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Ma X, Feng W, Shi C, Wang Y, Gao Q, Cai W, An H, Jing Q, Gao R, Ma A. Association between the location of social medical insurance and social integration among China's elderly rural migrants: a nationwide cross-sectional study. BMC Public Health 2023; 23:2108. [PMID: 37884916 PMCID: PMC10604806 DOI: 10.1186/s12889-023-16956-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/11/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Universal social medical insurance coverage is viewed as a major factor in promoting social integration, but insufficient evidence exists on the integration of elderly rural migrants (ERM), generally aged 60 years and above, in low- and middle-income countries. To address this problem, we explore the relationship between the location of social medical insurance (SMI), such as a host city, and social integration in the context of Chinese ERM. METHODS This study is based on data from the 2017 National Internal Migrant Dynamic Monitoring Survey in China. The study participants were Chinese ERM. An integration index was constructed to measure the degree of social integration in a multi-dimensional manner using a factor analysis method. This study used descriptive statistics and one-way analysis of variance to explore the differences in social integration between ERM with SMI from host cities and hometowns. Stepwise multiple linear regression analysis was used to test the correlation between SMI location and social integration level in the overall sample. Finally, the results were verified by propensity score matching. RESULTS It was found that 606 (18.2%) of the insured ERM chose host city SMI, while 2727 (81.8%) chose hometown SMI. The level of social integration was lower among ERM with hometown SMI (-1.438 ± 32.795, F = 28.311, p ≤ 0.01) than those with host city SMI (6.649 ± 34.383). Among the dimensions of social integration, social participation contributed more than other factors, with a contribution rate of 45.42%. Host city SMI increased the probability of the social integration index by 647% among ERM (k-nearest neighbor caliper matched (n = 4, caliper = 0.02), with a full sample ATT value of 6.47 (T = 5.32, SE = 1.48, p < 0.05)). CONCLUSIONS ERM with host city SMI have a higher social integration level than those with hometowns SMI. That is, host city SMI positively affects social integration. Policymakers should focus on the access of host city SMI for ERM. Removing the threshold of host city SMI coverage for ERM can promote social integration.
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Affiliation(s)
- Xiaojie Ma
- School of Public Health, Weifang Medical University, Weifang, 261000, China
| | - Wenjia Feng
- School of Public Health, Weifang Medical University, Weifang, 261000, China
| | - Chaojun Shi
- School of Public Health, Weifang Medical University, Weifang, 261000, China
| | - Yifan Wang
- School of Public Health, Weifang Medical University, Weifang, 261000, China
| | - Qianqian Gao
- School of Management, Weifang Medical University, Weifang, 261000, China.
- Institute of Public Health Crisis Management, Weifang Medical University, Weifang, China.
| | - Weiqin Cai
- School of Management, Weifang Medical University, Weifang, 261000, China.
- Institute of Public Health Crisis Management, Weifang Medical University, Weifang, China.
| | - Hongqing An
- School of Public Health, Weifang Medical University, Weifang, 261000, China
- Institute of Public Health Crisis Management, Weifang Medical University, Weifang, China
| | - Qi Jing
- School of Management, Weifang Medical University, Weifang, 261000, China
- Institute of Public Health Crisis Management, Weifang Medical University, Weifang, China
| | - Runguo Gao
- School of Public Health, Weifang Medical University, Weifang, 261000, China
- Institute of Public Health Crisis Management, Weifang Medical University, Weifang, China
| | - Anning Ma
- School of Public Health, Weifang Medical University, Weifang, 261000, China
- Institute of Public Health Crisis Management, Weifang Medical University, Weifang, China
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Fan X, Su M, Si Y, Zhao Y, Zhou Z. The benefits of an integrated social medical insurance for health services utilization in rural China: evidence from the China health and retirement longitudinal study. Int J Equity Health 2021; 20:126. [PMID: 34030719 PMCID: PMC8145815 DOI: 10.1186/s12939-021-01457-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 04/21/2021] [Indexed: 02/06/2023] Open
Abstract
Background Improving health equity is a fundamental goal for establishing social health insurance. This article evaluated the benefits of the Integration of Social Medical Insurance (ISMI) policy for health services utilization in rural China. Methods Using the China Health and Retirement Longitudinal study (2011‒2018), we estimated the changes in rates and equity in health services utilization by a generalized linear mixed model, concentration curves, concentration indices, and a horizontal inequity index before and after the introduction of the ISMI policy. Results For the changes in rates, the generalized linear mixed model showed that the rate of inpatient health services utilization (IHSU) nearly doubled after the introduction of the ISMI policy (8.78 % vs. 16.58 %), while the rate of outpatient health services utilization (OHSU) decreased (20.25 % vs. 16.35 %) after the implementation of the policy. For the changes in inequity, the concentration index of OHSU decreased significantly from − 0.0636 (95 % CL: −0.0846, − 0.0430) before the policy to − 0.0457 (95 % CL: −0.0684, − 0.0229) after it. In addition, the horizontal inequity index decreased from − 0.0284 before the implementation of the policy to − 0.0171 after it, indicating that the inequity of OHSU was further reduced. The concentration index of IHSU increased significantly from − 0.0532 (95 % CL: −0.0868, − 0.0196) before the policy was implemented to − 0.1105 (95 % CL: −0.1333, − 0.0876) afterwards; the horizontal inequity index of IHSU increased from − 0.0066 before policy implementation to − 0.0595 afterwards, indicating that more low-income participants utilized inpatient services after the policy came into effect. Conclusions The ISMI policy had a positive effect on improving the rate of IHSU but not on the rate of OHSU. This is in line with this policy’s original intention of focusing on inpatient service rather than outpatients to achieve its principal goal of preventing catastrophic health expenditure. The ISMI policy had a positive effect on reducing the inequity in OHSU but a negative effect on the decrease in inequity in IHSU. Further research is needed to verify this change. This research on the effects of integration policy implementation may be useful to policy makers and has important policy implications for other developing countries facing similar challenges on the road to universal health coverage. Supplementary Information The online version contains supplementary material available at 10.1186/s12939-021-01457-8.
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Affiliation(s)
- Xiaojing Fan
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
| | - Min Su
- School of Public Administration, Inner Mongolia University, Hohhot, China.
| | - Yafei Si
- School of Risk & Actuarial Studies and CEPAR, University of New South Wales, Kensington, China
| | - Yaxin Zhao
- School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, China
| | - Zhongliang Zhou
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
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Peng BL, Ling L. Association between rural-to-urban migrants' social medical insurance, social integration and their medical return in China: a nationally representative cross-sectional data analysis. BMC Public Health 2019; 19:86. [PMID: 30658619 PMCID: PMC6339269 DOI: 10.1186/s12889-019-6416-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Accepted: 01/08/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Without social medical insurance in the destination areas and with low social integration, rural-to-urban migrants had barriers to health service in the destination areas, some of the migrants had to seek health service in hometown, namely medical return. This study aimed at exploring the association between rural-to-urban migrants' medical return and social medical insurance type or social integration. METHODS We analysed a secondary cross-sectional data of the 2014 National Internal Migrant Dynamic Monitoring Survey collected in May of 2014 from all provinces or regions in mainland China. The medical return was measured by the location of hospitalisation, and the social integration included economic integration and permanent settlement intention. RESULTS Four thousand eighteen rural-to-urban migrants living in current residence at least one year and used inpatient service within the last 12 months were analysed. The rate of medical return for inpatient service was 15.3%. Having medical insurance of hometown (new rural cooperative medical scheme (NRCMS)) (OR = 2.44, 95%CIs 1.80-3.30) was positively related to the medical return. The permanent settlement intention was negatively associated with the medical return (OR = 0.66, 95%CIs 0.48-0.90). CONCLUSIONS Social medical insurance of hometown (NRCMS) was positively associated with the medical return, while the permanent settlement intention was negatively associated with it. Promoting the transfer of migrants' social medical insurance across different regions might be helpful to improve rural-to-urban migrants' health access.
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Affiliation(s)
- Bo-Li Peng
- Faculty of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China.,Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, China
| | - Li Ling
- Faculty of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China. .,Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, China.
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