Rural-to-urban migration and its implication for new cooperative medical scheme coverage and utilization in China.
Rural-to-urban migration and its implication for new cooperative medical scheme coverage and utilization in China.
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DOI：
10.1186/1471-2458-11-520
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发表时间：
2011-06-30
影响因子：
4.5
通讯作者：
Ma X
中科院分区：
文献类型：
--
作者：
Qiu P;Yang Y;Zhang J;Ma X
中国正在经历历史上最大规模的农村向城市迁移。进城务工人员是指在不改变户口身份的情况下离开家乡到其他地方工作或生活的人，这是中国的一种户籍制度，将人们分为农村居民和城市居民。从农村到城市的农民工通常在目的地城市找到更好的工作机会，这些城市的工资比他们家乡的工资更高。这有助于提高农村家庭的新型合作医疗(NCMS)的参保率，保护家庭免于因病陷入贫困。然而，目前的规定规定，在中国农村户口登记的人只能参加当地的新农合，这反过来又给流动人口在目的地城市的医疗机构寻求医疗服务造成了障碍。为了更深入地研究这一问题，本研究考察了移民、农村家庭的经济状况和新农合入学率以及农村向城市流动人口对新农合的利用之间的关系。采用多阶段整群抽样方法。我们的样本包括9,097户家庭和36,720人。用卡方检验和T检验检验流动人口和非流动人口在年龄、性别、婚姻状况和最高教育程度方面的差异。采用有序Logistic回归分析移民与家庭经济状况之间的关系。用二元Logistic回归检验家庭经济状况、移民和新农合注册人数之间的关系。移徙与家庭经济状况的改善呈正相关。在没有移民的家庭中，只有11.3%的人口属于最富有的五分之一，而在有家庭成员的家庭中，这一比例在2006年翻了一番多。在使用住院医疗服务的流动人口中，54.3%的流动人口使用县外医院，而非流动人口的比例为17.5%，其中许多医院不是指定医院(指定医院是指如果人们使用患者保健服务，可以从新农合获得报销的医院)；55.2%的流动人口(与2006年患有新农合的非流动人口的24.6%相比)没有获得新农合的补偿。未能获得报销的三个主要原因是：住在非新农合指定的医院，对新农合政策缺乏了解，以及难以获得报销。移民到城市中心改善了其农村家庭的经济状况。然而，在当前的新农合制度下，获得城市中心非指定提供者提供的医院服务费用的补偿是有限的。应对这一挑战是一项新兴的政策优先事项。
China 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. A 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. Migration 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. Migrants 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.
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影响因子：
2.1
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