Occupational status and health insurance among immigrants: effects by generation, length of residence in U.S., and race

The Impact of China's Family Floating Population on the Participation of Medical Insurance in the Inflow Areas

Background

With the transformation of China's economy and society, the floating population has also shown a new development trend, from individual migration to co-migration with family members. In 2020, among the 376 million floating population, the population flowing to cities and towns was 330 million, accounting for nearly 88.1%. The family mobility of the floating population is not just a simple personal gathering or geographical migration, but a profound adjustment of the living environment, social interaction and the interests of family members. Migrants no longer simply play the role of " urban passers-by", but gradually move with spouses, children, parents, and even settle in the city, which will inevitably produce different public service and social security needs.

Objective

To explore the impact of floating population's familyization on the participation of medical insurance in the inflow areas.

Methods

This study adopted the form of non-systematic literature review. The key words were floating population and medical insurance. The related analysis of PubMed, Embase, CNKI, Wanfang, and VIP databases were reviewed and summarized.

Results

Due to the flow between domestic immigrants and regions, their medical insurance is difficult to be guaranteed. The domestic floating population's demand for health services is increasing, but the coverage of medical services provided by medical insurance is not comprehensive enough.

Conclusion

It is necessary to integrate the medical insurance system and improve the adaptability of medical insurance to family mobility; protect the welfare needs of migrant families and increase their willingness to participate in medical insurance at the destination; pay attention to the interaction and integration of floating population families, understand and guide them to participate in the status quo of medical insurance, and improve the status quo.

Determining Regional Differences in Barriers to Accessing Health Care Among Farmworkers Using the National Agricultural Workers Survey

Farmworkers are an essential workforce in the U.S. We assessed the regions in the National Agricultural Workers Survey on the difficulty of accessing health care among farmworkers in the U.S. The study included 9577 farmworkers. Farmworkers in all regions were more likely to report having difficulty accessing health care because it was too expensive. The overall odds ratio for difficulty accessing health care was lower in the MW after adjusting. Farmworkers employed in the SE had greater difficulty accessing health care because of language barriers. Farmworkers employed in CA had difficulty accessing health care in the U.S. because it was too expensive or far away. Results follow previous studies on barriers to access health care among the farmworker population. Understanding regional disparities in the presence of barriers to accessing health care among farmworkers is an essential step to improving equitable health care access in the U.S.

Language Use and Generation Status are Associated with Chronic Pain Differences in Mexican Americans

Little is known about the pain experience of the Mexican American (MA) population. We investigated the associations between language use and generation status with chronic pain prevalence, health insurance coverage, and analgesic medication use. We examined 3373 MA respondents from the National Health and Nutrition Examination Survey. We found higher levels of English use and generation status were associated with higher odds of reporting chronic pain. For respondents reporting chronic pain, higher levels of English use and generation status were associated with higher odds of being covered by health insurance, lower odds of having a period of time last year without health insurance, and higher odds of being prescribed any analgesic medication, especially opioid medications. We found language use and generation status play a role in MAs' experience, access, and treatment of chronic pain. Patient-, provider-, and systems-level interventions may be needed to reduce these disparities.

Exploring the relationship between migrants' purchasing of commercial medical insurance and urbanisation in China

Background

Over the past 40 years, the Chinese government has diligently promoted the market-oriented reform of the health insurance system. However, as it is affected by the urban-rural dual structure, most rural-to-urban migrants are excluded from local public health services and medical insurance schemes in the cities in which they live. Buying local commercial medical insurance (CMI) is an important way for migrants to obtain local medical services. Therefore, this study’s purposes were to explore the city factors that affect migrants’ purchase of CMI and to investigate the relationship between urbanisation and migrants’ purchase of CMI.

Methods

This study used the 2013 National Floating Population (Migrants) Dynamic Monitoring Survey data, which covered 31 provinces, municipalities, and autonomous regions in China. The respondents were migrants (15–59 years; n = 164,752) who lived in the inflow areas for more than a month without obtaining a local household registration record. We used city factors, neighbourhood factors, and individual factors that affect residents’ purchase of CMI to construct a theoretical framework and examined the effect of urbanisation on migrants’ choice of CMI using multilevel logistic regression.

Results

The proportion of migrants who had local or hometown CMI was 5.70%; most migrants had no CMI (94.30%). Of these, 4.42% had CMI in the city in which they live (i.e. local CMI) and 1.64% had CMI in their hometown (i.e. hometown CMI). Migrants living in first-tier and third-tier cities were less likely to have CMI than those in second-tier cities (odds ratio [OR] = 0.454, 95% confidence interval [CI]: 0.395–0.521; OR = 0.588, 95% CI: 0.464–0.746). Furthermore, the regression results revealed a U-shaped relationship between the odds of migrants having CMI and the urbanisation rate of the prefecture-level cities. The findings also indicated that with higher socioeconomic status, there was a greater probability of purchasing CMI.

Conclusions

The improvement of urbanisation has a positive effect on migrants’ purchase of CMI. However, China’s medical insurance market is still underdeveloped. It is necessary for the Chinese government to increase migrants’ participation rate in CMI to cover soaring medical expenses.

The personal and workplace characteristics of uninsured expatriate males in Saudi Arabia

Background

A major concern by the health decision makers in Gulf Cooperative Council (GCC) countries is the burden of financing healthcare. While other GCC countries have been examining different options, Saudi Arabia has endeavoured to reform its private healthcare system and control expatriate access to government resources through the provision of Compulsory Employment-Based Health Insurance (CEBHI). The objective of this research was to investigate, in a natural setting, the characteristics of uninsured expatriates based on their personal and workplace characteristics.

Methods

Using a cross-sectional survey, data were collected from a sample of 4,575 male expatriate employees using a multi-stage stratified cluster sampling technique. Descriptive statistics were used to summarize all variables, and the dependent variable was tabulated by access to health insurance and tested using Chi-square. Logistic analysis was performed, guided by the conceptual model.

Results

Of survey respondents, 30% were either uninsured or not yet enrolled in a health insurance scheme, 79.4% of these uninsured expatriates did not have valid reasons for being uninsured, with Iqama renewal accounting for 20.6% of the uninsured. The study found both personal and workplace characteristics were important factors influencing health insurance status. Compared with single expatriates, married expatriates (accompanied by their families) are 30% less likely to be uninsured. Moreover, workers occupying technical jobs requiring high school level of education or above were two-thirds more likely to be insured compared to unskilled workers. With regard to firm size, respondents employed in large companies (more than 50 employees) are more likely to be insured compared to those employed in small companies (less than ten employees). In relation to business type, the study found that compared to workers from the agricultural sector, industrial/manufacturing, construction and trading sectors, workers were, respectively, 76%, 85%, and 60% less likely to be uninsured.

Conclusion

Although the CEBHI is mandatory, this study found that the characteristics of uninsured expatriates, in respect of their personal and workplace characteristics have similarities with the uninsured from other private employment-sponsored health insurance schemes. Other factors influencing access to health insurance, besides employee and workplace characteristics, include the development and extent of the country’s insurance industry.