Inequality in Health Services for Internal Migrants in China: A National Cross-Sectional Study on the Role of Fund Location of Social Health Insurance
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Data Source
2.1.1. Setting and Sampling
2.1.2. Data Collection
2.2. Data Analysis
2.2.1. Dependent Variables
2.2.2. Independent and Control Variables
2.2.3. Statistical Analysis
3. Results
3.1. Characteristics of Respondents
3.2. Having a Health Record
3.3. Use of Medical Services
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
Availability of Data and Materials
Ethics Approval and Consent to Participate
References
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Variable | Description | Sample Size | Number (%) of Respondents | Number (%) of Respondents | χ2 Value | p Value | |||
---|---|---|---|---|---|---|---|---|---|
n | % | without Local Insurance | with Local Insurance | ||||||
Gender | 7.61 | 0.01 | |||||||
Male | 74,864 | 51.65 | 57,319 | (51.85) | 17,545 | (51.00) | |||
Female | 70,092 | 48.35 | 53,233 | (48.15) | 16,859 | (49.00) | |||
Age (Years) | 1400 | <0.001 | |||||||
15–24 | 17,952 | 12.38 | 14,103 | (12.76) | 3849 | (11.19) | |||
25–34 | 54,823 | 37.82 | 39,180 | (35.44) | 15,643 | (45.47) | |||
35–44 | 39,393 | 27.18 | 30,247 | (27.36) | 9146 | (26.58) | |||
45–54 | 24,433 | 16.86 | 20,070 | (18.15) | 4363 | (12.68) | |||
55+ | 8355 | 5.76 | 6952 | (6.29) | 1403 | (4.08) | |||
Marital status | 369.67 | <0.001 | |||||||
Never married/Single | 20,340 | 14.03 | 14,458 | (13.08) | 5882 | (17.10) | |||
Married | 120,687 | 83.26 | 93,030 | (84.15) | 27,657 | (80.39) | |||
Divorced | 2591 | 1.79 | 1969 | (1.78) | 622 | (1.81) | |||
Widowed | 1338 | 0.92 | 1095 | (0.99) | 243 | (0.71) | |||
Educational attainment | 18,000 | <0.001 | |||||||
Illiterate | 3994 | 2.76 | 3500 | (3.17) | 494 | (1.44) | |||
Primary school | 21,460 | 14.8 | 18,601 | (16.83) | 2859 | (8.31) | |||
Junior middle school | 64,450 | 44.46 | 54,660 | (49.44) | 9790 | (28.46) | |||
Senior middle school | 31,178 | 21.51 | 23,268 | (21.05) | 7910 | (22.99) | |||
University/college | 23,874 | 16.47 | 10,523 | (9.52) | 13,351 | (38.81) | |||
Employment | 850.73 | <0.001 | |||||||
Unemployed | 25,837 | 17.82 | 21,513 | (19.46) | 4324 | (12.57) | |||
Employed | 119,119 | 82.18 | 89,039 | (80.54) | 30,080 | (87.43) | |||
Household income ranking | 3000 | <0.001 | |||||||
Lowest (<percentile 20) | 33,249 | 22.94 | 27,658 | (25.02) | 5591 | (16.25) | |||
Lower (percentile 20–39) | 30,504 | 21.04 | 24,548 | (22.20) | 5956 | (17.31) | |||
Middle (percentile 40–59) | 27,913 | 19.26 | 21,406 | (19.36) | 6507 | (18.91) | |||
Higher (percentile 60–79) | 27,771 | 19.16 | 20,239 | (18.31) | 7532 | (21.89) | |||
Highest (≥percentile 80) | 25,519 | 17.6 | 16701 | (15.11) | 8818 | (25.63) | |||
Type of social health insurance | 69,000 | <0.001 | |||||||
BMIUR/RNCMS * | 118,123 | 81.49 | 106,546 | (96.38) | 11,577 | (33.65) | |||
BMIUE | 26,594 | 18.35 | 3874 | (3.50) | 22,720 | (66.04) | |||
Others | 239 | 0.16 | 132 | (0.12) | 107 | (0.31) | |||
Self-rating of health | 136.8 | <0.001 | |||||||
Good | 118,780 | 81.94 | 89,901 | (81.32) | 28,879 | (83.94) | |||
General | 22,123 | 15.26 | 17,357 | (15.70) | 4766 | (13.85) | |||
Poor | 4053 | 2.8 | 3294 | (2.98) | 759 | (2.21) | |||
Two-week morbidity | 0.66 | 0.42 | |||||||
No | 135,728 | 93.63 | 103,482 | (93.60) | 32,246 | (93.73) | |||
Yes | 9228 | 6.37 | 7070 | (6.40) | 2158 | (6.27) | |||
Chronic morbidity | 59.71 | <0.001 | |||||||
No | 136,874 | 94.42 | 104,101 | (94.16) | 32,773 | (95.26) | |||
Yes | 8082 | 5.58 | 6451 | (5.84) | 1631 | (4.74) | |||
Type of migration | 8700 | <0.001 | |||||||
Rural to urban | 114,153 | 78.75 | 93,233 | (84.33) | 20,920 | (60.81) | |||
Urban to urban | 30,803 | 21.25 | 17,319 | (15.67) | 13,484 | (39.19) | |||
Having a health record | 524.63 | <0.001 | |||||||
No | 91,925 | 69.72 | 70,635 | (71.39) | 21,290 | (64.69) | |||
Yes | 39,933 | 30.28 | 28,312 | (28.61) | 11,621 | (35.31) | |||
Visits to physicians | 1.83 | 0.18 | |||||||
No | 34,634 | 49.23 | 25,649 | (49.08) | 8985 | (49.66) | |||
Yes | 35,722 | 50.77 | 26,614 | (50.92) | 9108 | (50.34) | |||
Total | 144,956 | 100 | 110,552 | (100.00) | 34,404 | (100.00) |
Variables | Rural to Urban Respondents | Urban to Urban Respondents | All Respondents | |||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
AOR/ICC † | SE | p Value | 95%CI | AOR/ICC | SE | p Value | 95%CI | AOR/ICC | SE | p Value | 95%CI | |||||
Fixed effects (Level 1) | ||||||||||||||||
Enrolment with a local social health insurance program | No (reference) | |||||||||||||||
Yes * | 1.56 | 0.10 | <0.001 | 1.38 | 1.77 | 1.46 | 0.17 | <0.001 | 1.16 | 1.83 | 1.47 | 0.09 | <0.001 | 1.30 | 1.65 | |
Gender | Male (reference) | |||||||||||||||
Female | 1.21 | 0.04 | <0.001 | 1.13 | 1.29 | 1.19 | 0.07 | <0.001 | 1.06 | 1.33 | 1.21 | 0.03 | <0.001 | 1.14 | 1.28 | |
Age (Years) | 15–24 (reference) | |||||||||||||||
25–34 | 1.00 | 0.07 | 0.95 | 0.87 | 1.15 | 1.10 | 0.12 | 0.38 | 0.89 | 1.36 | 1.01 | 0.07 | 0.85 | 0.88 | 1.16 | |
35–44 | 1.04 | 0.08 | 0.62 | 0.90 | 1.20 | 1.01 | 0.12 | 0.92 | 0.80 | 1.27 | 1.02 | 0.08 | 0.79 | 0.88 | 1.18 | |
45–54 | 0.93 | 0.07 | 0.39 | 0.80 | 1.09 | 1.02 | 0.15 | 0.89 | 0.76 | 1.36 | 0.95 | 0.07 | 0.45 | 0.82 | 1.09 | |
55+ | 1.09 | 0.15 | 0.51 | 0.84 | 1.43 | 1.31 | 0.19 | 0.07 | 0.98 | 1.75 | 1.20 | 0.14 | 0.13 | 0.95 | 1.51 | |
Marital status | Never married/Single (reference) | |||||||||||||||
Married | 1.31 | 0.09 | <0.001 | 1.14 | 1.50 | 1.31 | 0.14 | 0.01 | 1.06 | 1.62 | 1.32 | 0.10 | <0.001 | 1.14 | 1.53 | |
Divorced | 1.19 | 0.15 | 0.18 | 0.92 | 1.54 | 1.38 | 0.24 | 0.07 | 0.98 | 1.94 | 1.26 | 0.15 | 0.05 | 1.00 | 1.58 | |
Widowed | 1.12 | 0.22 | 0.55 | 0.77 | 1.64 | 1.22 | 0.42 | 0.57 | 0.61 | 2.41 | 1.12 | 0.20 | 0.52 | 0.80 | 1.58 | |
Educational attainment | Illiterate (reference) | |||||||||||||||
Primary school | 1.34 | 0.14 | 0.01 | 1.09 | 1.64 | 1.58 | 0.58 | 0.22 | 0.77 | 3.25 | 1.41 | 0.14 | <0.001 | 1.16 | 1.71 | |
Junior middle school | 1.55 | 0.16 | <0.001 | 1.27 | 1.90 | 2.02 | 0.73 | 0.05 | 1.00 | 4.09 | 1.66 | 0.16 | <0.001 | 1.37 | 2.01 | |
Senior middle school | 1.84 | 0.22 | <0.001 | 1.45 | 2.33 | 2.15 | 0.79 | 0.04 | 1.05 | 4.42 | 1.94 | 0.22 | <0.001 | 1.56 | 2.42 | |
University/college | 1.97 | 0.24 | <0.001 | 1.54 | 2.50 | 2.28 | 0.88 | 0.03 | 1.07 | 4.85 | 2.08 | 0.23 | <0.001 | 1.67 | 2.57 | |
Employment | Unemployed (reference) | |||||||||||||||
Employed | 0.94 | 0.04 | 0.11 | 0.86 | 1.01 | 0.98 | 0.08 | 0.78 | 0.83 | 1.15 | 0.93 | 0.03 | 0.06 | 0.87 | 1.00 | |
Household income ranking | Lowest (<percentile 20, reference) | |||||||||||||||
Lower (percentile 20–39.9) | 1.13 | 0.05 | 0.01 | 1.03 | 1.24 | 1.02 | 0.07 | 0.80 | 0.89 | 1.17 | 1.11 | 0.05 | 0.01 | 1.02 | 1.20 | |
Middle (percentile 40–59.9) | 1.12 | 0.05 | 0.01 | 1.03 | 1.23 | 1.03 | 0.10 | 0.79 | 0.85 | 1.25 | 1.10 | 0.05 | 0.02 | 1.01 | 1.20 | |
Higher (percentile 60–79.9) | 1.01 | 0.05 | 0.76 | 0.93 | 1.11 | 1.02 | 0.10 | 0.88 | 0.84 | 1.23 | 1.02 | 0.04 | 0.61 | 0.94 | 1.11 | |
Highest (≥percentile 80) | 1.11 | 0.07 | 0.10 | 0.98 | 1.25 | 0.93 | 0.10 | 0.52 | 0.75 | 1.16 | 1.06 | 0.06 | 0.31 | 0.95 | 1.17 | |
Type of social health insurance | BMIUR/RNCMS (reference) | |||||||||||||||
BMIUE | 1.05 | 0.10 | 0.59 | 0.88 | 1.26 | 1.03 | 0.14 | 0.82 | 0.79 | 1.34 | 1.09 | 0.10 | 0.34 | 0.91 | 1.30 | |
Others | 2.09 | 1.58 | 0.33 | 0.48 | 9.16 | 1.27 | 0.45 | 0.50 | 0.63 | 2.54 | 1.43 | 0.48 | 0.29 | 0.74 | 2.76 | |
Self-rating of health | Good (reference) | |||||||||||||||
General | 0.75 | 0.04 | <0.001 | 0.67 | 0.84 | 0.66 | 0.04 | <0.001 | 0.58 | 0.75 | 0.73 | 0.03 | <0.001 | 0.67 | 0.80 | |
Poor | 0.83 | 0.08 | 0.05 | 0.69 | 1.00 | 0.74 | 0.12 | 0.08 | 0.53 | 1.03 | 0.80 | 0.06 | 0.01 | 0.69 | 0.93 | |
Two-week morbidity | No (reference) | |||||||||||||||
Yes | 1.01 | 0.09 | 0.92 | 0.85 | 1.20 | 1.11 | 0.14 | 0.40 | 0.87 | 1.41 | 1.04 | 0.08 | 0.63 | 0.89 | 1.21 | |
Chronic morbidity | No (reference) | |||||||||||||||
Yes | 1.24 | 0.07 | <0.001 | 1.11 | 1.38 | 1.44 | 0.17 | <0.001 | 1.13 | 1.82 | 1.30 | 0.06 | <0.001 | 1.18 | 1.43 | |
Radom effects (Level 2) | ||||||||||||||||
Variance (enrolment with local social health insurance) | 0.57 | 0.08 | 0.44 | 0.75 | 0.70 | 0.15 | 0.46 | 1.07 | 0.58 | 0.11 | 0.39 | 0.85 | ||||
Variance (intercept) | 2.74 | 0.18 | 2.42 | 3.11 | 1.92 | 0.17 | 1.62 | 2.27 | 2.56 | 0.18 | 2.22 | 2.95 | ||||
ICC | ||||||||||||||||
Empty model | 0.45 | 0.02 | 0.42 | 0.48 | 0.36 | 0.02 | 0.32 | 0.40 | 0.45 | 0.01 | 0.42 | 0.48 | ||||
Full model | 0.45 | 0.02 | 0.42 | 0.49 | 0.37 | 0.02 | 0.33 | 0.41 | 0.44 | 0.02 | 0.40 | 0.47 | ||||
Wald Chi Square test | ||||||||||||||||
Chi-Square | 372.43 | 184.3 | 422.56 | |||||||||||||
p value | <0.001 | <0.001 | <0.001 |
Variables | Rural to Urban Respondents | Urban to Urban Respondents | All Respondents | |||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
AOR/ICC † | SE | p Value | 95%CI | AOR/ICC | SE | p Value | 95%CI | AOR/ICC | SE | p Value | 95%CI | |||||
Fixed effects (Level 1) | ||||||||||||||||
Enrolment with a local social health insurance program | No (reference) | |||||||||||||||
Yes * | 1.24 | 0.08 | <0.001 | 1.09 | 1.42 | 1.09 | 0.09 | 0.32 | 0.92 | 1.28 | 1.18 | 0.06 | <0.001 | 1.06 | 1.30 | |
Gender | Male (reference) | |||||||||||||||
Female | 1.06 | 0.04 | 0.10 | 0.99 | 1.13 | 1.15 | 0.07 | 0.03 | 1.02 | 1.30 | 1.08 | 0.03 | 0.01 | 1.02 | 1.14 | |
Age (Years) | 15–24 (reference) | |||||||||||||||
25–34 | 1.09 | 0.08 | 0.21 | 0.95 | 1.25 | 0.90 | 0.13 | 0.46 | 0.68 | 1.19 | 1.05 | 0.06 | 0.42 | 0.93 | 1.18 | |
35–44 | 1.05 | 0.08 | 0.47 | 0.91 | 1.22 | 0.82 | 0.13 | 0.21 | 0.61 | 1.12 | 1.00 | 0.07 | 0.98 | 0.87 | 1.14 | |
45–54 | 0.91 | 0.07 | 0.24 | 0.79 | 1.06 | 0.84 | 0.13 | 0.28 | 0.62 | 1.15 | 0.89 | 0.06 | 0.10 | 0.78 | 1.02 | |
55+ | 1.02 | 0.11 | 0.88 | 0.82 | 1.27 | 0.85 | 0.17 | 0.42 | 0.58 | 1.26 | 0.97 | 0.09 | 0.75 | 0.82 | 1.16 | |
Marital status | Never married/Single (reference) | |||||||||||||||
Married | 1.02 | 0.08 | 0.75 | 0.89 | 1.18 | 1.08 | 0.13 | 0.55 | 0.85 | 1.37 | 1.03 | 0.08 | 0.73 | 0.89 | 1.18 | |
Divorced | 1.03 | 0.14 | 0.83 | 0.78 | 1.36 | 1.13 | 0.28 | 0.63 | 0.70 | 1.83 | 1.04 | 0.13 | 0.78 | 0.81 | 1.32 | |
Widowed | 0.90 | 0.19 | 0.60 | 0.60 | 1.34 | 1.47 | 0.41 | 0.17 | 0.85 | 2.53 | 0.99 | 0.18 | 0.98 | 0.70 | 1.41 | |
Educational attainment | Illiterate (reference) | |||||||||||||||
Primary school | 1.05 | 0.10 | 0.61 | 0.87 | 1.27 | 0.64 | 0.19 | 0.13 | 0.36 | 1.14 | 1.01 | 0.10 | 0.94 | 0.84 | 1.21 | |
Junior middle school | 1.14 | 0.11 | 0.17 | 0.94 | 1.38 | 0.66 | 0.20 | 0.16 | 0.37 | 1.18 | 1.09 | 0.10 | 0.32 | 0.92 | 1.29 | |
Senior middle school | 1.09 | 0.15 | 0.52 | 0.84 | 1.43 | 0.72 | 0.21 | 0.27 | 0.41 | 1.29 | 1.06 | 0.12 | 0.61 | 0.85 | 1.31 | |
University/college | 1.12 | 0.13 | 0.37 | 0.88 | 1.41 | 0.74 | 0.23 | 0.32 | 0.40 | 1.34 | 1.07 | 0.10 | 0.46 | 0.89 | 1.29 | |
Employment | Unemployed (reference) | |||||||||||||||
Employed | 0.89 | 0.04 | 0.02 | 0.81 | 0.98 | 1.13 | 0.12 | 0.24 | 0.92 | 1.40 | 0.94 | 0.04 | 0.13 | 0.86 | 1.02 | |
Household income ranking | Lowest (<percentile 20, reference) | |||||||||||||||
Lower (percentile 20–39.9) | 1.02 | 0.05 | 0.74 | 0.93 | 1.11 | 1.14 | 0.13 | 0.24 | 0.92 | 1.42 | 1.03 | 0.05 | 0.49 | 0.95 | 1.12 | |
Middle (percentile 40–59.9) | 1.00 | 0.06 | 0.95 | 0.90 | 1.12 | 1.15 | 0.14 | 0.24 | 0.91 | 1.46 | 1.03 | 0.05 | 0.63 | 0.93 | 1.14 | |
Higher (percentile 60–79.9) | 1.02 | 0.05 | 0.65 | 0.93 | 1.13 | 1.03 | 0.11 | 0.78 | 0.84 | 1.26 | 1.01 | 0.05 | 0.82 | 0.92 | 1.11 | |
Highest (≥percentile 80) | 1.07 | 0.08 | 0.42 | 0.92 | 1.24 | 0.96 | 0.12 | 0.77 | 0.76 | 1.23 | 1.01 | 0.07 | 0.84 | 0.88 | 1.17 | |
Type of social health insurance | BMIUR/RNCMS (reference) | |||||||||||||||
BMIUE | 0.83 | 0.07 | 0.02 | 0.71 | 0.97 | 0.95 | 0.09 | 0.62 | 0.80 | 1.14 | 0.85 | 0.05 | <0.001 | 0.76 | 0.95 | |
Others | 6.43 | 4.49 | 0.01 | 1.63 | 25.29 | 1.06 | 0.24 | 0.81 | 0.68 | 1.64 | 1.19 | 0.23 | 0.36 | 0.82 | 1.75 | |
Self-rating of health | Good (reference) | |||||||||||||||
General | 1.15 | 0.06 | 0.01 | 1.04 | 1.27 | 1.16 | 0.10 | 0.10 | 0.97 | 1.39 | 1.14 | 0.05 | <0.001 | 1.05 | 1.25 | |
Poor | 1.81 | 0.18 | <0.001 | 1.49 | 2.20 | 1.87 | 0.45 | 0.01 | 1.16 | 3.01 | 1.80 | 0.19 | <0.001 | 1.47 | 2.20 | |
Two-week morbidity | No (reference) | |||||||||||||||
Yes | 1.21 | 0.06 | <0.001 | 1.10 | 1.34 | 1.20 | 0.11 | 0.05 | 1.00 | 1.45 | 1.21 | 0.06 | <0.001 | 1.10 | 1.32 | |
Chronic morbidity | No (reference) | |||||||||||||||
Yes | 1.30 | 0.10 | <0.001 | 1.12 | 1.51 | 1.39 | 0.18 | 0.01 | 1.08 | 1.80 | 1.33 | 0.09 | <0.001 | 1.16 | 1.52 | |
Radom effects (Level 2) | ||||||||||||||||
Variance (enrolment with local social health insurance) | 0.36 | 0.07 | 0.25 | 0.52 | 0.21 | 0.07 | 0.11 | 0.41 | 0.26 | 0.04 | 0.19 | 0.36 | ||||
Variance (intercept) | 0.37 | 0.04 | 0.31 | 0.45 | 0.39 | 0.06 | 0.29 | 0.53 | 0.38 | 0.03 | 0.32 | 0.45 | ||||
ICC | ||||||||||||||||
Empty model | 0.10 | 0.01 | 0.09 | 0.12 | 0.10 | 0.01 | 0.08 | 0.13 | 0.10 | 0.01 | 0.09 | 0.12 | ||||
Full model | 0.10 | 0.01 | 0.09 | 0.12 | 0.11 | 0.01 | 0.08 | 0.14 | 0.10 | 0.01 | 0.09 | 0.12 | ||||
Wald Chi Square test | ||||||||||||||||
Chi-Square | 178.31 | 84.32 | 216.78 | |||||||||||||
p value | <0.001 | <0.001 | <0.001 |
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Share and Cite
Yao, Q.; Liu, C.; Sun, J. Inequality in Health Services for Internal Migrants in China: A National Cross-Sectional Study on the Role of Fund Location of Social Health Insurance. Int. J. Environ. Res. Public Health 2020, 17, 6327. https://doi.org/10.3390/ijerph17176327
Yao Q, Liu C, Sun J. Inequality in Health Services for Internal Migrants in China: A National Cross-Sectional Study on the Role of Fund Location of Social Health Insurance. International Journal of Environmental Research and Public Health. 2020; 17(17):6327. https://doi.org/10.3390/ijerph17176327
Chicago/Turabian StyleYao, Qiang, Chaojie Liu, and Ju Sun. 2020. "Inequality in Health Services for Internal Migrants in China: A National Cross-Sectional Study on the Role of Fund Location of Social Health Insurance" International Journal of Environmental Research and Public Health 17, no. 17: 6327. https://doi.org/10.3390/ijerph17176327