School of Public Administration, Southwestern University of Finance and Economics, Chengdu, Sichuan, China.
School of Economics, Sichuan University, Chengdu, China.
Int J Equity Health. 2021 Feb 1;20(1):52. doi: 10.1186/s12939-021-01383-9.
China initiated a reform of the health insurance system in the late 1990s. The new insurance, Urban Employee Basic Medical Insurance (UEBMI), is employment-based, which makes it more difficult than it used to be for those unemployed or informal employed (most of whom are women) to be covered by health insurance.
Based on three large sample of micro datasets, we first use statistical methods to identify gender differences in health insurance. Next, we construct a logistic regression model to capture the differences in insurance coverage across age groups using the parameter of interaction terms for gender and age groups.
Based on data from a demographic survey that covers a large sample, we find that in the below 50 (in 2005) or 60 (in 2015) years age group, the coverage gap of UEBMI between men and women was relatively smaller, while a larger disparity existed in the above 50 (in 2005) or 60 (in 2015) group. Moreover, gender differences in health insurance were more significant in the low-education group, while no gender differences were found in the high-education group.
This paper explains the gender gap in health insurance and the reason for the wider gap among older people. Our study indicates that because the UEBMI in China mainly covers people with formal jobs, a lower labor participation rate (even much lower in formal jobs) of women has led to their greater difficulty in obtaining health insurance. Since the older women's greater difficulty in obtaining jobs or susceptibility to lay-offs during the period of the UEBMI's implementation, the possibility of being covered was even much lower. In fact, it was because of the combined effects of the UEBMI system and the labor market condition at that time that older women had a lower proportion of being covered under the UEBMI.
中国在 20 世纪 90 年代末启动了医疗保险制度改革。新的医疗保险——城镇职工基本医疗保险（UEBMI）是基于就业的，这使得失业或非正式就业（其中大多数是女性）的人比以往更难获得医疗保险。
基于三个大型微观数据集，我们首先使用统计方法来确定医疗保险中的性别差异。然后，我们构建了一个逻辑回归模型，使用性别和年龄组的交互项参数来捕捉不同年龄组的保险覆盖差异。
基于一项涵盖大样本的人口调查数据，我们发现，在 50 岁以下（2005 年）或 60 岁以下（2015 年）的年龄组中，UEBMI 男女之间的覆盖差距相对较小，而在 50 岁以上（2005 年）或 60 岁以上（2015 年）的年龄组中，差距较大。此外，医疗保险中的性别差异在低教育群体中更为显著，而在高教育群体中则不存在性别差异。
本文解释了医疗保险中的性别差距以及老年人差距更大的原因。我们的研究表明，由于中国的 UEBMI 主要覆盖有正式工作的人，女性较低的劳动参与率（甚至在正式工作中更低）导致她们更难获得医疗保险。由于在 UEBMI 实施期间，老年女性更难找到工作或面临裁员，她们获得保险的可能性甚至更低。事实上，正是由于 UEBMI 制度和当时劳动力市场状况的综合影响，老年女性在 UEBMI 中的参保比例较低。
