Chronic Conditions, Health Insurance and Receipt of Treatment in China
While there has always been an urban-rural divide in health-care provision, the inequality in accessing care has been exacerbated by years of market reform. Recently, China has radically reformed its health-care system. A number of studies have assessed the impacts of the ongoing health-care reform, but few focus on chronic conditions and treatment.
This study addresses two vital questions. First, how does the prevalence of chronic conditions, health insurance, and receipt of treatment differ among urban residents, rural-to-urban migrants, rural-to-urban converts, and rural residents? Second, how do various health insurance schemes (the basic medical insurance offered in cities, the New Rural Cooperative Medical System, and commercial health insurance) compare in their means of addressing chronic conditions?
Methods: The study uses primary data from the 2011 national Migration and Quality of Life survey collected by the author. The final sample contains 1,288 adult respondents with a response rate of 67.6%. Spatial probability sampling technology was employed to reach the migrant population. All interviews were conducted in person by trained interviewers.
Chronic health conditions are assessed using the World Mental Health Composite International Diagnostic Interview (WMH-CIDI) and are divided into four major categories: cardiovascular, respiratory, pain, and other.
Negative binomial regression is employed to estimate the differences in the number of chronic conditions according to migration and residency status, and logistic regressions are used to model the specific conditions, controlling for demographic and socio-economic characteristics. Logistic regressions are further applied to estimate the differences in treatment in the past 12 months among those with chronic conditions. Weights and survey design effects are taken into account in the analysis.
Results: The prevalence of chronic conditions is the same in urban and rural areas, but there is a divide in the receipt of treatment. Rural residents are less likely to receive treatment for chronic conditions, particularly for cardiovascular conditions. Only commercial health insurance (not the basic medical insurance available in cities or the New Rural Cooperative Medical System) significantly increases the odds of receiving treatment. Moreover, rural-to-urban migrants experience more difficulties in paying medical bills, rural-to-urban converts perceive more discrimination in seeking medical help, and rural residents are more anxious about their potential inability to cover medical expenses.
Conclusions and Implications: The emergence of chronic conditions and the narrowing urban-rural gap in prevalence present tremendous challenges for China’s ongoing health-care reform. The wide coverage offered by basic health insurance schemes is encouraging; yet, the efficacy of these health insurance schemes in treating chronic conditions, particularly those of rural residents, is limited. As China strives to meet its ambitious goal of universal health insurance coverage by 2020, these issues need to be tackled with an integrated approach.