School of Public Management, Northwest University, Xi'an, PR China.
School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, 710049, PR China.
BMC Public Health. 2022 Jun 3;22(1):1110. doi: 10.1186/s12889-022-13486-1.
While reducing inequity in health service utilization is an important goal of China's health system, it has been widely acknowledged that a huge number of rural migrant workers cannot be effectually protected against risks with the New Rural Cooperative Medical Insurance (NCMS).
Data of the 2016 China Labor-force Dynamic Survey and the Chinese Urban Statistical Yearbook were used. The multilevel regression approach was implemented with a nationally representative sample of rural migrant workers with NCMS. Our study adopted the concentration index and its decomposition method to quantify the inequality of their health service utilization.
The multilevel model analysis indicated that impact variables for health service utilization were not concentrated, especially the contextual and individual characteristics. The concentration indices of the probability of two weeks outpatient and the probability of inpatient were -0.168 (95%CI:-0.236,-0.092) and -0.072 (95%CI:-1.085,-0.060), respectively. The horizontal inequality indices for the probability of two-week outpatient and the probability of inpatient were -0.012 and 0.053, respectively.
The health service utilization of rural migrant workers with NCMS is insufficient. Our study highlighted that substantial inequalities in their health service utilization did exist. In addition, their need of health service utilization increased the pro-poor inequality. Based on the findings, our study offered notable implications on compensation policies and benefit packages to improve the equality among rural migrant workers with NCMS.
尽管减少卫生服务利用方面的不平等是中国卫生系统的一个重要目标，但人们普遍认识到，大量农村流动人口无法通过新型农村合作医疗保险（NCMS）有效地防范风险。
使用 2016 年中国劳动力动态调查和中国城市统计年鉴的数据。采用多水平回归方法对具有 NCMS 的农村流动人口进行了全国代表性样本的分析。本研究采用集中指数及其分解方法来量化其卫生服务利用的不平等程度。
多水平模型分析表明，卫生服务利用的影响变量没有集中，特别是上下文和个体特征。两周门诊和住院的概率的集中指数分别为-0.168（95%CI：-0.236，-0.092）和-0.072（95%CI：-1.085，-0.060）。两周门诊和住院概率的水平不平等指数分别为-0.012 和 0.053。
参加新型农村合作医疗保险的农村流动人口的卫生服务利用不足。本研究强调，他们的卫生服务利用存在显著的不平等。此外，他们对卫生服务利用的需求增加了贫困倾向的不平等。基于这些发现，本研究为改善参加新型农村合作医疗保险的农村流动人口的平等性提供了显著的补偿政策和福利方案的启示。
