Achieving Equitable Social Health Insurance Benefits in China: How Does Domestic Migration Pose a Challenge?

Abstract

\n Background: Universal coverage through social health insurance is promoted by many researchers and policymakers to improve health equity within a country or region. In China, the mass internal migration since 1980s has posed challenges for the social health insurance to ensure equitable benefits for migrant population. This study evaluated the benefit distribution of social health insurance among internal migrants in China.Methods: Using the 2014 China National Internal Migrants Dynamic Monitoring Survey, , by applying a two-part model, we conducted a benefit analysis of social health insurance among a representative sample of migrants in China.Results: The study found that the broader the geographic scope of migration, the lower the probability of receiving reimbursements from the social health insurance and the reimbursement ratio; but among those who received reimbursements, the broader the geographic scope of migration, the larger amounts they were reimbursed for health care use. We attributed this unequal benefit distribution to the current insurance design that replies on localized administration and patients paying services up-front and requesting reimbursement later.Conclusion: To improve the equity in social insurance benefits between migrants and non-migrants and among migrants, policies that promote the insurance portability across regions and immediate reimbursement are warranted, while at the same time efforts should be done to control inflation of health care expenditures and to prevent inverse government subsidies from the regions that have more out-migration to regions that have in-migration.