Shanquan Chen1, Yingyao Chen2, Zhanchun Feng3, Xi Chen4, Zheng Wang5,6, Jianfeng Zhu7, Jun Jin8, Qiang Yao9, Li Xiang3, Lan Yao3,10, Ju Sun9, Lu Zhao11, Hong Fung12, Eliza Lai-Yi Wong12, Dong Dong13. 1. The School of Clinical Medicine, University of Cambridge, Cambridge, UK. 2. School of Public Health, Fudan University, Shanghai, China. 3. School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. 4. Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, USA. 5. Research Center for Healthcare Management, School of Economic and Management, Tsinghua University, Beijing, China. 6. Guizhou Provincial Institute of Health Development, Guizhou Medical University, Guiyang, Guizhou, China. 7. School of Social Development and Public Policy, Fudan University, Shanghai, China. 8. Department of Sociology, Tsinghua University, Beijing, China. 9. School of Political Science and Public Administration, Wuhan University, Wuhan, Hubei, China. 10. Health Bureau, Macao SAR, China. 11. State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China. 12. The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China. 13. The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China. dongdong@cuhk.edu.hk.
Abstract
BACKGROUND: More than 90% of the Chinese population was covered by its three basic social health insurances. However, the Chinese rural-to-urban migrant workers (RUMWs), accounting for about one-fifth of China's total population, seem to be put on a disadvantaged position under the current health insurance schemes. The purpose of this study is to identify the current barriers and to provide policy suggestions to the ineffective health insurance coverage of RUMWs in China. METHODS: A systematic review guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The searched databases included PubMed, Embase, Medline, Web of Science, PsycINFO, Maternity and Infant Care Database MIDIRS, the Cochrane Library, WHO Library Database (WHOLIS), WHO Global Health Library, World Bank eLibrary, OpenGrey, CNKI, and Wanfang. In total, 70 articles were reviewed. RESULTS: (1) Chinese RUMWs have high work mobility and low job stability; (2) Barriers faced by RUMWs in obtaining effective health insurance coverage are primarily due to the reluctance of employers to provide insurance for all employees and the disadvantaged position held by RUMWs when negotiating with their employers; (3) Fissures among existing health insurance schemes leaves no room for RUMWs to meet their primary needs; and (4) Recent efforts in improving the portability and transferability of insurance across borders and schemes are not enough to solve the barriers. CONCLUSION: It is argued that the Chinese central government must deal with the fragmentation of healthcare system in China and promote effective coverage by: (1) playing a more active role in coordinating different healthcare and social welfare schemes across the country, (2) increasing the health insurance portability, (3) making the healthcare policies more compatible with RUMW's characteristics to meet their primary health needs, (4) strengthening supervision of employers, and (5) providing more vocational training and other support to increase RUMW's job stability.
BACKGROUND: More than 90% of the Chinese population was covered by its three basic social health insurances. However, the Chinese rural-to-urban migrant workers (RUMWs), accounting for about one-fifth of China's total population, seem to be put on a disadvantaged position under the current health insurance schemes. The purpose of this study is to identify the current barriers and to provide policy suggestions to the ineffective health insurance coverage of RUMWs in China. METHODS: A systematic review guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The searched databases included PubMed, Embase, Medline, Web of Science, PsycINFO, Maternity and Infant Care Database MIDIRS, the Cochrane Library, WHO Library Database (WHOLIS), WHO Global Health Library, World Bank eLibrary, OpenGrey, CNKI, and Wanfang. In total, 70 articles were reviewed. RESULTS: (1) Chinese RUMWs have high work mobility and low job stability; (2) Barriers faced by RUMWs in obtaining effective health insurance coverage are primarily due to the reluctance of employers to provide insurance for all employees and the disadvantaged position held by RUMWs when negotiating with their employers; (3) Fissures among existing health insurance schemes leaves no room for RUMWs to meet their primary needs; and (4) Recent efforts in improving the portability and transferability of insurance across borders and schemes are not enough to solve the barriers. CONCLUSION: It is argued that the Chinese central government must deal with the fragmentation of healthcare system in China and promote effective coverage by: (1) playing a more active role in coordinating different healthcare and social welfare schemes across the country, (2) increasing the health insurance portability, (3) making the healthcare policies more compatible with RUMW's characteristics to meet their primary health needs, (4) strengthening supervision of employers, and (5) providing more vocational training and other support to increase RUMW's job stability.
Keywords:
China; Rural-to-urban migrant workers; Systematic review; Universal health coverage
Authors: Hunter K Holt; Xi Zhang; Shang-Ying Hu; Fang-Hui Zhao; Jennifer S Smith; You-Lin Qiao Journal: Cancer Control Date: 2021 Jan-Dec Impact factor: 3.302