Access to health insurance and essential public health services remains a pressing issue in China, particularly among internal migrants. Between 2013 and 2018, significant inequalities were documented in the provision of these services, highlighting the various challenges this population faces.
Current State of Health Insurance Access Among Internal Migrants
Internal migration in China, fueled by rapid urbanization, has led to millions of individuals relocating from rural areas to cities in search of better job opportunities and living standards. However, this demographic shift has resulted in disparities in access to health insurance and essential public health services (EPHS).
The China Migrants Dynamic Survey (CMDS) provides a comprehensive overview of the health status and access to insurance among this group. The survey analyzed 978,152 respondents over the six years, offering insights into the socio-economic factors influencing access to health care among internal migrants.
Methodologies and Measurement
The study employed various methodologies to assess health service access and the financial protection afforded by health insurance. Two key dimensions of Universal Health Coverage (UHC) were evaluated: coverage of essential health services and financial protection from health care costs.
The indicators of interest included:
- Standardized Health Record Establishment Proportion (SHREP): This reflects the extent to which health records are established for individuals.
- Standardized Health Education Intervention Coverage (SHEIC): This measures the reach of health education initiatives.
From a financial protection perspective, the study considered:
- Basic Medical Insurance Enrollment Proportion (BMIEP): Indicates how many people are enrolled in health insurance.
- Hospitalization Reimbursement Rate (HRB): Measures the percentage of costs reimbursed by insurance for hospitalization.
Socio-Economic Status and Inequalities
Socioeconomic status (SES) plays a pivotal role in determining access to health care services. In this study, SES was quantified by combining factors like income, educational level, and occupation. A composite SES index was generated using Principal Components Analysis, enabling a nuanced understanding of how these variables interact to influence access to health services.
Inequalities in UHC were quantified using the Erreygers Index and Wagstaff Index, which provide insight into how access to health services favors individuals based on their socioeconomic status. Results revealed that high SES groups typically enjoy greater access to health insurance and services, while low SES groups, often comprising the majority of internal migrants, continue to face substantial barriers.
Findings and Trends from 2013 to 2018
The analysis uncovered several critical trends over the five-year period:
Health Insurance Enrollment: Despite improvements, basic medical insurance enrollment remained disproportionately lower among low SES migrants when compared to their higher SES counterparts.
Reimbursement Rates: The hospitalization reimbursement rates were significantly higher among those with better socioeconomic standing, exacerbating the financial burden on low SES migrants who often lack adequate health coverage.
Service Utilization: Health service utilization rates were low among internal migrants, reflecting both a lack of access and socio-cultural barriers to seeking care.
- Continuous Disparities: The inequities persisted from 2013 to 2018, with minimal progress noted, as policies intended to enhance access to health care for migrants have struggled to address systemic inconsistencies.
Challenges to Health Security
Several factors contribute to the challenges faced by internal migrants in accessing health care:
Policy Gaps: The Chinese healthcare system frequently ties health insurance eligibility to residency status. Migrants often lose access to health services unless they obtain local household registration (hukou), leading to significant gaps in provision.
Information Barriers: Lack of awareness regarding health insurance programs and services further exacerbates the issue. Many internal migrants do not receive adequate information about their rights or the healthcare services available to them.
- Economic Constraints: Low-income levels and job insecurity prevent many internal migrants from affording out-of-pocket expenses even if they have basic insurance coverage.
Conclusion
The study of inequalities in access to health insurance and public health services among internal migrants in China from 2013 to 2018 reveals a complex landscape defined by persistent disparities. Although strides toward improving access have been made, the challenges stemming from socio-economic inequities and systemic policy barriers necessitate urgent attention.
In order to enhance health insurance coverage and access to essential public health services, a multi-faceted approach is required. This includes reforms to streamline health insurance eligibility, improve information dissemination to migrant communities, and create targeted health interventions aimed at low SES groups. Only through concerted efforts can we hope to bridge the gap in health services and ensure that all individuals, regardless of their migration status or socio-economic background, have access to the care they need.
The goal moving forward should be to foster a health care environment that prioritizes equity, allowing every individual the opportunity to achieve optimal health regardless of their circumstances. Addressing these inequalities is not only a matter of health policy but also a fundamental issue of social justice and human rights.
