low funds of the NRCMS [12] This leads to a tiered system in which people who participate in urban health insurance can enjoy access to a wide range of high-quality services, while those who participate in rural health insurance have access to a less generous benefit package and incur higher costs due to co-payments or excluded services [13, 14]. This kind of health insurance system featuring an “urban-rural duality” has resulted in potential barriers to obtaining appropriate and cost-effective health care for a large number of rural-to-urban migrant workers, who are caught in the gap between urban and rural areas [11, 15] This situation leads to increasing concerns over whether this unique group has benefited from insurance coverage

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