Zhou Mei, Zhang Longwei, Liang Yunjia, Chen Yuxiao
School of Public Administration, Southwestern University of Finance and Economics, Chengdu, Sichuan, China.
Department of Economics, Sichuan University, Chengdu, China.
Int J Equity Health. 2024 Mar 11;23(1):49. doi: 10.1186/s12939-024-02096-5.
Improving the accessibility of public services for migrants is an important endeavor to promote equity in economic and social development. As a response to the large-scale movement of migrants and the fragmentation of China's health insurance system, the Chinese Government has launched a policy of trans-provincial immediate reimbursement for healthcare expenses. The present study hopes to examine the effect of immediate reimbursement policy on the utilization of healthcare services for migrants in China.
This study used two waves of data from the China Migrants Dynamic Survey (CMDS) collected in 2013 and 2017, with the sample comprising 13,540 individuals. We constructed a difference-in-differences (DID) model to investigate the impact of the policy on the utilization of healthcare services for migrants. Meanwhile, we also analyzed the heterogeneity of the policy effect by grouping the samples by industry, gender, income, and education level.
The results found that the trans-provincial immediate reimbursement significantly promoted the probability of migrants' utilization of quality healthcare services (average treatment effect on the treated = 0.072, p < 0.05). Heterogeneity analyses revealed that the policy effect was more pronounced among higher-income and better-educated migrants. In addition, the policy effect was more significant for female migrants, and the benefits were more marked for migrants in high-risk industries.
The trans-provincial immediate reimbursement policy has improved the inequity of healthcare services utilization among migrants as a whole; however, within the migrants, inequity still exists. More attention should also be paid to low-income or low-education groups in future policy design.
提高农民工公共服务可及性是促进经济社会发展公平性的一项重要举措。针对农民工大规模流动以及我国医保体系碎片化的问题，中国政府出台了医保费用跨省即时报销政策。本研究旨在考察即时报销政策对我国农民工医疗服务利用的影响。
本研究使用了2013年和2017年中国农民工动态监测调查（CMDS）的两期数据，样本包含13540人。我们构建了双重差分（DID）模型来研究该政策对农民工医疗服务利用的影响。同时，我们还按行业、性别、收入和教育水平对样本进行分组，分析了政策效果的异质性。
结果发现，跨省即时报销显著提高了农民工利用优质医疗服务的概率（处理组平均处理效应=0.072，p<0.05）。异质性分析表明，该政策效果在高收入和高学历农民工中更为明显。此外，该政策对女性农民工的效果更显著，对高危行业的农民工福利更明显。
跨省即时报销政策整体上改善了农民工医疗服务利用的不公平性；然而，在农民工群体内部，不公平现象仍然存在。在未来的政策设计中，也应更多关注低收入或低学历群体。
