Barriers of effective health insurance coverage for rural-to-urban migrant workers in China: A systematic review and policy gap analysis

Abstract

Objective: To review China’s healthcare policies and their applications to rural-to-urban migrant workers (RUMWs) in China, to identify problems faced by RUMWs and the policy gaps that need to be addressed in future, and to facilitate better implementation of the UHC on RUMWs. Methods: A systematic review guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The searched databases included PubMed, Embase, Medline, Web of Science, PsycINFO, Maternity and Infant Care Database MIDIRS, the Cochrane Library, WHO Library Database (WHOLIS), WHO Global Health Library, World Bank eLibrary, OpenGrey, CNKI, and Wanfang. In total 71 articles were reviewed. Findings: (1) Chinese RUMWs have a high work mobility and low job stability; (2) Barriers faced by RUMWs to have effective health insurance coverage are mainly due to the reluctancy of employers to provide insurance for all employees and a disadvantaged position held by RUMWs when negotiating with their employers; (3) Fissures among existing health insurance schemes leaves no room for RUMWs to meet their primary needs; and (4) Recent efforts in improving the portability and transferability of insurance across borders and schemes are not enough to solve the barriers. Conclusion: It is argued that the Chinese central government must deal with the fragmentation of healthcare system in China and promote the effective coverage by: (1) playing a more active role in coordinating different healthcare and social welfare schemes across the country, (2) increasing the health insurance portability, (3) making the healthcare policies more compatible with RUMW’s characteristics to meet their primary health needs, (4) strengthening supervision over employers, and (5) providing more vocational trainings and other supports to increase RUMW’s job stability.

Associação entre possuir plano de saúde e realização de exames de rastreio para fatores de risco cardiovascular no estudo ELSA-Brasil

“…Os indivíduos podiam voluntariamente se aderir a esquemas de cobertura de saúde, como os seguros voluntários do Regime de Medicina Cooperativa Rural (RMCR) e do regime de Seguro de Saúde Básico (RSSB) advindos pela reforma de 2009, na qual estava em fase de implementação durante o período do estudo. Vale ressaltar que havia problemas de acesso e de padronização do subsídio regional dos regimes, alterando o valor pago de acordo com a região (44,45).…”