Sustainable Development of China’s Maternity Insurance System in the Context of Population Policy Changes: Using a Grounded Theory Approach
Abstract
:1. Introduction
2. Methods
2.1. Study Design
2.2. Case Selection and Data Acquisition
2.3. Ethical Considerations
3. Results
3.1. Initial Coding
3.2. Axial Coding
3.3. Theoretical Coding
3.3.1. Institutional Change—Sustainable Development of MIS
3.3.2. Operation of the Maternity Insurance Fund—Sustainable Development of MIS
3.3.3. Financing of Maternity Insurance Funds—Sustainable Development of MIS
3.3.4. Expenditure of the Maternity Insurance Fund—Sustainable Development of the MIS
3.3.5. Level of MIS Coverage—Sustainable Development of MIS
3.3.6. Willingness to Have Children—Sustainable Development of MIS
3.3.7. National Health Insurance Fund Operation—Sustainable Development of MIS
4. Discussion and Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Acknowledgments
Conflicts of Interest
Appendix A. Full Initial Coding List
Full Initial Coding List | ||
No. | Type | Interview Content Coding |
1 | Researcher | A1 can judge the sustainable state of maternity insurance fund by the current balance and accumulated balance; A2 The per capita income of local employees will affect the revenue of the fund; The dynamic adjustment of A3 pooling fund policy can ensure its dynamic adaptability; A4 Per capita insurance expenses should be commensurate with the local per capita GDP level; A5 The public’s response to the reform and change of maternity insurance system, and the degree of support; A6 Response of medical institutions to the reform and change of maternity insurance system; A7 The degree of implementation of the reform and change of maternity insurance system by insurance handling personnel and implementation personnel; A8 The degree of cognition, attitude, understanding, and support for the birth policy; A9 Changes in payment rates shall be in line with actual conditions. |
2 | Researcher | A10 Comprehensive two-child policy destroys the balance of maternity insurance fund; A11 The increase in the number of participants has a positive impact on the fund balance; A12 Payment rate adjustments should be scientifically determined to prevent excessive surpluses or deficits. |
3 | Researcher | A13 The balance of maternity insurance fund is mainly considered from two aspects: financing and payment; A14 Any factor affecting the financing or disbursement of the fund will have an impact on the balance of the fund; A15 The funding level of maternity insurance fund is much lower than that of medical insurance; A16 The number of insured payers is a direct factor affecting the level of financing; A17 Payment rate directly affects the level of financing; A18 Contributory wage base also affects financing level; A19 The average salary of employees is linked to the level of social and economic development; A20 The number of insurance participants is affected by the structure of employees; A21 Some factors will indirectly affect the scale of fund financing; A22 The type, level and mode, of payment affect the expenditure of maternity insurance fund. |
4 | Researcher | A23 The number of people covered by the maternity insurance system directly affects their income; A24 Payment rate is a direct factor affecting the amount of financing; A25 Contributory wage base is a direct factor affecting the amount of financing; A26 The more people who participate in maternity insurance, the greater the amount of funds raised by maternity insurance fund; A27 The higher the premium rate of maternity insurance, the more funds raised by the maternity insurance fund; A28 The larger the wage base, the more funds raised; A29 The structure of active and retired personnel is an indirect influencing factor; A30 The level of social and economic development is an indirect factor; A31 Population flow is an indirect factor; A32 Bank interest rate is an indirect factor. |
5 | Implementer | A33 Before the adjustment of the payment rate, the accumulative balance of maternity insurance fund will be paid for approximately 6 to 9 months; A34 Risk margin withdrawal ratio is 10–15%; The A35 vaginal birth costs approximately 5000 yuan, of which 3000 is paid by the maternity insurance fund. The C-section costs approximately 8000 yuan, of which 5000 is paid by the maternity insurance fund. Among A36 insured people, floating population is a gap and gap at present, which will increase financing revenue after all of them are included. A37 The scope of the two-child policy is very small, so the comprehensive two-child policy may have a greater impact on the maternity insurance fund. The economic development level of A38 Z city also affects the fund-raising level of maternity insurance fund |
6 | Developer | A39 Payment rate will be changed from fixed rate to dynamic floating rate; A40 At present, maternity insurance funds in the province are mainly the data of actual receipts and disbursements, while the data of receivables and disbursements cannot be revealed; A41 Maternity insurance fund management level is still in a relatively extensive degree; For A42, population policy directly affects the number of second children, and people’s fertility intention is also an important factor. The price reform of A43 public hospital reduces the price of drugs, increases the cost of diagnosis and treatment items, and increases the expenditure of maternity insurance; A44 After the relaxation of the two-child policy, there will be an increase in the number of elderly women, which may lead to an increase in the rate of dystocia and expenditure; A45 In the future, if the cost of midwifery is added to maternity insurance, the fund expenditure will also increase; A46 At present, it is difficult to determine the risk control point when the payment rate should be raised or lowered; A47 Individual expenditure treatment needs to be cancelled in some regions to unify and standardize expenditure items; A48 Bank interest rate and individual tax deduction policy also affect the revenue of the maternity insurance fund to a certain extent |
7 | Developer | A49 The average annual salary of employees affects the revenue of maternity insurance fund; A50 The number of insured people, the number of on-the-job workers and the number of workers with labor relations all affect the revenue of maternity insurance fund; The management of A51 maternity insurance fund is also very important, which is well managed. There are N cities and C cities in J province at present, and the balance is relatively large. The longitudinal time axis of the treatment level of A52 fluctuates greatly, with an annual increase rate of approximately 10%; A53 Maternity insurance fund settlement method currently has pay by disease, pay by unit, etc., not unified, so the treatment level of fund expenditure in each city is not the same, the goal of the future needs to achieve unified treatment; A54 At present, the pooling level of maternity insurance fund is municipal-level pooling, which is weak in risk resistance, and some cities have deficits. The number of insured people in A55 J province continues to rise, by several million each year. The number of second children in A56 is different in different parts of J Province. The number of births in N2 has a small change, while the number of births in H has a large increase, but on the whole the number is less than the predicted number; A57 Childcare services, educational resources, housing price regulation, and other factors indirectly affect people’s willingness to have children, thus affecting the number of second children. |
8 | Researcher | A58 China’s population structure affects the number of births; A59 The willingness to have children affects the implementation of the two-child policy; A60 It will be more scientific to consider the financing according to the expenditure of maternity insurance fund, but how to forecast is a problem; The contents of A61 maternity insurance subsidies are also changing; A62 Gross regional product affects the revenue of public insurance, and funding levels are different in different regions; A63 reducing the payment rate can rapidly consume the accumulated balance of the maternity insurance fund in a short term; A64 The difference between the expenditure policy of the maternity insurance fund for the second child and that of the first child will also affect the sustainability of the fund; A65 Fertility surveys are important. |
9 | Researcher | A66 The future trend is to further improve maternity subsidies; A67 On the sustainable development of the maternity insurance fund to share the concept, improving the overall planning level is the development trend; A68 for the sustainable development of maternity insurance fund to have foresight, it should dynamically grasp the adjustment of payment rates; A69 If maternity insurance and medical insurance are combined in the future, the fund pool reserves of medical insurance fund will be much larger than maternity insurance fund, which can improve the sustainability of maternity insurance fund; If A70 is merged, the sustainability of medical insurance fund will affect the sustainability of maternity insurance fund. |
10 | Implementer | A71 At present, the balance of maternity insurance fund in various cities is not balanced; A72 With the increase of wage income, the fund-raising level of maternity insurance fund is also improving; A73 Due to the implementation of the two-child policy, both the Ministry of Finance and J Province have issued some documents. Specifically, we can pay attention to The No. 70 document of the Ministry of Finance and No. 331 document of J Province; A74 In the future, if maternity insurance and medical insurance merge, this does not represent the disappearance of maternity insurance, because in function, maternity insurance can guarantee the rights and interests of female workers; A75 If the two insurances are successfully merged, the revenue and expenditure of urban employee medical insurance will also indirectly affect the sustainability of maternity insurance fund. |
11 | Developer | In terms of policy A76, the fifth Plenary Session of the 13th Central Committee of the Communist Party of China issued a two-child policy, which will affect the sustainability of the maternity insurance fund; A77 In terms of economy, the large economic environment affects the GDP growth rate of our province, and the GDP growth rate affects the growth of the average annual wage of our province. The average annual wage is the source of the contribution base of maternity insurance. All these factors affect the sustainability of maternity insurance fund; A78 In terms of population, the total population affects the number of employees on the job, and the number of employees on the job affects the number of insured people, which in turn affects the sustainability of maternity insurance fund. At present, China is confronted with the crisis of birth decreases and population aging, so the national government adjusts the population policy to increase the birth population and slow down the sudden arrival of the aging society. |
12 | Implementer | The maternity insurance fund of A80 N2 city is currently in deficit, which is related to the insured personnel structure and financing level of N2 City; A81 can establish a monitoring system to predict the state of maternity insurance fund in the short and medium term and adjust the payment rate in real time; A82 Mining scientific and reasonable risk indicators, conducive to the sustainable maternity insurance fund; The accumulated balance of maternity insurance fund in A83 N2 is less than 15 months income; A84 In the expenditure of maternity insurance fund, the proportion of maternity allowance is the largest; A85 suggests that J province improve the pooling level and uniformly collect the risk adjustment fund with the province as the unit. |
13 | Implementer | Maternity insurance was implemented in A86H city in 1995. The initial payment rate of enterprise employees was 0.5%, mainly including medical expenses and maternity allowance; A87 The maternity insurance fund of H city was managed by the Pension Insurance Office of H City from 1995 to 2002; A88 In 2002, H City decreed No. 161 to expand the scope of insured people, with a payment rate of 0.7% in urban areas and 1% in new areas; A89 The balance rate of maternity insurance fund in H city from 2002 to 2008 was ≥50%, and the fund has been in a sustainable state; A90 In 2008, the maternity insurance fund of H city added expenses for treatment of related complications and physical examination expenses. |
14 | Implementer | A91 At present, the balance rate of maternity insurance fund in H city is less than 50%. In 2015, the balance rate of maternity insurance fund in H City is approximately 10%, which has been continuously consuming the accumulated balance; A92 The non-coverage of maternity insurance in H city was extended to public institutions in 2010, and to Party and government offices in 2014; A93 In 2014, Jiangsu Province issued Decree No. 94, which unified the payment rate and payment treatment level of H city; The cost of maternity insurance for freelancers in the municipality of A94 H is covered by a share of the medical insurance fund; A95 In 2014, H city realized municipal pooling, and the risk adjustment fund, was set at 10% of the annual income; A96 H city currently pays approximately 1200 yuan for prenatal treatment and 4000 yuan to 5000 yuan for childbirth; A97 In 2015, the maternity insurance fund deficit of QH District in H city was 3 million yuan, mainly due to the increase of medical service costs and the large number of female employees in the district. |
15 | Implementer | A98 Generally, there is no problem that the maternity insurance fund in W city can maintain operation for 2–3 years under the current payment rate; A99 in 2008, maternity insurance began to distribute medical cards. The maternity allowance was initially issued to individuals, and began to be settled directly with the unit in 2005; A100 The medical cost of childbirth is an uncertain factor, especially in the treatment of complications, which will increase the expenditure of maternity insurance fund; A101 With the changes of the system, if the combined medical insurance and maternity insurance fund are successfully merged in the future, it is believed that the operation pressure of maternity insurance fund will be relieved. |
16 | Implementer | A102 C The maternity insurance fund of The City is in a current deficit and intends to adjust the payment rate; A103 Strengthen management, strengthening monitoring can promote scientific throttling; The city will also expand maternity insurance coverage, as freelancers currently only opt for pension and medical insurance. |
17 | Implementer | A105 To predict the sustainable development of maternity insurance fund, we should consider the change trend of revenue and expenditure of maternity insurance fund; A106 From the perspective of S city, the influencing factors of maternity insurance fund are not only payment rate; A107 From the operation status of maternity insurance fund in S City, the average annual salary affects the payment base; A108 The quality and fees of maternity insurance treatment items affect the level of maternity insurance treatment; At present, the treatment items of A109 maternity insurance mainly include the cost of family planning operation, nutrition subsidy, prenatal examination, hospital delivery, and maternity allowance, among which the maternity allowance is the major expenditure. |
18 | Developer | At present, the implementation of the combination of maternity insurance and medical insurance is only a pilot project. In the future, it is not possible to directly merge the system from the legal level. It should be merged from the management level first, and the types of maternity insurance should be retained. A111 National ministries and commissions believe that the management should be consolidated, insurance types retained, and treatment adjusted to reduce the management cost and improve the efficiency of maternity insurance. |
19 | Developer | A112 The merger of maternity insurance and medical insurance is now in the pilot stage. The following points should be done in the implementation of the merger in the future; A113 Unified insurance registration, that is, when participating in medical insurance, is regarded as simultaneous participation in maternity insurance; A114 Medical insurance fund and birth insurance fund unified collection and management, this point is important in the actual process of operation because the situation is not the same, the implementation is more difficult; A115 Harmonize the management of medical services, which is relatively easy and requires agreements with designated medical institutions; A116 Maternity insurance benefits should not be reduced, which is the cornerstone of the protection of women’s rights; When compared with some other provinces, there are more one-time nutrition subsidies for maternity insurance treatment projects in A117 J Province; A118 Currently flexible employment personnel are not insured and there is no maternity allowance, which is inconsistent with the contents of Decree No. 94 of J Province. The coverage of maternity insurance should be further expanded in the future; A119 Unemployed women and unemployed male spouses are coverage blind spots. |
20 | Researcher | A120 Maternity insurance and medical insurance have different financing principles and paths, respectively, so it is difficult to merge directly; A121 There is a legal difference between maternity insurance and medical insurance, and the nature of maternity allowance and medical expenses is different, so whether it needs to be merged is a problem; After the merger of the A122 hypothesis, should the one-time nutrition benefit continue to exist? |
21 | Researcher | A123 J province has the lowest maternal mortality rate in the country; A124 However, the proportion of Cesarean sections in J province is increasing, approximately 50–80%, and the national average normal rate is approximately 26%; A125 In terms of insured population, the two are different, mainly affected by the number of insured and insured rate; A126 The fund raising composition of medical treatment insurance and birth insurance is different, medical treatment insurance is divided into unit and individual pay charges, two parts, birth insurance is unit direct pay. |
22 | Implementer | The maternity insurance benefits in A127 N1 city are 800 yuan more than last year for natural birth and approximately 4600 yuan for Cesarean section; A128 The fundraising principles of maternity insurance fund and medical insurance fund are different, medical insurance fund is settled with revenue, maternity insurance fund is settled with revenue; A129 Currently, maternity insurance fund and medical insurance fund are managed separately, kept separately, and paid separately; A130 N1 Maternity insurance and medical insurance coverage is inconsistent, maternity insurance does not cover retirees; A131 The individual and the unit shall pay part of the contribution for medical insurance, and the unit only needs to pay for maternity insurance; A132 The comprehensive two-child policy has impacted maternity insurance funds, and the combined implementation can greatly improve the sustainability of maternity insurance funds; A133 The treatment items of maternity insurance are different from medical insurance; A134 The size of the maternity insurance fund can be said to be very small when compared to the size of the medical insurance fund; A135 The annual per capita expenditure of the medical insurance fund is higher than that of the maternity insurance fund. |
23 | Implementer | A136 X city currently uses a single disease payment mechanism to guide the reduction of Cesarean section rates, which have been reduced from 70 to 80 to 50%, reducing the expenditure of maternity insurance funds; A137 Policy guidance is very important for the sustainable development of maternity insurance fund; A138 fully agrees with the combination of maternity insurance and medical insurance in the future, which is conducive to the implementation of the new national population policy; A139 The combination of the two insurance schemes will help to reverse the decline in the number of births, thus helping to alleviate the problem of an aging society. |
24 | Implementer | A140 City of Z’s current maternity insurance pooling fund is in overspend operation state; In A141 Z, due to the pilot medical insurance policy, the budget balance of individual account of medical insurance fund is large. If maternity insurance and medical insurance in A142 city of Z are to be implemented together, it is necessary to scientifically adjust the account structure and ceiling line; A143 Although the state has introduced the two-child policy, individual fertility will not be ignored. Fertility will be affected by educational resources; A144 Housing price regulation strategies and housing price level also affect the willingness to have children. |
References
- Sethi, N.; Jena, N.R.; Loganathan, N. Does financial development influence fertility rate in South Asian economies? An empirical insight. Bus. Strat. Dev. 2021, 4, 94–108. [Google Scholar] [CrossRef]
- Pezzulo, C.; Nilsen, K.; Carioli, A.; Tejedor-Garavito, N.; Hanspal, S.E.; Hilber, T.; James, W.H.M.; Ruktanonchai, C.W.; Alegana, V.; Sorichetta, A. Geographical distribution of fertility rates in 70 low-income, lower-middle-income, and upper-middle-income countries, 2010–16: A subnational analysis of cross-sectional surveys. Lancet Glob. Health. 2021, 9, E802–E812. [Google Scholar] [CrossRef]
- Zoeller, G.E.; Drew, B.L.; Schmidt, C.W.; Peterson, R.; Wilson, J.J. A paleodemographic assessment of mortality and fertility rates during the second demographic transition in rural central Indiana. Am. J. Hum. Biol. 2021, 34, e23571. [Google Scholar] [CrossRef] [PubMed]
- Jakovljevic, M.M.; Netz, Y.; Buttigieg, S.C.; Adany, R.; Laaser, U.; Varjacic, M. Population aging and migration—History and UN forecasts in the EU-28 and its east and south near neighborhood—One century perspective 1950–2050. Glob. Health 2018, 14, 30. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Eroğlu, K.; Koruk, F.; Koruk, I.; Çelik, K.; Güner, P.; Kiliçli, A. Women’s reproductive behaviour and perspectives on fertility, and their modifying factors, in a Turkish province with a high fertility rate. Eur. J. Contracept. Reprod. Health Care 2021, 26, 139–147. [Google Scholar] [CrossRef]
- Segura-Sampedro, J.J. Foreplay, a selected strategy that might be able to increase fertility rates. Med. Hypotheses 2016, 91, 32–33. [Google Scholar] [CrossRef] [PubMed]
- Gandasegui, V.D.; Miguel, B.E.-S.; Sanz, M.T. Back to the Future: A Sensitivity Analysis to Predict Future Fertility Rates Considering the Influence of Family Policies—The Cases of Spain and Norway. Soc. Indic. Res. 2021, 154, 943–968. [Google Scholar] [CrossRef]
- Lass, A.; Lass, G. Is there a correlation between total fertility rate, utilization of assisted reproduction technology, and national wealth in Europe? J. Med Econ. 2021, 24, 536–539. [Google Scholar] [CrossRef]
- Hong, C.-H.; Gilbert, N. Cognitive Dissonance and Fertility Rates: A Comparative Analysis of Attitudes toward the Gender Division of Labour in East Asian and Western Industrial Societies. Soc. Policy Soc. 2021, 20, 44–61. [Google Scholar] [CrossRef]
- Mahmoodkhani, M.; Saboory, E.; Roshan-Milani, S.; Azizi, N.; Karimipour, M.; Rasmi, Y.; Gholinejad, Z. Pregestational stress attenuated fertility rate in dams and increased seizure susceptibility in offspring. Epilepsy Behav. 2018, 79, 174–179. [Google Scholar] [CrossRef]
- Jia, N.; Dong, X.-Y.; Song, Y.-P. Paid Maternity Leave and Breastfeeding in Urban China. Fem. Econ. 2018, 24, 31–53. [Google Scholar] [CrossRef] [Green Version]
- Zhang, X.T.; Zhou, L.L.; Antwi, H.A. The impact of China’s latest population policy changes on maternity insurance—A case study in Jiangsu Province. Int. J. Health Plan M 2019, 34, E617–E633. [Google Scholar] [CrossRef] [Green Version]
- Liu, T.; Sun, L. Maternity Insurance in China: Global Standards and Local Responses. Asian Women Win 2015, 31, 23–51. [Google Scholar] [CrossRef]
- Huang, J.; Yuan, L.; Liang, H. Which Matters for Medical Utilization Equity under Universal Coverage: Insurance System, Region or SES. Int. J. Environ. Res. Public Health 2020, 17, 4131. [Google Scholar] [CrossRef] [PubMed]
- Antwi, H.A.; Zhou, L.; Xu, X.; Mustafa, T. A Comparative Analysis of Impact of Universal Two-Child Policy on Maternity Insurance Fund in Jiangsu Province and Guangxi Zhuang AR. Healthcare 2021, 9, 468. [Google Scholar] [CrossRef]
- Chang, S.; Yang, W.; Deguchi, H. Care providers, access to care, and the Long-term Care Nursing Insurance in China: An agent-based simulation. Soc. Sci. Med. 2020, 244, 112667. [Google Scholar] [CrossRef]
- Chen, S.; Chen, Y.; Feng, Z.; Chen, X.; Wang, Z.; Zhu, J.; Jin, J.; Yao, Q.; Xiang, L.; Yao, L.; et al. Barriers of effective health insurance coverage for rural-to-urban migrant workers in China: A systematic review and policy gap analysis. BMC Public Health 2020, 20, 1–16. [Google Scholar] [CrossRef]
- Zang, W.J.; Zhao, Y.J. The Study of Chinese Maternity Insurance Issues. Adv. Educ Res. 2014, 49, 245–248. [Google Scholar]
- Listyowardojo, T.A.; Yan, X.; Leyshon, S.; Ray-Sannerud, B.; Yu, X.Y.; Zheng, K.; Duan, T. A safety culture assessment by mixed methods at a public maternity and infant hospital in China. J. Multidiscip. Health 2017, 10, 253–262. [Google Scholar] [CrossRef] [Green Version]
- Ke, Y. The Adjustments of the Maternity Insurance System in Consequence of Two-Child Policy in China. In Proceedings of the 2017 International Conference on Innovations in Economic Management and Social Science (IEMSS 2017), Hangzhou, China, 15–16 April 2017; Atlantis Press: Paris, France, 2017; Volume 29, pp. 818–820. [Google Scholar]
- Chen, J. Consider fund balance as the blood pressure of the life of the system. China Health Insur. 2011, 30, 10–11. (In Chinese) [Google Scholar]
- Shi, Y. Long-term equilibrium of the Fund: A review of the final project and workshop on “Equilibrium mechanisms and risk control of the Health Insurance Fund”. China Med. Insur. 2012, 8, 30–31. (In Chinese) [Google Scholar]
- Zhan, C.; Li, Y.; Lu, Z. Fund Balance Mechanism of the Integration Between the Maternity Insurance and Medical Insurance: Under the Policy of Universal Two-Child Family Plan. Econ. Surv. 2018, 35, 153–159. (In Chinese) [Google Scholar]
- Zhang, L. Factors Influencing the Affordability of Social Health Insurance Funds and Evaluation. Ph.D. Thesis, Nanjing University, Nanjing, China, 2013. [Google Scholar]
- An, N.; Zhou, L.L.; Zhang, X.J. Constructing the Evaluation Index System for the Implementation Effectiveness of the Combination of Maternity Insurance and Employee Basic Medical Insurance. Chin. Health Econ. 2019, 38, 29–32. (In Chinese) [Google Scholar]
- Einarsdóttir, K. Changes in maximum parental leave payment in Iceland and total fertility rates. Scand. J. Public Health 2021. online first. [Google Scholar] [CrossRef]
- Son, Y.J. Do childbirth grants increase the fertility rate? Policy impacts in South Korea. Rev. Econ. Househ. 2017, 16, 713–735. [Google Scholar] [CrossRef]
- Xie, L.; Wang, H.W. Research on the Operation Module of Maternity Insurance Fund. In Proceedings of the 2012 International Conference on Management Innovation and Public Policy (Icmipp 2012), Chongqing, China, 11–14 November 2012; Volumes 1–6, pp. 2877–2882. [Google Scholar]
- Corbin, J.; Strauss, A. Grounded Theory Research—Procedures, Canons and Evaluative Criteria. Z Soziol. 1990, 19, 418–427. [Google Scholar] [CrossRef]
- Kim, J.; Lee, J.; Lee, T. The Sustainable Success and Growth of Social Ventures: Their Internal and External Factors. Sustainability 2021, 13, 5005. [Google Scholar] [CrossRef]
- Neyman, J. On the Two Different Aspects of the Representative Method: The Method of Stratified Sampling and the Method of Purposive Selection. J. R. Stat. Soc. 1934, 97, 558. [Google Scholar] [CrossRef]
- Corbin, J.; Strauss, A. Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory, 3rd ed.; Sage: Thousand Oaks, CA, USA, 2008. [Google Scholar] [CrossRef]
- Huang, Y.; Han, S. Explaining social insurance participation: The importance of the social construction of target groups in China. Policy Stud. 2021, 5, 1–21. [Google Scholar] [CrossRef]
- Lamnisos, D.; Giannakou, K.; Jakovljevic, M. (Michael) Demographic forecasting of population aging in Greece and Cyprus: One big challenge for the Mediterranean health and social system long-term sustainability. Health Res. Policy Syst. 2021, 19, 1–8. [Google Scholar] [CrossRef]
- Clark, W.A.; Yi, D.; Zhang, X. Do House Prices Affect Fertility Behavior in China? An Empirical Examination. Int. Reg. Sci. Rev. 2020, 43, 423–449. [Google Scholar] [CrossRef]
- Shi, Y.; Zhang, J. On high fertility rates in developing countries: Birth limits, birth taxes, or education subsidies? J. Popul. Econ. 2009, 22, 603–640. [Google Scholar] [CrossRef]
Interviewee | Type | Title | Source | Gender | Age |
---|---|---|---|---|---|
1 | researcher | Professor | University | M | 40’s |
2 | researcher | Professor | University | M | 40’s |
3 | researcher | Professor | University | M | 30’s |
4 | researcher | Professor | University | M | 50’s |
5 | implementer | Section Chief | HRSSB of city Z | M | 30’s |
6 | developer | Division Director | HISC of J Province | M | 40’s |
7 | developer | Deputy Division Director | HISC of J Province | F | 30’s |
8 | researcher | Professor | University | M | 30’s |
9 | researcher | Professor | University | M | 40’s |
10 | implementer | Section Chief | HRSSB of city N | M | 40’s |
11 | developer | Consultant | HIB of J Province | M | 60’s |
12 | implementer | Section Chief | HISC of city N2 | M | 30’s |
13 | implementer | Section Chief | HRSSB of city H | M | 40’s |
14 | implementer | Section Chief | HIB of city H | M | 30’s |
15 | implementer | Section Chief | HIB of city W | M | 30’s |
16 | implementer | Section Chief | HIB of city C | M | 40’s |
17 | implementer | Section Chief | HIB of city S | F | 40’s |
18 | developer | Division Director | HIB of J Province | M | 50’s |
19 | developer | Section Chief | HIB of J Province | M | 40’s |
20 | researcher | Professor | University | F | 40’s |
21 | researcher | Professor | University | M | 50’s |
22 | implementer | Section Chief | HISC of city N2 | M | 40’s |
23 | implementer | Section Chief | HIB of city X | M | 40’s |
24 | implementer | Deputy Division Director | HRSSB of city Z | M | 40’s |
No. | Type | Interview Content Codes |
---|---|---|
1 | Researcher from University | A1 The sustainability of the fund can be judged by the current balance and accumulated balance of the maternity insurance fund; A2 The per capita income of local employees affects the revenue of the fund; A3 The dynamic adjustment of the policy of the unified fund can ensure its dynamic adaptability; A4 The per capita insurance cost expenditure should be in line with the level of local GDP per capita; A5 The reaction of the public to the reform and changes of the maternity insurance system, and degree of support; A6 The response of medical institutions in the face of the reform and changes in the MIS; A7 The degree of implementation of the reform and changes in the MIS by insurance administrators and executive implementers; A8 The degree of awareness, attitude, understanding and support for the maternity policy; A9 Changes in contribution rates should be commensurate with the actual situation. |
... | ... | ... |
24 | Implementer from Human resources and Social Security Bureau in city Z | A140 City Z is currently operating in a state of overspending in the maternity insurance coordination fund; A141 City Z has a large budget balance in the individual account of the health insurance fund due to the pilot health insurance policy; A142 City Z needs to scientifically adjust the account structure and cap line if maternity insurance and health insurance are to be implemented together; A143 Although the state has introduced the two-child policy, individual willingness to have children cannot be ignored; A144 The strategy for regulating housing prices and the level of housing prices also affects the willingness to have children. |
Main-Category | Sub-Category | Frequency | The Connotation of Initial Coding | Dimension |
---|---|---|---|---|
Institutional change 20.13% | Comprehensive two-child policy | 7 | After the implementation of the comprehensive two-child policy, the number of births covered by the maternity insurance fund increased and the cost of expenditure from the fund increased | Policy |
Two insurance policies combined | 13 | To avoid overwhelming the maternity insurance fund after the implementation of the comprehensive two-child policy, the state proposes to merge maternity insurance with medical insurance | Policy | |
Dynamic Contribution Rate Policy | 4 | Dynamic adjustment of contribution rates can effectively hedge against the collapse of maternity insurance funds | Policy | |
Drug price reform | 1 | The price reform in public hospitals has led to a decrease in the price of drugs and an increase in the cost of treatment items, resulting in an increase in maternity insurance expenses | Policy | |
Reforming the level of integration | 2 | The sustainable development of the maternity insurance fund should be based on the concept of sharing, and the trend is to increase the level of coordination in the future | Policy | |
Social crisis | 2 | Social crises such as declining births and aging populations contribute to changes in population policies and thus influence changes in MIS | Social environment | |
Operation of the Maternity Insurance Fund 15.28% | Cumulative balance | 7 | The higher the accumulated balance, the more sustainable the maternity insurance fund will be | Economy |
Risk margin situation | 2 | Risk margin will be used when the fund falls short of its revenue and expenditure | Economy | |
Fund Management | 8 | Improving the management of maternity insurance funds can improve the efficiency of fund operations | Management | |
Deficit situation | 5 | Current deficits will ring alarm bells, cumulative deficits herald fund collapse | Economy | |
Funding of the maternity insurance fund 20.13% | Contribution rate | 13 | Contribution rates are determined by national policy and are a very direct and important factor affecting the revenue of maternity insurance funds | Economy |
Contribution base | 12 | The average contribution base of the maternity insurance fund should have been the average social wage, the size of which is positively related to the revenue of the social insurance fund | Economy | |
Gross regional product (GDP) | 4 | Gross regional product corresponds to the general economic environment of the region and affects people’s income | Economy | |
Expenditure from the maternity insurance fund 16.67% | Level of entitlement per capita | 13 | Level of total annual maternity insurance fund expenditure apportioned to each individual | Economy |
Maternity insurance fund expenditure items | 9 | The expenditure of the maternity insurance fund mainly covers prenatal check-ups, one-off nutrition benefits, maternity allowances, cesarean sections, treatment of complications, hospital deliveries, family planning operations, etc. The more items there are, the more likely it is that the expenditure will increase | Economy | |
Number of beneficiaries | 2 | The higher the number of people entitled to maternity insurance benefits, the greater the expenditure of the maternity insurance fund and vice versa | Population | |
Level of maternity insurance coverage 11.81% | Number of insured persons | 9 | The number of participants is an important factor affecting the revenue of the social insurance fund, and to a certain extent, it has a positive relationship with the revenue of the social insurance fund, i.e., the greater the number of participants, the greater the revenue of the social insurance fund | Population |
Population movements | 3 | Mobile population as a potential insured population | Population | |
Coverage | 5 | Expanding coverage can boost maternity insurance fund revenue | Population | |
Willingness to have children 4.86% | Fertility Policy Awareness | 2 | A high level of awareness can increase willingness to have children | Policy |
Bank Rate | 1 | Boosting or reducing income affects willingness to have children | Economy | |
Personal tax deductions | 1 | Boosting or reducing income is associated with financial stress | Economy | |
Childcare services | 1 | A good package of childcare services can reduce the pressure on people who have children | Education Services | |
Education offers | 1 | Excellent education policies can reduce the pressure on people who give birth | Education Services | |
House price control | 1 | Reasonable house prices allow people with children to put their worries aside | Economy | |
Health insurance fund performance 11.11% | Funding levels | 5 | If the two insurances are combined, the higher the level of funding of the health insurance fund the higher the sustainability of the fund, which in turn affects the sustainability of the maternity insurance fund | Economy |
Expenditure profile | 5 | A reasonable level of expenditure is conducive to the sustainability of the health insurance fund, which in turn affects the sustainability of the maternity insurance fund | Economy | |
Fund pool cumulative holdings | 4 | The accumulated pool of the medical insurance fund is much larger than the maternity insurance fund, and if combined, could improve the sustainability of the maternity insurance fund | Economy | |
Population insured | 2 | The higher the coverage of the insured population, the higher the revenue of the health insurance fund | Population |
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Zhang, X.; Liu, X.; Wang, Y.; Zhou, L.; Cheng, X. Sustainable Development of China’s Maternity Insurance System in the Context of Population Policy Changes: Using a Grounded Theory Approach. Sustainability 2022, 14, 2138. https://doi.org/10.3390/su14042138
Zhang X, Liu X, Wang Y, Zhou L, Cheng X. Sustainable Development of China’s Maternity Insurance System in the Context of Population Policy Changes: Using a Grounded Theory Approach. Sustainability. 2022; 14(4):2138. https://doi.org/10.3390/su14042138
Chicago/Turabian StyleZhang, Xiaotian, Xiaoyun Liu, Yang Wang, Lulin Zhou, and Xiaoran Cheng. 2022. "Sustainable Development of China’s Maternity Insurance System in the Context of Population Policy Changes: Using a Grounded Theory Approach" Sustainability 14, no. 4: 2138. https://doi.org/10.3390/su14042138