Health Insurance of Rural/township Schoolchildren in Pinggu, Beijing: Coverage Rate, Determinants, Disparities, and Sustainability
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CitationZhu, Jane M., Yiliang Zhu, and Rui Liu. 2008. Health insurance of rural/township schoolchildren in Pinggu, Beijing: coverage rate, determinants, disparities, and sustainability. International Journal for Equity in Health 7: 23.
AbstractBackground: As China re-establishes its health insurance system through various cooperative schemes, little is known about schoolchildren's health insurance. This paper reports findings from a study that examined schoolchildren's insurance coverage, disparities between farmer and non-farmer households, and effects of low-premium cooperative schemes on healthcare access and utilization. It also discusses barriers to sustainable enrollment and program growth. Method: A survey of elementary school students was conducted in Pinggu, a rural/suburban district of Beijing. Statistical analyses of association and adjusted odds ratio via logistic regression were conducted to examine various aspects of health insurance. Results: Children's health insurance coverage rose to 54% by 2005, the rates are comparable for farmers' and non-farmer's children. However, 76% of insured farmers' children were covered under a low-premium scheme protecting only major medical events, compared to 42% among insured non-farmers' children. The low-premium schemes improved parental perceptions of children's access to and affordability of healthcare, their healthcare-seeking behaviors, and overall satisfaction with healthcare, but had little impact on utilization of outpatient care. Conclusion: Enrolling and retaining schoolchildren in health insurance are threatened by the limited tangible value for routine care and low reimbursement rate for major medical events under the low-premium cooperative schemes. Coverage rates may be improved by offering complimentary and supplementary benefit options with flexible premiums via a multi-tier system consisting of national, regional, and commercial programs. Health insurance education by means of community outreach can reinforce positive parental perceptions, hence promoting and retaining insurance enrollment in short-term.
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