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Multi-Level Social Health Insurance System in the Age of Frequent Employment Change: The Urban Unemployment-Induced Insurance Transition and Healthcare Utilization in China

1
Center for Tourism Development Planning and Research, School of Tourism Management, Sun Yat-sen University, West Xingang Rd. 135, Guangzhou 510275, China
2
International School of Business & Finance, Sun Yat-sen University, West Xingang Rd. 135, Guangzhou 510275, China
3
School of Economics and Management, Shenyang Agricultural University, Shenyang 110041, China
*
Authors to whom correspondence should be addressed.
Healthcare 2019, 7(2), 77; https://doi.org/10.3390/healthcare7020077
Received: 25 April 2019 / Revised: 30 May 2019 / Accepted: 11 June 2019 / Published: 13 June 2019
Job tenure has been significantly shortened with the prevalence of the gig economy around the world. Workers are faced with a new age of frequent employment change. This emerging situation is out of expectation of social health insurance policymakers. As the multi-level social health insurance system in China is closely associated with employment status; urban workers cannot enjoy the urban employee basic medical insurance (UEBMI) during the unemployment period. At this time, unemployed rural-to-urban migrant workers can only rely on the new cooperative medical scheme (NCMS) and unemployed urban residents can only rely on the urban resident basic medical insurance (URBMI). This study provides a preliminary analysis on healthcare utilization change triggered by the unemployment-induced social health insurance transition that has never been investigated. Using the data of a nationwide survey, empirical results show that the unemployment-induced social health insurance transition can significantly deteriorate the healthcare utilization of insurance beneficiaries experiencing the transitions from the UEBMI to the NCMS (or from the UEBMI to the URBMI). Specifically, the outpatient service quality and the conventional physical examination become worse, and the out-of-pocket expenditure increases. Therefore, the multi-level social health insurance system currently in effect can expose workers to a high risk of insufficient health security in the age of frequent employment change. View Full-Text
Keywords: health insurance transition; unemployment; urban employee basic medical insurance (UEBMI); urban resident basic medical insurance (URBMI); new cooperative medical scheme (NCMS); healthcare utilization; Gig Economy health insurance transition; unemployment; urban employee basic medical insurance (UEBMI); urban resident basic medical insurance (URBMI); new cooperative medical scheme (NCMS); healthcare utilization; Gig Economy
MDPI and ACS Style

Yuan, B.; Li, J.; Wu, L.; Wang, Z. Multi-Level Social Health Insurance System in the Age of Frequent Employment Change: The Urban Unemployment-Induced Insurance Transition and Healthcare Utilization in China. Healthcare 2019, 7, 77.

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