Assessing Income-Related Inequality on Health Service Utilization among Chinese Rural Migrant Workers with New Co-Operative Medical Scheme: A Multilevel Approach

Abstract

Background: Eliminating inequality in health service utilization is an explicit goal of China’s health system. Rural migrant workers with New Rural Cooperative Medical Insurance (NCMS) still face the dilemma of limited health service; however, there is a lack of analysis or measurement on the income-related inequality of health service utilization. Method: The nationally representative data of the China Labor-Force Dynamic Survey in 2016 were used for analysis. Multilevel regressions were used to obtain robust estimates and to account for various covariates associated with health service utilization of rural migrant workers with NCMS. The concentration index and its decomposition method were applied to quantify the income-related inequality of health service utilization of rural migrant workers. Result: The multilevel model analysis indicated that influencing factors of health service utilization were diversified, including gender, city service quality index, type of industry, the per capita annual income, marital status, health self-assessment, the community health index and the number of friends. The concentration indices of the total cost of inpatient and OOP cost of inpatient were 0.102 (95%CI: 0.031, 0.149), and the CI of OOP cost of inpatient was 0.094 (95%CI: 0.007, 0.119), respectively. The horizontal inequality indices of the total cost of inpatient and OOP cost of inpatient were 0.051 and 0.009, respectively. Conclusion: Our study presented a unique opportunity to examine the potential influence factors of health service utilization of rural migrant workers with NCMS, and highlighted that unequal health service utilization is evident among rural migrant workers with NCMS. This study provides important corroborative evidence to take full account of the contribution of each determinant to the inequality and health service needs among rural migrant workers with NCMS, in order to improve the basic medical insurance and social security systems—particularly for some marginal groups in China.

Socio-economic inequalities in health service utilization among Chinese rural migrant workers with New Cooperative Medical Scheme: a multilevel regression approach

“…The Chinese government should spare more coordinated and comprehensive efforts to ensure people’s equal access to health services, especially that of rural migrant workers. In line with previous studies [ 5 , 25 ], the current health service system discouraged rural migrant workers from seeking appropriate care of good quality. Combined with this factor and others, such as: the lack of specific implementation rules for NCMS, low income, frequent job changes, and high work intensity, have led to poor health service utilization by those workers.…”

“…In the Chinese socio-cultural context, we simplified the analysis framework considering the availability of data and the purposes of our study. We set parameters for the following variables of the conceptual framework: Individual characteristics: age group (50 ~ 60, 61 and above), gender (male, female), living arrangement (living with spouse, living without spouse), educational attainment (below primary school, primary school, middle school and above), technical certificate (yes, no), type of industry (professional technician/clerical staff, service staff, manufacturing and construction, freelancer), type of employer (party/government institutions and state/collective-owned enterprises, private/foreign/joint venture, self-employed and freelancer), migration distance (within the county/district, cross the county/district), working hour (moderate labor, excessive labor [ 5 ]), income quintiles (poorest, poorer, middle, richer, richest), injury insurance (yes, no), number of friends (≤ 5, 6 ~ 10, ≥ 11), SAH (good, fair, poor). health behavior: smoking (yes, no), alcohol use (yes, no), regular exercise per month (yes, no).…”

“…Guo et al [ 4 ] found that NCMS played a certain role in improving the incidence of compensation, but its effect was still limited in eliminating the economic burden of the rural residents. Li et al [ 5 ] highlighted that the inequalities in the total cost and out-of-pocket cost of both outpatient and inpatient were evident among rural migrant workers with NCMS, and health service needs of the rural migrant workers with NCMS should be fully considered. With the goal of reducing inequality initiated by UN, the Chinese government focused on the healthcare service inequality by carrying out policies regarding basic public services.…”

Health status and public health education for internal older migrants in China: Evidence from a nationally representative survey

“…A considerable body of literature has focused on the health-related issues in older migrants. Significantly, plenty of studies accentuated public health services utilization in internal migrants (13,(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29). One of the main findings of those studies provides preliminary evidence that migrants had higher health care needs than native residents (13).…”

Associations between new health conditions and healthcare service utilizations among older adults in the United Kingdom: effects of COVID-19 risks, worse financial situation, and lowered income

“…For example, a study indicated that COVID-19 lockdown reduced numbers of patients living in poor socio-economic conditions accessing the mental health service [ 49 ]. A study among rural migrant workers in China indicated that unequal health service utilization sourced from income-related inequality [ 50 ]. A study in Japan concluded change in household income might influence the utilization of long-term home care services [ 51 ].…”