West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.
Sichuan Academy of Social Sciences, Chengdu, China.
BMC Health Serv Res. 2021 Jun 29;21(1):614. doi: 10.1186/s12913-021-06646-3.
Following 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.
Using 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.
Using 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.
There 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.
中国医疗保险改革后，医疗保障制度取得了长足进步。但城乡医保制度仍存在较大差异，对于进城务工的农村户籍人员而言，使用城乡医保对其健康状况的改善作用可能存在差异。本研究旨在从城乡分割视角出发，探讨城乡医保对我国西南地区进城务工农村户籍人员自评健康的影响是否存在差异。
利用 2016 年中国西南地区的横断面调查数据，对来自 8507 名进城务工农村户籍人员的代表性数据样本进行分析。采用普通最小二乘法（OLS）模型和工具变量（IV）估计方法，分析城乡医保与进城务工农村户籍人员自评健康之间的关系。
采用 IV 方法控制医保的内生性问题后发现，城乡医保与进城务工农村户籍人员自评健康之间的关系存在差异。城镇医保与进城务工农村户籍人员自评健康显著相关。与新型农村合作医疗保险（NRCMS）相比，参加城镇职工基本医疗保险（UEBMI）和城镇居民基本医疗保险（URBMI）均能显著提高农村户籍人员自评健康的可能性。
中国城乡医保与进城务工农村户籍人员自评健康之间存在差异。与农村医保相比，城镇医保与进城务工农村户籍人员健康的相关性更为积极。本研究表明，有必要整合城乡医保以促进社会公平。
