Rural-to-urban migration and its implication for new cooperative medical scheme coverage and utilization in China

Abstract

BackgroundChina has been experiencing the largest rural to urban migration in history. Rural-to-urban migrants are those who leave their hometown for another place in order to work or live without changing their hukou status, which is a household registration system in China, categorizing people as either rural residents or urban residents. Rural-to-urban migrants typically find better job opportunities in destination cities, and these pay higher salaries than available in their home regions. This has served to improve the enrollment rates in the New Cooperative Medical Scheme (NCMS) of rural families, protecting households from falling into poverty due to diseases. However, current regulations stipulate that people who are registered in China's rural hukou can only participate in their local NCMS, which in turn poses barriers when migrants seek medical services in the health facilities of their destination cities. To examine this issue in greater depth, this study examined the associations between migration, economic status of rural households, and NCMS enrollment rate, as well as NCMS utilization of rural-to-urban migrants.MethodsA multistage cluster sampling procedure was adopted. Our sample included 9,097 households and 36,720 individuals. Chi-square test and T-test were used to examine differences between the two populations of migrants and non-migrants based on age, gender, marriage status, and highest level of education. Ordinal logistic regression was used to examine the association between migration and household economic status. Binary logistic regression was used to examine the associations between household economic status, migration and enrollment in the NCMS.ResultsMigration was positively associated with improved household economic status. In households with no migrants, only 11.3% of the population was in the richest quintile, whereas the percentage was more than doubled in households with family members who migrated in 2006. Among those using in-patient medical services, 54.3% of migrants in comparison with 17.5% of non-migrants used out-of-county hospitals, many of which were not designated hospitals (Designated hospitals refer to hospitals where, if people use in patient health care, could receive reimbursement from the NCMS.); and 55.2% of migrants in comparison with 24.6% of non-migrants, who had the NCMS in 2006, received no reimbursement from the NCMS. The three main reasons of not receiving reimbursement were: staying in a hospital not designated by the NCMS, lack of knowledge of NCMS policies, and encountering difficulties obtaining reimbursement.ConclusionMigrants to urban centers improve the economic status of their rural household economic of origin. However, obtaining reimbursement under the current NCMS for the cost of hospital services provided by undesignated providers in urban centers is limited. Addressing this challenge is an emerging policy priority.

Income-related inequality in health insurance coverage: analysis of China Health and Nutrition Survey of 2006 and 2009

“…Therefore, future priorities of health reforms could focus on improving health care equalities in outcomes, controlling health care cost [32], and addressing major concerns on the benefit packages of health insurance and payment fairness. The discussion about integrating CHNS and URBMI to tackle the challenges of rural–urban migrate and urbanization in China is very heated[33]. In our opinion, it is important for the policy makers to understand the relationship between income and health insurance rate in each type of plans before moving forward to integrate them.…”

Towards Universal Health Coverage via Social Health Insurance in China: Systemic Fragmentation, Reform Imperatives, and Policy Alternatives

“…Concerned about potential moral hazard in claiming non-local bills and the sustainability of funding, the insurers tend to set a variety of restrictions. Even though out-of-county bills are now covered by some NCMS schemes, the reimbursement ratio tends to be lower while outpatient costs are typically non-reimbursable [27]. One investigation has suggested that the floating population are more frequent users of out-of-county inpatient services than the nonfloating population (54.3 vs. 17.5 %), but the former are more likely not to receive due reimbursement as a result of the various restrictions mentioned above (55.2 vs. 24.6 %) [27].…”

Defining migration and its health impact in China

“…41 Out-of-pocket (OOP) health expenditure caused financial catastrophe to 14% and impoverishment to 8% of rural households 42 in rural western and central China. Although the New Rural Co-operative Medical Schemes (NCMS or NRCMS, a voluntary health insurance) and the Medical Assistance Program (financial relief program) had been established in 2003 for rural China, vulnerable rural-to-urban migrants were not financially protected, due to the low level of support from the NCMS.…”

“…Although the New Rural Co-operative Medical Schemes (NCMS or NRCMS, a voluntary health insurance) and the Medical Assistance Program (financial relief program) had been established in 2003 for rural China, vulnerable rural-to-urban migrants were not financially protected, due to the low level of support from the NCMS. 41 Stereotypes of China's peasant migrants being marginalized may not be applicable to all ruraleurban individuals and situations as some studies actually show improved well-being, selfsatisfaction and psychological advancement. 43 As time passes, the demographics of migrant populations are also evolving, with changing sex ratio, education level and age distribution.…”