School of Public Management, Northwest University, Xi'an 710127, China.
Department of Health Care Management and Medical Education, School of Military Preventive Medicine, Air Force Medical University, Xi'an 710032, China.
Int J Environ Res Public Health. 2021 Sep 2;18(17):9291. doi: 10.3390/ijerph18179291.
The New Rural Cooperative Medical Insurance (NCMS) in China has provided benefits for rural migrant workers' health service utilization, but the financial coordination and mutual aid of NCMS is mainly based on the county or district as a unit, leading NCMS with the characteristics of regional segmentation. Our study aims to explore their health service utilization, as well as to decompose differences of the health service utilization into contributors. Data from the China Labor-Force Dynamic Survey in 2016 and Urban Statistical Yearbook in 2016 were used. We used coarsened exact matching to control the confounding factors in order to enhance the comparison of two groups. The Fairlie decomposition method was used to analyze the differences and the sources of health service utilization. Influencing factors of health service utilization for rural migrant workers with NCMS were diversified, especially contextual characteristic and individual characteristics. The proportion of ethnic minorities, the number of medical institutions for 10,000 people in the community, the number of beds for 10,000 people in the city, and the urban service quality index were the major contributors of the differences. The proportion of difference in the health service utilization of rural migrant workers with NCMS caused by health service need were -54.73% and 6.92%, respectively. The inequities of the probability of two weeks outpatient, and the probability of inpatients, were -0.006 and -0.007, respectively. There were substantial differences in the health service utilization between rural migrant workers with NCMS in the county/district and rural migrant workers with NCMS across the county/district. Our results illustrated the inequity from the differences on basis of characteristic effect and the discrimination effect. Our studies clarified that health service needs of should be fully considered, contributing to a more reliable understanding of the health service utilization of rural migrant workers.
中国的新型农村合作医疗保险(NCMS)为农民工的卫生服务利用提供了福利,但 NCMS 的财务协调和互助主要以县或区为单位,导致 NCMS 具有区域性分割的特点。我们的研究旨在探讨他们的卫生服务利用情况,并将卫生服务利用的差异分解为贡献者。本研究使用了 2016 年中国劳动力动态调查和 2016 年城市统计年鉴的数据。我们使用粗化精确匹配来控制混杂因素,以增强两组之间的比较。使用 Fairlie 分解方法分析卫生服务利用的差异和来源。影响有 NCMS 的农民工卫生服务利用的因素多种多样,特别是背景特征和个体特征。少数民族比例、社区每万人医疗机构数、城市每万人床位数和城市服务质量指数是差异的主要贡献者。NCMS 农民工卫生服务利用差异中由卫生服务需求引起的比例分别为-54.73%和 6.92%。两周门诊和住院的概率不公平分别为-0.006 和-0.007。有 NCMS 的农民工在县/区之间和跨县/区之间的卫生服务利用存在显著差异。我们的研究结果说明了基于特征效应和歧视效应的差异不公平性。我们的研究表明,应该充分考虑卫生服务需求,有助于更可靠地理解农民工的卫生服务利用情况。