School of Political Science and Public Administration, Wuhan University, Wuhan, China.
Centre for Social Security Studies, Wuhan University, Wuhan, China.
Front Public Health. 2022 Nov 24;10:1008720. doi: 10.3389/fpubh.2022.1008720. eCollection 2022.
China's welfare system including social health insurance has been closely linked to its unique household registration system, despite high population mobility over the past few decades. This study aimed to determine the pattern of health insurance usage from internal migrants in mainland China for hospital care.
Data were extracted from the 2018 China Migrants Dynamic Survey. The respondents who enrolled in a social health insurance program and reported illness or injury over the past year were eligible for this study ( = 15,302). Two groups of outcome indicators were calculated assessing the use (incidence and settlement location) of insurance funds for hospital care and the burden of hospital expenditure (total hospital expenditure, out-of-pocket payments, and share of insurance reimbursement), respectively. Logit regression and Heckman's sample selection models were established to determine the predictors of insurance fund usage and the burden of hospital expenditure, respectively.
Most respondents enrolled in a social health insurance program outside of their residential location (70.72%). About 28.90% were admitted to a hospital over the past year. Of those hospitalized, 72.98% were admitted to a hospital at their migration destination, and 69.96% obtained reimbursement from health insurance, covering on average 47% of total hospital expenditure. Those who had a local insurance fund aligned with residency (AOR = 2.642, 95% CI = 2.108-3.310, < 0.001) and enrolled in employment-based insurance (AOR = 1.761, 95% CI = 1.348-2.301, < 0.001) were more likely to use insurance funds for hospital care, and paid less out-of-pocket (β = -0.183 for local funds, = 0.017; β = -0.171 for employment-based insurance, = 0.005) than others. A higher share of insurance reimbursement as a proportion of hospital expenditure was found in the employment-based insurance enrollees (β = 0.147, < 0.001). Insurance claim settlement at the residential location was associated with lower total hospital expenditure (β = -0.126, = 0.012) and out-of-pocket payments (β = -0.262, < 0.001), and higher share of insurance reimbursement (β = 0.066, < 0.001) for hospital expenditure.
Low levels of health insurance benefits for hospital care are evident for internal migrants in mainland China, which are associated with the funding arrangements linked to household registration and inequality across different funds.
尽管过去几十年人口流动频繁，但中国的福利体系包括社会医疗保险与中国独特的户籍制度密切相关。本研究旨在确定中国大陆内部移民使用医疗保险的模式，以获得医院护理。
数据来自 2018 年中国流动人口动态调查。本研究纳入了参加社会医疗保险计划并报告过去一年患病或受伤的受访者（=15302）。分别计算了两组结果指标，以评估保险基金在医院护理中的使用情况（发生率和结算地点）和医院支出负担（总医院支出、自付支出和保险报销比例）。分别建立了 Logit 回归和 Heckman 的样本选择模型来确定保险基金使用和医院支出负担的预测因素。
大多数受访者在居住地点以外的地方参加了社会医疗保险计划（70.72%）。约 28.90%的人在过去一年住院。在住院的人群中，72.98%的人在迁移目的地住院，69.96%的人从医疗保险中获得报销，平均覆盖总医院支出的 47%。那些具有与居住地相匹配的本地保险基金（AOR=2.642，95%CI=2.108-3.310，<0.001）和参加就业为基础的保险（AOR=1.761，95%CI=1.348-2.301，<0.001）的人更有可能使用保险基金进行医院护理，并且自付支出较少（本地基金为-0.183，=0.017；就业为基础的保险为-0.171，=0.005）。在就业为基础的保险参保者中，保险报销占医院支出的比例更高（β=0.147，<0.001）。在居住地进行保险理赔与总医院支出（β=-0.126，=0.012）和自付支出（β=-0.262，<0.001）较低以及医院支出的保险报销比例较高（β=0.066，<0.001）相关。
中国大陆内部移民的医院护理医疗保险福利水平较低，这与与户籍制度相关的资金安排和不同基金之间的不平等有关。
