Assessing Income-Related Inequality on Health Service Utilization among Chinese Rural Migrant Workers with New Co-Operative Medical Scheme: A Multilevel Approach

Dan Li, Shaoguo Zhai, Jian Zhang, Jinjuan Yang and Xiao Wang
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Dan Li: School of Public Management, Northwest University, Xi’an 710127, China
Shaoguo Zhai: School of Public Management, Northwest University, Xi’an 710127, China
Jian Zhang: School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an 710049, China
Jinjuan Yang: Health Science Center, School of Public Health, Xi’an Jiaotong University, Xi’an 710061, China
Xiao Wang: International Business School Suzhou, Xi’an Jiaotong-Liverpool University, Suzhou 215123, China

IJERPH, 2021, vol. 18, issue 20, 1-18

Abstract: Background: Eliminating inequality in health service utilization is an explicit goal of China’s health system. Rural migrant workers with New Rural Cooperative Medical Insurance (NCMS) still face the dilemma of limited health service; however, there is a lack of analysis or measurement on the income-related inequality of health service utilization. Method: The nationally representative data of the China Labor-Force Dynamic Survey in 2016 were used for analysis. Multilevel regressions were used to obtain robust estimates and to account for various covariates associated with health service utilization of rural migrant workers with NCMS. The concentration index and its decomposition method were applied to quantify the income-related inequality of health service utilization of rural migrant workers. Result: The multilevel model analysis indicated that influencing factors of health service utilization were diversified, including gender, city service quality index, type of industry, the per capita annual income, marital status, health self-assessment, the community health index and the number of friends. The concentration indices of the total cost of inpatient and OOP cost of inpatient were 0.102 (95%CI: 0.031, 0.149), and the CI of OOP cost of inpatient was 0.094 (95%CI: 0.007, 0.119), respectively. The horizontal inequality indices of the total cost of inpatient and OOP cost of inpatient were 0.051 and 0.009, respectively. Conclusion: Our study presented a unique opportunity to examine the potential influence factors of health service utilization of rural migrant workers with NCMS, and highlighted that unequal health service utilization is evident among rural migrant workers with NCMS. This study provides important corroborative evidence to take full account of the contribution of each determinant to the inequality and health service needs among rural migrant workers with NCMS, in order to improve the basic medical insurance and social security systems—particularly for some marginal groups in China.

Keywords: income-related inequality; health service utilization; Chinese rural migrant workers; New Co-operative Medical Scheme; multilevel approach (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2021
References: View references in EconPapers View complete reference list from CitEc
Citations: View citations in EconPapers (2)

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