Zheng Yunting, Wang Kun, Qin Xueying, Kong Xiangran, Cai Tianji, Wang Xiaoyu, Dong Yuan, Chang Chun, Ji Ying
School of Health Management, Fujian Medical University, Fuzhou, 350122, China.
School of Public Health, Peking University, Beijing, 100191, China.
Sci Rep. 2025 Aug 29;15(1):31830. doi: 10.1038/s41598-025-17282-w.
China launched a major health-care reform in 2009 aimed to provide all citizens with equal access to basic health care with reasonable quality and financial risk protection. Since then, China has made substantial progress toward Universal Health Coverage (UHC). However, the access of UHC among internal migrants might be disadvantaged compared with local residents. This study aimed to provide an assessment of inequalities and trends in internal migrants' access to Universal Health Coverage. Six rounds (2013-2018) of the China Migrants Dynamic Survey were used including 976,430 respondents. Financial protection was measured using the basic medical insurance enrollment proportion (BMIEP) and hospital reimbursement rate (HRB). Essential health services were measured using the standardized health record establishment proportion (SHREP) and standardized health education intervention coverage (SHEIC). The Erreyers Index (EI) and Wagstaff Index (WI) were used to measure socio-economic related UHC inequalities. The process of the Recentered Influence Function (RIF)-Ordinary Least Squares (OLS) method was used to decompose risk factors of the EI and WI. The average coverage rate of SHREP and SHEIC were 24.3% and 75.7%, respectively. The average coverage rate of BMIEP and the percentage of HRB were 87.4% and 58.3% respectively. Regarding inequalities, it was found that for SHREP and SHEIC, the general trends of inequalities raised while for BMIEP, the general trends decreased. Regarding HRB, it was less inequalities in 2018 compared with 2014. RIF-OLS regression showed that both individual factors and regional factors contributed to the inequalities in UHC among China's internal migrants. Progress has been made in financial protection of migrants as the high coverage of BMIEP and its decrease in inequalities as well as lower inequalities in 2014 of HRB compared with 2018. While challenges remained in the lower coverage rate of SHEIC and increasing inequalities of SHREP and SHEIC. Policy efforts on narrowing down both individual and regional inequalities should be put forward.
2009年，中国启动了一项重大医疗改革，旨在让所有公民都能平等地获得质量合理且有财务风险保障的基本医疗保健服务。自那时以来，中国在全民健康覆盖（UHC）方面取得了重大进展。然而，与当地居民相比，内部流动人口在全民健康覆盖方面的可及性可能处于劣势。本研究旨在评估内部流动人口在全民健康覆盖方面的不平等情况及其趋势。研究使用了中国流动人口动态监测调查的六轮数据（2013 - 2018年），涵盖976,430名受访者。财务保障通过基本医疗保险参保率（BMIEP）和住院报销率（HRB）来衡量。基本医疗服务通过标准化健康档案建立率（SHREP）和标准化健康教育干预覆盖率（SHEIC）来衡量。使用埃雷尔斯指数（EI）和瓦格斯塔夫指数（WI）来衡量与社会经济相关的全民健康覆盖不平等情况。采用重新中心化影响函数（RIF）-普通最小二乘法（OLS）来分解EI和WI的风险因素。SHREP和SHEIC的平均覆盖率分别为24.3%和75.7%。BMIEP的平均覆盖率和HRB的百分比分别为87.4%和58.3%。关于不平等情况，研究发现，对于SHREP和SHEIC，不平等的总体趋势上升，而对于BMIEP，总体趋势下降。关于HRB，与2014年相比，2018年的不平等程度较低。RIF - OLS回归显示，个体因素和地区因素都导致了中国内部流动人口在全民健康覆盖方面的不平等。流动人口在财务保障方面取得了进展，BMIEP覆盖率高且不平等程度下降，与2018年相比，2014年HRB的不平等程度也较低。然而，SHEIC覆盖率较低以及SHREP和SHEIC不平等程度增加的挑战依然存在。应提出缩小个体和地区不平等的政策措施。
