Should the poor have no medicines to cure? A study on the association between social class and social security among the rural migrant workers in urban China

Abstract

BackgroundThe rampant urbanization and medical marketization in China have resulted in increased vulnerabilities to health and socioeconomic disparities among the rural migrant workers in urban China. In the Chinese context, the socioeconomic characteristics of rural migrant workers have attracted considerable research attention in the recent past years. However, to date, no previous studies have explored the association between the socioeconomic factors and social security among the rural migrant workers in urban China. This study aims to explore the association between socioeconomic inequity and social security inequity and the subsequent associations with medical inequity and reimbursement rejection.MethodsData from a regionally representative sample of 2009 Survey of Migrant Workers in Pearl River Delta in China were used for analyses. Multiple logistic regressions were used to analyze the impacts of socioeconomic factors on the eight dimensions of social security (sick pay, paid leave, maternity pay, medical insurance, pension insurance, occupational injury insurance, unemployment insurance, and maternity insurance) and the impacts of social security on medical reimbursement rejection. The zero-inflated negative binomial regression model (ZINB regression) was adopted to explore the relationship between socioeconomic factors and hospital visits among the rural migrant workers with social security.ResultsThe study population consisted of 848 rural migrant workers with high income who were young and middle-aged, low-educated, and covered by social security. Reimbursement rejection and abusive supervision for the rural migrant workers were observed. Logistic regression analysis showed that there were significant associations between socioeconomic factors and social security. ZINB regression showed that there were significant associations between socioeconomic factors and hospital visits among the rural migrant workers. Also, several dimensions of social security had significant associations with reimbursement rejections.ConclusionsThis study showed that social security inequity, medical inequity, and reimbursement inequity happened to the rural migrant workers simultaneously. Future policy should strengthen health justice and enterprises’ medical responsibilities to the employed rural migrant workers.Electronic supplementary materialThe online version of this article (10.1186/s12939-017-0692-x) contains supplementary material, which is available to authorized users.

Socioeconomic status inequity in inpatient service utilization based on need among migrants: Evidence from a national study in China

“…Even if they needed inpatient health services, going to hospital would cost them a fortune. Despite the nearly universal medical insurance coverage in China, economic status remains the dominant barrier to healthcare services utilization [25,41,42], including outpatient and inpatient services, and lead to inequity in general health care utilization [38,40,43]. This phenomenon is even more severe among the internal migrants.…”

How internal migrants’ socioeconomic status affect their unmet inpatient service need? Evidence from a national study in China

“…Even they had inpatient need, going to hospital would cause substantial economic losses for them. Despite the nearly universal medical insurance coverage in China, economic status remains the dominant obstacle in the use of healthcare services [26][27][28], including outpatient and inpatient services, and contributed to inequity in general health care utilization [29][30][31]. This phenomenon is even more serious among the internal migrants.…”

Barriers of effective health insurance coverage for rural-to-urban migrant workers in China: a systematic review and policy gap analysis

“…A majority of RUMWs are discriminated and treated as a low-cost labor force. But sometimes they are also acclaimed as contributors to urbanization and economic development [14,16,17,28,33,38,58]. Therefore, most RUMWs have high work mobility and low job stability, placing them in a disadvantaged and marginalized socioeconomic position [33].…”

“…But sometimes they are also acclaimed as contributors to urbanization and economic development [14,16,17,28,33,38,58]. Therefore, most RUMWs have high work mobility and low job stability, placing them in a disadvantaged and marginalized socioeconomic position [33]. The inherent characteristics of RUMWs inevitably shape their health needs, as follows: (1) They exhibit better physical health [17,19,40,59,60], but worse mental health than local residents [17,19,34,59,2) Except for industrial injury, they are less likely to suffer from serious diseases, but are more likely affected by common ailments, infectious diseases [15,[60][61][62] or sexually transmitted diseases [3,63] Their needs for healthcare and medical services are often delayed and the origins of their illness are often far from where they end up [14,34], as they devote their young and healthy bodies to the flow-in cities, and bring their older and ailing bodies back to the flow-out place [40].…”